Patient monitoring in the operating theatre

Anaesthetised patients are monitored to ensure their safety. Simple clinical observations must not be replaced by electronic instruments--these provide an extension of the clinical senses. The choice of parameters for monitoring is discussed. The design of the Ninewells main operating theatre suite is described. An 8-channel bourne in the base of the theatre table conveys patient signals to a 4-channel recorder in a monitoring laboratory. Outputs are displayed on a wall mounted display in theatre. Two-way speech intercommunication exists with monitoring technician and students.     

Teaching and learning in the operating theatre

The anaesthetist's role during an anaesthetic is one of vigilance. Any interaction between tutor and student in this situation must be structured around the vigilance task. Teaching that recognizes this role may be educationally fruitful and may even improve vigilance. Teaching which disregards this function is less likely to result in learning and may interfere with patient care. Some of the types of teaching that are likely to be appropriate or inappropriate to different phases of an anaesthetic are indicated.     

Inefficiency of upward displacement operating theatre ventilation

In the previous study the authors found at least one peptide of 39 amino acid residues of several purified tryptic-fragments of the cobra serum antitoxic protein (CSAP), whose sequence had shown certain correlation with the rat serum albumin. For further clarification of the toxin-binding activity of CSAP in relation with its corresponding structure, the cDNA gene library of cobra liver cells was established and DNA primers were designed according to the known amino acid sequences of the tryptic peptides of CSAP. The specific probes were prepared and the specific clone was screened out from the library by PCR. Finally, the CSAP cDNA was sequenced from its sub-clones. Then the complete amino acid sequence of CSAP was elucidated. It is a polypeptide chain of 614 amino acid residues with a molecular size of 69.8 KDa. In comparing the whole sequence of CSAP, especially its signal peptide, with mammalian serum albumins, the authors have come to realize that CSAP is just the cobra serum albumin (CSA).     

Legal problems in the operating theatre: learning from mistakes

Nurses and other professionals have a legal as well as a professional duty to keep up to date with developments and changes in their clinical field of practice. Healthcare professionals should also be aware of major studies and the complaint and litigation trends in their specialties. This information can inform practice and lead to improvements in the quality of patient care. The information can often be found in the healthcare literature and the general press. This article looks at examples of the reported cases and research on negligence in theatres and discusses the legal and professional duty to keep up to date.     

Music in theatre: not so harmonious. A survey of attitudes to music played in the operating theatre

Monoamines (MA) such as dopamine (DA), norepinephrine (NE), and 5-hydroxytryptamine (5-HT) are now generally regarded as widely distributed and essential endogenous mediators contributing to the integration of reproductive physiology. MA measured in the hypothalamus tissue of male and female rats aged 1 to 90 days showed its own characteristic development pattern. Significant differences were observed at 5, 15, and 90 days of age in NE mean levels and at all ages except for 3 days of age in 5-HT mean levels. In contrast, no sex differences were seen in DA mean levels.     

Nitrous oxide in blood and urine of operating theatre personnel and the general population

A prototype of a totally implantable vascular catheter-port system was evaluated on its design using three animals of different species. The catheter was placed either intravenously or intra-arterially, and connected to the port which was retained outside the body. Parameters used for design evaluation or functionality testing were focused on the use and handling of the port-catheter system such as easiness of flushing, injection, blood sampling, septum stiffness to prevent blood reflux after pushing the septum, and possible diffusion of blood into the saline present in the port-catheter system. This pilot experiment showed that the septum of the prototype port system was too flexible, and that the distance between septum and base of the port was too short. These findings have led to a major improvement of the catheter-port system, currently successfully used in cancer chemotherapy.     

Surgeons' assistants: a new role for operating theatre nurses?

In the current climate of changing nursing and medical roles, discussions about the role of the operating theatre nurse have been rekindled, with particular emphasis being placed on the role of the nurse as 'assistant' to the surgeon. This article examines perioperative roles and identifies and discusses the factors that have stimulated their development. It is argued that these roles are not necessarily new and that their recent re-emergence may have as much to do with the sustained drive to reduce junior doctors' hours as the need to enhance the quality of patient care. However, they may offer operating theatre nurses clearer direction and purpose to practice. Provided they can improve the quality of patient care and are given careful consideration, they may prove to be an opportunity worth exploiting.     

Differences in attentional strategies by novice and experienced operating theatre scrub nurses.

This study investigated the effect of nursing experience on attention allocation and task performance during surgery. The prevention of cases of retained foreign bodies after surgery typically depends on scrub nurses, who are responsible for performing multiple tasks that impose heavy demands on the nurses' cognitive resources. However, the relationship between the level of experiences and attention allocation strategies has not been extensively studied. Eye movement data were collected from 10 novice and 10 experienced scrub nurses in the operating theater for caesarean section surgeries. Visual scanning data, analyzed by dividing the workstation into four main areas and the surgery into four stages, were compared to the optimum expected value estimated by SEEV (Salience, Effort, Expectancy, and Value) model. Both experienced and novice nurses showed significant correlations to the optimal percentage dwell time values, and significant differences were found in attention allocation optimality between experienced and novice nurses, with experienced nurses adhering significantly more to the optimal in the stages of high workload. Experienced nurses spent less time on the final count and encountered fewer interruptions during the count than novices indicating better performance in task management, whereas novice nurses switched attention between areas of interest more than experienced nurses. The results provide empirical evidence of a relationship between the application of optimal visual attention management strategies and performance, opening up possibilities to the development of visual attention and interruption training for better performance. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Time consumption at an orthopedic operating theatre. Physicians' ability to predict their own time consumption

The aim of the study was to investigate the time spent on different procedures in an orthopaedic operating theatre, and to evaluate the ability of doctors to predict their own time consumption. Time schedules were registered for 146 operations, of these 104 were either knee or hip replacements. Sixty percent of the total time was spent on surgery. The median misjudgment was 15 minutes for surgeons and five minutes for anaesthetists. An improvement in the doctors' ability to predict their own time consumption in the course of the study period could not be demonstrated. Comparing the study period with the similar period the year before it was not possible to demonstrate a change in the number of cancelled operations or the number of days with overtime. Epidural anaesthesia with bupivacaine was the most time consuming anaesthesia, the differences between the other forms of anaesthesia used were insignificant.     

Hazards and safety in theatre

The Health and Safety at Work Act (1974) provides legislation aimed at securing the safety of everyone at their place of work, and of any other person whose safety may be at risk by their presence in that area. Responsibility rests at all levels. Management have a duty to provide a safe working environment and to provide education and training for workers. At a departmental level daily safety checks need to be carried out and continuous safety conscious management must be in evidence. At a personal level we must all work carefully, bearing in mind the particular hazards in our area to ourselves, to our colleagues and our patients. This article hopes to highlight some of the trouble spots we should already be familiar with.     

Psychological understanding of anthropomorphism in theatre architecture

Traces of collective projective mechanisms in architecture in general are sedimenting for millenniums. Such case is also with theatre, an old institution of a great social importance. This paper discovers anthropomorphic elements of theatrical architecture. They have been transformed through history into patterns outlined and explained by the author.     

考虑土―结构相互作用的运转状态风电塔抗震分析

针对某陆上风电场1.5 MW风电塔结构,建立了"塔筒-基础-地基"整体三维精细有限元模型,研究土-结构相互作用对风机运转状态下风电塔结构地震动力响应的影响规律.在风机运转状态下,使用FAST程序把风速时程转化为风荷载时程输入模型,并使用EERA程序进行土层地震反应分析得到模型土层底部的地震波,作为地震激励进行输入,对风电塔进行模态分析并计算风电塔地震动力响应.研究表明,考虑土-结构相互作用效应会引起风电塔体系自振频率降低,并显著增加风电塔的结构动力响应.      

Teamwork in the operating department

The Gynaecology theatre team of the Leicester Royal Infirmary NHS Trust were runners-up in the 1997 3M/NATN joint award. This article is a report of their work on the concept of teamwork and its benefits to the organisation and delivery of patient care in the operating department.     

Skin injury in the operating room

Judge Christian Byk renders service to the Steering Committee on Bioethics of the Council of Europe (CDBI) by proposing a draft of the protocol destined to fill in a gap in international law on the status of the human embryo. This proposal, printed in a previous issue of the Journal of Medical Ethics deserves nevertheless to be questioned on important points. Is Christian Byk proposing to legalise research on human embryos not only in vitro but also in utero?