Morbidity, mortality, and systems safety in non-operating room anaesthesia: a narrative review.

Non-operating room anaesthesia (NORA) describes anaesthesia delivered outside a traditional operating room (OR) setting. Non-operating room anaesthesia cases have increased significantly in the last 20 yr and are projected to account for half of all anaesthetics delivered in the next decade. In contrast to most other medication administration contexts, NORA is performed in high-volume fast-paced environments not optimised for anaesthesia care. These predisposing factors combined with increasing case volume, less provider experience, and higher-acuity patients increase the potential for preventable adverse events. Our narrative review examines morbidity and mortality in NORA settings compared with the OR and the systems factors impacting safety in NORA. A review of the literature from January 1, 1994 to March 5, 2021 was conducted using PubMed, CINAHL, Scopus, and ProQuest. After completing abstract screening and full-text review, 30 articles were selected for inclusion. These articles suggested higher rates of morbidity and mortality in NORA cases compared with OR cases. This included a higher proportion of death claims and complications attributable to inadequate oxygenation, and a higher likelihood that adverse events are preventable. Despite relatively few attempts to quantify safety concerns, it was possible to find a range of systems safety concerns repeated across multiple studies, including insufficient lighting, noise, cramped workspace, and restricted access to patients. Old and unfamiliar equipment, lack of team familiarity, and limited preoperative evaluation are also commonly noted challenges. Applying a systems view of safety, it is possible to suggest a range of methods to improve NORA safety and performance.

Aromatherapy for Preoperative Anxiety: A Pilot Study.

PURPOSE: The aim of this study was to evaluate the use of a lavender aromatherapy skin patch on anxiety and vital sign variability during the preoperative period in female patients scheduled for breast surgery. DESIGN: This observational pilot study used a one-group, pretest and post-test design. METHODS: Participants received an aromatherapy patch in addition to standard preoperative care. Anxiety levels were assessed with a 10-cm visual analog scale at baseline and then every 15 minutes after patch placement. Vital sign measurements were recorded at the same interval. FINDINGS: There was a statistically significant decrease (P = .03) in the anxiety visual analog scale measurements from baseline to final scores. CONCLUSIONS: Findings from this study suggest the use of aromatherapy is beneficial in reducing anxiety experienced by females undergoing breast surgery. Further research is needed to address the experience of preoperative anxiety, aromatherapy use, and the challenges of managing preoperative anxiety.

Instruments to Measure Preoperative Acute Situational Anxiety: An Integrative Review.

Acute situational anxiety is a subjective fearful feeling of emotion that is influenced by an immediate situation. It can vary in intensity and duration among patients in the preoperative period of hospitalization. In adults, the incidence of preoperative acute situational anxiety ranges from 11% to 80%. Untreated anxiety in the perioperative period can lead to multiple deleterious effects for patients. Previous reviews on instruments to measure anxiety have not focused on the preoperative period of hospitalization for surgical patients. The objective of this integrative review was to synthesize and describe the instruments used over the last decade to measure preoperative anxiety in the surgical setting. A systematic search strategy of the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases was used to review the literature. A total of 370 articles were identified, but only 5 met the inclusion criteria for this review. In the 5 articles, varying levels of reliability, validity, and feasibility of the instruments were reported as well as context considerations. Reliability and validity are not consistently reported among instruments that measure preoperational anxiety, making it difficult for providers to measure preoperational anxiety and provide treatment based on the instrument results.

Relief from anxiety using complementary therapies in the perioperative period: A principle-based concept analysis.

AIMS AND OBJECTIVES: To analyze and clarify the concept of providing relief from anxiety using complementary therapies in the perioperative period utilizing the epistemological, pragmatic, linguistic and logical principles of a principle-based concept analysis to examine the state of the science. BACKGROUND: The majority of patients scheduled for surgery experience anxiety in the perioperative period. Anxiety has the potential to limit a patient's ability to participate in his or her care throughout their hospitalization. Although medications are the conventional medical treatment for anxiety in the perioperative period, the addition of a complementary therapy could be an effective holistic approach to providing relief from anxiety. DESIGN: Principle-based concept analysis. METHODS: In 2015, strategic literature searches of CINHAL and PUBMED using keywords were performed. Fifty-six full text articles were assessed for eligibility. RESULTS: Twelve studies were used in the final analysis to clarify the concept of relief from anxiety using complementary therapies in the perioperative period. CONCLUSION: This analysis has clarified the maturity and boundaries, within the four principles of a principle-based concept analysis, of the concept of relief from anxiety using complementary therapies in the perioperative period. A greater understanding of relief from anxiety using complimentary therapies in the perioperative period as an adjunct to conventional medicine will allow perioperative nurses and anesthesia providers to modify and specify the plan of care for their surgical patients. The use of complementary therapies for relief in the perioperative period appears to be an area of promising research and treatment for patients, families and providers.