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?     

A balloon protection sheath to prevent peripheral embolization during aortoiliac endovascular procedures

Several correlational questionnaire studies have observed a positive relationship between psychological stress and periodontal diseases. This paper analyses the effects of academic stress on periodontal health in a prospective quasi-experimental design. 26 medical students participating in a major exam and the same number of medical students not participating in any exam throughout the study period volunteered for the study. Bleeding on probing was assessed 4 weeks prior to the exam period (baseline) and at the last day of the exam. Severe deterioration in gingival health from baseline to the last exam day were observed more frequently in exam students than in controls (p=0.014). 6 exam students but only 1 control person developed a severe gingivitis at at least one formerly healthy tooth throughout the study period. These results further support the hypothesis that psychological stress is a significant risk factor for periodontal inflammation. Future studies should examine factors mediating this relationship.     

Understanding conscious sedation in the operating room

Conscious sedation is an appropriate choice for patients who do not require a general anesthetic, but rather need sedation to alleviate anxiety, minimize the discomfort of less invasive surgical procedures, or even to tolerate a regional or local anesthetic. New pharmaceutical agents, with their short half lives, provide amnesia, analgesia, and sedation quite safely. This concept, combined with standardized and controlled safety monitoring, offers an anesthetic alternative quite acceptable to many patients and health care providers. Standards and guidelines have been extensively developed by the American Society of Anesthesiologists, and the American Association of Nurse Anesthetists, to set forth a practice for all providers that will promote patient safety and provider vigilance (AANA, 1998). The purpose of this article is to review the process of conscious sedation.     

Protecting your eyes in the laser operating room

1. Laser protective eyewear is nearly as important to the OR nurse as the surgical mask in an operating room where laser surgery is performed. 2. Most hospitals require OR personnel to wear protective eyewear during laser procedures in voluntary compliance with American National Standards Institute (ANSI) Z136.3 for the safe use of lasers in health care facilities. 3. The basic steps to protecting your eyes are as follows: Select the appropriate eyewear (plastic or glass); make sure the eyewear fits properly; wear the protective lenses during laser testing and operation; and heed your laser safety officer.     

Crossreactions to muscle relaxants in the operating room

A 62-year-old man was admitted to our hospital for evaluation of bilateral tumor-like shadows along the ribs. He had been a diamond-grinder for twenty years. Thoracoscopic examination with a flexible bronchoscope revealed many well-circumscribed tumors with shiny, smooth, convex surfaces on the parietal pleura. The biopsy specimen had hyaline collagen with no cellular components. Based on these findings the tumors were diagnosed as pleural plaques. Cases of pleural plaques are usually followed up with chest radiography only, but the clinical course may be complicated by malignant mesothelioma and other malignant disease. To differentiate these conditions we performed biopsy during intrathoracic observation. The flexible bronchoscope can be useful in such procedures because it is relatively easy to operate and the procedure is relatively non invasive.     

The practice of nursing theory in the operating room

Nursing theory is a set of ideas, experiences, or observations regarding how and why nurses engage in certain activities and exhibit various behavioral attributes in providing patient care. The individualized caregiving activities perioperative nurses express during all phases of the surgical experience are supported by nursing theory.     

Ocular examination cart for the operating room

I modified an office refraction and treatment cart in order to have mobile and convenient ocular examination equipment easily available in the operating room.     

Developing critical pathways for the operating room

Glial cell line-derived neurotrophic factor (GDNF) has been demonstrated to enhance the survival and process outgrowth of mesencephalic dopamine neurons. A nuclease protection assay was utilized to determine whether GDNF mRNA is expressed in the ventral mesencephalon and/or striatum during normal mouse postnatal development. While no GDNF mRNA was detected in the ventral mesencephalon, expression was detected in the striatum throughout postnatal development and maturity with the peak of expression being in the second postnatal week. In the process of normal aging, no change in the levels of GDNF mRNA was observed in the striatum, while a 10-fold increase in glial fibrillary acid protein (GFAP) mRNA was detected in 24-month-old relative to either 4.5- or 11-month-old mice. Further analysis addressed whether there are changes in GDNF gene expression associated with the neurodegeneration of dopamine neurons that occurs in the weaver mutant mouse. A transient 65% increase in the expression of GDNF mRNA was observed in weaver mutant striatum on postnatal day 22. The results of this study suggest that GDNF could provide target derived of dopaminergic neurotrophic support and stimulate fiber outgrowth during development and that decreased levels of GDNF expression are not responsible for either aging-associated decreases in dopaminergic neuronal plasticity or neurodegeneration in the weaver mutant mouse.     

Chemical disinfectant pollution of the air in the operating room

After monitoring the air the operating room, the author found that the air was polluted by various chemical disinfectants which had exceeded the standard seriously. Close attention should be paid to it since health can be influenced by long period exposed to the polluted air. The author suggested the improved method for using chemical disinfectants to prevent air pollution in the operating room.     

Who uses transesophageal echocardiography in the operating room?

A survey was made of 155 anesthesiology residency programs in the United States to determine the patterns of use, responsibility for interpretation, and training of those responsible for intraoperative transesophageal echocardiography (TEE). Survey questions included numbers and types of cases for which TEE is used, who interprets TEE data and how they are trained, the extent of resident training in TEE, and beliefs about the utility of TEE. One hundred eight completed surveys were returned (70% response). Of those responding, 98 (91%) use intraoperative TEE. In 53 of those 98 institutions (54%), an anesthesiologist was primarily responsible for the interpretation of TEE data, whereas a cardiologist was responsible in the remainder. Approximately 35% of anesthesiologists using TEE had training in its use during residency or fellowship; the remainder were trained after finishing residency or fellowship. Forty-two percent of anesthesiologists who use TEE leave a formal interpretation on the chart apart from the anesthesia record, and 43% bill specifically for performing TEE. Although 69% of those responding thought that formal credentials should be required for anesthesiologists to use intraoperative TEE, only 32% reported that their institutions actually mandated this. 38% of those responding stated that they offer a dedicated TEE rotation to their residents, and 13% thought that their graduating residents were trained well enough to use TEE on their own. Among academic institutions responding, the use of intraoperative TEE is nearly universal, responsibility for its interpretation is split almost evenly between cardiologists and anesthesiologists, and there is a disparity between opinions and reality with regard to TEE credentialing for anesthesiologists.     

目标管理清单在手术室的应用

目的 探讨目标管理清单在手术室中的应用效果.方法 总结近年来国内外医院手术室在执行国际病人安全目标中发生的不良事件,制定出符合本院实际的21项安全目标及防控措施,并将安全目标内容细化为47句温馨语言组成的目标管理清单,要求逐项完成并打钩,统计实施后的不良事件发生情况,病人满意度和医生满意度.结果 本院1年中没有发生安全不良事件;护理工作质量明显提高,医生满意度97.4%、病人满意度为99.3%.结论 目标管理清单的运用有助于控制手术室安全隐患.     

Results of an intervention for the improvement of operating room quality and safety. Note 1: anesthetic gases

The proliferation of human melanoma cell line A375-6 is inhibited by several cytokines, including interleukin-1 (IL-1) and interleukin-6 (IL-6). However, during a long period of culture, the cells progressively acquire resistance to IL-1 irrespective of functional IL-1 receptor expression. These cells constitutively produce IL-1alpha and IL-6, and also acquire resistance to IL-6. In order to investigate the mechanism of the acquired resistance to these cytokines, we performed somatic cell hybridization experiments. Parental cells for the construction of hybrid cells were rendered G418- or hygromycin B-resistant by transfection with expression vectors containing drug-resistant genes. Hybridization was conducted using IL-1-resistant subclones A375-R8 and R19 and an IL-1 highly sensitive clone C2-1, which was originally resistant but became sensitive to IL-1 upon transfection with a human type I IL-1 receptor (IL-1R) expression plasmid. Cells produced by hybridization of resistant cells and C2-1 cells appeared to be sensitive to IL-1 and IL-6. In contrast, production of IL-1 was augmented in the hybrid cells. These results suggest that resistance to IL-1 and IL-6 is a recessive phenotype, while production of IL-1 is dominant in melanoma cells.     

When the operating room has a multicultural team

Working with a culturally diverse team can be enlightening but challenging. Healthy interpersonal relationships are essential in a culturally diverse OR team. Communication, understanding, and tolerance are crucial for all members of the team.     

Managing rumor and gossip in operating room settings

The unique features of the operating room (OR) make it an ideal setting for the proliferation of gossip and rumor. Although not always negative, these "grapevine" communications can reduce productivity and work satisfaction. Hence, OR managers need to understand these forms of communication and prevent or control their negative consequences. The authors offer suggestions for undertaking this challenge.     

人性化服务在手术室工作中的体现

人性化服务是一门艺术,是一种创造性、个性化、整体性、有效的护理模式.手术室护士通过对患者术前温馨访视、术中关心体贴、术后真情探视,以其专业的人性化服务,既提高了自身素质和工作热情,融洽了护患关系,又促进了各项工作的创新,提高了手术室的护理质量.