Reexamining traditional intraoperative fluid administration: evolving views in the age of goal-directed therapy.

Intraoperative volume administration has long been a topic of debate in the field of anesthesia. Only recently, however, has the conversation shifted to a discussion of appropriate intraoperative volume. A thorough review of the literature explores the history of today's widely accepted fluid administration equation and discusses possible explanations and consequences of iatrogenically induced hypervolemia. Current studies exploring various volume administration techniques are reviewed, as are emerging technologies available to help guide anesthesia providers with intraoperative fluid management.

Intraoperative stress and anxiety reduction with music therapy: a controlled randomized clinical trial of efficacy and safety.

OBJECTIVE: The purpose of this study was to investigate the music therapy (MT) effect in levels of intraoperative anxiety in patients undergoing crossectomy with stripping of the great saphenous vein and to assess the efficacy, safety, and feasibility of this alternative therapy as a complement of standard intraoperative care. MATERIAL AND METHODS: The study is a simple blind, controlled, parallel groups, prospective randomized clinical trial. Patients were allocated by means of randomized controlled sampling. The study was performed in the surgery room of Getafe University Hospital in Madrid. The study was carried out in 40 patients, 20 randomized to the experimental group and 20 randomized to the control group, with an age range from 27 to 70 years. The control group was given intraoperative routine attention, and the experimental group was given an MT passive intervention that consisted of audition of musical fragments during varicose veins surgery. These pieces previously showed relaxing actions on the cardiovascular system. The anxiety levels were measured by means of pre- and postsurgical questionnaires by a blinded investigator for the study arm to which the patients had been randomized. Heart rate and systolic and diastolic blood pressures were determined during the intervention, and adrenaline and noradrenaline plasma levels were determined before and after the surgical procedure. RESULTS: The majority of the patients in the MT group (95%) and standard care group (90%) completed the study. There were no statistical differences between the control and experimental groups in heart rate gradient or systolic and diastolic blood pressures measured after the intervention. The anxiety state and the stress feeling scale score after surgery were significantly inferior in the MT group (94.7% vs 57.9% decrease in anxiety levels, P < .05, and stress score of 1.31 vs 2.36, P < .05, respectively). The adverse events ratio was low and occurred with similar frequency in both groups. CONCLUSIONS: The MT intervention was easily implemented in the context of nursing care received during varicose vein surgery and was positively accepted and valued by the majority of the patients. MT is a safe procedure that is proved to reduce anxiety and stress in the study patients.

The effect of music listening on older adults undergoing cardiovascular surgery.

The purpose of this study was to determine the effect of music listening on postoperative anxiety and intubation time in patients undergoing cardiovascular surgery. Coronary artery disease and valvular heart disease affect approximately 15 million Americans and 5 million persons in the U.K. annually, with the majority of these patients being older adults. The anxiety experienced before, during and after surgery increases cardiovascular workload, thereby prolonging recovery time. Music listening as a nursing intervention has shown an ability to reduce anxiety. The study used a randomized control trial design. Sixty adults older than 65 years were randomly assigned to the control and the experimental groups. The experimental group listened to music during and after surgery, while the control group received standard postoperative care. The Spielberger State Trait Anxiety Inventory was administered to both groups before surgery and 3 days postoperatively. The mean of the differences between scores was compared using analysis of variance. Differences in mean intubation time were measured in both groups. Older adults who listened to music had lower scores on the state anxiety test (F = 5.57, p = .022) and had significantly fewer minutes of postoperative intubation (F = 5.45, p = .031) after cardiovascular surgery. Older adults undergoing cardiovascular surgery who listen to music had less anxiety and reduced intubation time than those who did not.

A 4-cm thermoactive viscoelastic foam pad on the operating room table to prevent pressure ulcer during cardiac surgery.

AIMS AND OBJECTIVES: In this experimental study, a 4-cm thermoactive viscoelastic foam overlay and a heating source on the operating room table was compared with the standard operating room table with a heating source for the effect on the postoperative pressure ulcer incidence in cardiac surgery patients. BACKGROUND: Pressure ulcer incidence in the cardiac surgery population is reported to be up to 29.5%. The prolonged compressive forces from lying on the operating room table are one source of pressure ulcer development in this population. Pressure-reducing devices on the operating room (OR)-table should reduce the patients' interface pressure and thus the hazard of skin breakdown. METHODS: A randomized controlled trial was performed to test the effect of a 4-cm thermoactive viscoelastic foam overlay with a water-filled warming mattress on the OR-table (test OR-table) compared with the standard OR-table (a water-filled warming mattress, no pressure-reducing device) on the postoperative pressure ulcer incidence in cardiac surgery patients. INSTRUMENTS: The pressure ulcer classification system of the European Pressure Ulcer Advisory Panel (EPUAP) was used for pressure ulcer grading. RESULTS: The results show that patients lying on the 4-cm thermoactive viscoelastic foam overlay suffer slightly more pressure ulcer (17.6%) than patients on the standard OR-table without the foam overlay (11.1%). Because of the clinical relevance of the results, the randomized controlled trial was terminated after 175 patients at the interim analysis although the power calculation stated 350 patients. CONCLUSIONS: The combination of a 4-cm viscoelastic foam overlay and a warming source cannot be recommended for pressure ulcer prevention on the operating room table. RELEVANCE TO CLINICAL PRACTICE: Foam overlays are used to prevent pressure ulcers in patients. It is necessary to use such devices according to patient safety and use of resources.

Patient communication during cataract surgery.

PURPOSE: Most cataract surgery is now performed under local anaesthesia on a day-case basis. As patients are fully conscious during the procedure, it is important that they remain still. There are a variety of reasons why patients may need to move, and it is important that the surgeon is made aware that this may happen. Some centres offer a nurse's hand as a means of perioperative patient communication. We sought to study the safety and efficacy of using an electronic patient-controlled alert device. METHOD: We compared hand-holding with the use of a patient alert device, and with both communication methods at the same time, on 150 subjects undergoing cataract surgery under local anaesthesia. Assessment of pre- and postoperative state anxiety was undertaken and patients' satisfaction with the communication strategies was assessed. RESULTS: There was a significant difference between pre- and postoperative state anxiety for each group (P<0.001) but no significant differences in pre-, peri-, or postoperative state anxiety between groups. There were no significant differences in confidence, pain, understanding, satisfaction, memory, and reassurance between the three groups. A total of 46% of all patients reported experiencing one or more of the potential problems enquired about, during the operation. Significant correlations were also identified between some of the psychological variables investigated. CONCLUSIONS: An electronic patient alert device is as effective a means of perioperative patient communication as holding a nurse's hand, during cataract surgery under local anaesthesia. It is safe, reassuring and it allows patients to communicate directly with the surgeon.

A clinical trial of distraction techniques for pain and anxiety control during cataract surgery.

This research study evaluates the effectiveness of distraction interventions on subject perceptions of discomfort or pain and anxiety during the ocular anesthetic injection prior to cataract surgery. Eighty subjects received either usual care, usual care with massage, usual care with verbal coaching and slow breathing, or usual care with massage and verbal coaching and slow breathing combined as different types of distraction interventions. After the ocular anesthetic injection(s), the subjects rated their level of experienced discomfort or pain and anxiety on a Likert scale of 0 to 10. The statistical analyses revealed a significant reduction of discomfort or pain and anxiety when the distraction interventions were implemented during the ocular anesthetic injections. Because the different distraction interventions are effective, inexpensive, and easy to implement, routine use during ocular anesthetic injections, prior to cataract surgery, is recommended.

Cirugía en el niño y el adolescente / Surgery for children and adolescents. Intra-operative phase

Se expone la segunda fase del proceso quirúrgico, conocida como intraoperatorio, desarrollando un modelo estandarizado de la atención de enfermería al niño y adolescente durante la fase intraoperatoria. Transcurre en la sala de operaciones desde el momento en el que el niño / adolescente llega procedente de la unidad de hospitalización hasta que es trasladado a la unidad de reanimación. Se efectúa una valoración sistemática y holística utilizando los Patrones Funcionales de Salud de Gordon. Se seleccionan los Diagnósticos de Enfermería de la NANDA (North American Nursing Diagnosis Association) que con mayor frecuencia se presentan en esta fase intraoperatoria: riesgo de lesión, riesgo de infección, riesgo de hipotermia y riesgo de asfixia. También se mencionan las complicaciones potenciales que pueden aparecer durante la intervención según la edad del niño, el tipo de anestesia, la técnica quirúrgica y el estado general previo. Finalmente, describimos las intervenciones enfermeras relacionadas con las complicaciones potenciales y los diagnósticos enfermeros reseñados (AU)

Cirugía en el niño y el adolescente. Preoperativo / Surgery for children and adolescents pre-operative phase

Se expone un modelo estandarizado de la atención de enfermería al niño y adolescente durante la fase preoperatoria, la primera parte del proceso quirúrgico global. Comienza en el momento en el que se decide realizar la intervención y finaliza cuando se traslada al niño/adolescente al quirófano. Se efectúa una valoración sistemática y holística utilizando los Patrones Funcionales de Salud de Gordon. Se incide especialmente en aspectos como el patrón percepción-manejo de la salud, el patrón nutricional-metabólico, el patrón de eliminación, el patrón actividad-ejercicio, el patrón sueño-descanso, el patrón autopercepción y el patrón adaptación-tolerancia al estrés. Se evalúa la percepción y respuestas del niño con diferentes edades a la separación de los padres. Se resaltan los factores culturales que se han de tener presentes para lograr una adecuada valoración y unos cuidados individualizados. Se seleccionan los Diagnósticos de Enfermería de la NANDA (North American Nursing Diagnosis Association) que con mayor frecuencia se presentan en esta fase preoperatoria: temor/ansiedad, riesgo de aspiración, riesgo de alteración en el mantenimiento de la salud y riesgo de infección. Finalmente, se describen las intervenciones enfermeras relacionadas con estos diagnósticos (AU)

The effects of handholding on anxiety in cataract surgery patients under local anaesthesia.

AIM OF THE STUDY: To assess the effectiveness of handholding on the anxiety of patients undergoing planned cataract surgery under local anaesthesia. BACKGROUND: Anxiety concerning anaesthesia, pain, physical injuries, isolation, prognosis, possibilities of deformity, or loss of self-control may be stressful to patients undergoing surgery. Anxiety activates the sympathetic nervous system, characterized by an increase in catecholamine concentration, heart rate and blood pressure and increased glucocorticoid levels; it also affects immune responses. Therefore, there is a need for nursing interventions to reduce the anxiety of patients under local anaesthesia who are conscious. METHODS: An untreated control group design with pre and post-test was used. Among 62 patients, 30 were randomly assigned to the handholding group and 32 to the control group. Handholding was provided to subjects of the handholding group during surgery. Visual analogue scales and interviews were used to measure anxiety, and pulse rate and systolic and diastolic blood pressure were used as physiological measures of stress. Blood was taken for analysis of levels of epinephrine, norepinephrine, cortisol, neutrophils, lymphocytes and natural killer cells. RESULTS: The number of subjects who reported decreased anxiety during operation was significantly higher in the handholding group compared with the control group and most of the subjects reported that handholding during operation was very helpful in reducing anxiety. Epinephrine levels in the handholding group were significantly lower than in the control group. CONCLUSIONS: Results suggest that this noninvasive intervention has potential for reducing anxiety in patients having cataract surgery under local anaesthesia.

Transfusión autóloga. Sistema de Baylor / Baylor system autologous transfusions

Se efectúa un recorrido histórico hasta llegar al momento en que comienza a utilizarse la propia sangre para transfundir. Se analizan los diferentes tipos de transfusión autóloga, para pasar a detallar específicamente el sistema de transfusión autóloga rápida de Baylor. Se describen sus aplicaciones clínicas y las ventajas que presenta en cuanto a recuperación intraoperatoria, en disminución de riesgos de transmisión de infecciones y la mejor aceptación del paciente (AU)

Incorporating music into the surgical environment.

Responsibility for patient comfort has always been the concern of the nurse. Conscious sedation and or local anesthesia are commonly becoming the primary method of anesthesia for a variety of outpatient plastic surgical procedures. These surgical methods require the nurse to become aware of nonchemical adjuncts that can assist in providing a safe comfortable atmosphere for the patients. Furthermore, many patients now request nonchemical adjuncts for anxiolysis and sedation as well as for analgesia in the surgical suite. This article will provide the nurse with a basic overview of one such alternative, music, including a brief historical review, relevant research, and guidelines for use of music with the operative client.

Local and regional anesthesia. Nursing implications.

Local and regional anesthesia offers many advantages and is relatively safe, resulting primarily in positive outcomes for the patient. The potential for complications and the need for patient education, however, dictate that the PACU nurse prepare the patient appropriately, remain vigilant, and initiate the necessary measures for monitoring and intervention when caring for such patients in both the preanesthesia and postanesthesia phases. Local and regional anesthetic agents and techniques have been discussed along with their implications for nursing care. Readers are also encouraged to consult the references and their own institutional policies for additional information.

Anesthesia alternatives for ophthalmic surgery.

1. Traditionally, local anesthesia has only been used in patients with coexisting diseases that jeopardize the safety of general anesthesia. Local anesthesia, however, provides a number of advantages that make it suitable for ophthalmic surgery of both the anterior and posterior segment. 2. Preoperative emotional and physical assessment and patient counseling is essential to the successful use of local anesthesia. 3. Anxiety that exists intraoperatively can be relieved by sedentary social diversions such as listening to music, handholding, and other holistic approaches. 4. Discomfort caused by draping can be eliminated by using a drapeholder that lifts the drapes away, providing the patient with a high flow of air.