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1.
Am J Surg ; 221(2): 331-335, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33729917

RESUMO

BACKGROUND: The regulatory focus theory (RFT) posits that people can pursue goals with a promotion or prevention focus. Greater alignment of RFT motivational styles between faculty and residents may enhance resident operative autonomy. This study establishes a set of faculty behaviors residents can identify to infer faculty motivational styles. METHODS: 10 behaviors associated with promotion and prevention motivational styles were identified. General surgery residents rated faculty on how strongly they exhibit these behaviors. Faculty conducted a self-assessment of how strongly they exhibit these behaviors. RESULTS: There is a positive correlation between resident and faculty ratings for the promotion-associated behaviors of "works quickly," "high energy," and "mostly provides broad oversight," and for the prevention-associated behaviors of "works slowly and deliberately," "quiet and calm," and "preference for vigilant strategies." CONCLUSION: Residents can observe faculty operative behaviors to infer faculty motivational styles. Residents may use this knowledge to adjust to faculty motivational styles and enhance operative interactions.


Assuntos
Cirurgia Geral/educação , Internato e Residência/métodos , Salas Cirúrgicas/métodos , Cirurgiões/psicologia , Competência Clínica/normas , Docentes de Medicina/psicologia , Feminino , Cirurgia Geral/métodos , Humanos , Masculino , Motivação , Autonomia Profissional , Autocontrole , Inquéritos e Questionários , Confiança
2.
BMJ Open Respir Res ; 7(1)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33023899

RESUMO

Patients with COVID-19 often need therapeutic interventions that are considered high aerosol-generating procedures. These are either being performed by healthcare providers with potentially inadequate personal protective equipment or the procedures are being delayed until patients clear their viral load. Both scenarios are suboptimal. We present a simple, cost-effective method of creating a portable negative pressure environment using equipment that is found in most hospitals to better protect healthcare providers and to facilitate more timely care for patients with COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Exposição Ocupacional/prevenção & controle , Salas Cirúrgicas/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Campos Cirúrgicos , Aerossóis , Humanos , Pressão , Sucção
4.
Chin Med Sci J ; 35(2): 114-120, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32684231

RESUMO

A novel coronavirus that emerged in late 2019 rapidly spread around the world. Most severe cases need endotracheal intubation and mechanical ventilation, and some mild cases may need emergent surgery under general anesthesia. The novel coronavirus was reported to transmit via droplets, contact and natural aerosols from human to human. Therefore, aerosol-producing procedures such as endotracheal intubation and airway suction may put the healthcare providers at high risk of nosocomial infection. Based on recently published articles, this review provides detailed feasible recommendations for primary anesthesiologists on infection prevention in operating room during COVID-19 outbreak.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Salas Cirúrgicas/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Anestesiologistas/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Salas Cirúrgicas/métodos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
5.
Eur J Trauma Emerg Surg ; 46(4): 731-735, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32488448

RESUMO

BACKGROUND: Surgery in the era of the current COVID-19 pandemic has been curtailed and restricted to emergency and certain oncological indications, and requires special attention concerning the safety of patients and health care personnel. Desufflation during or after laparoscopic surgery has been reported to entail a potential risk of contamination from 2019-nCoV through the aerosol generated during dissection and/or use of energy-driven devices. In order to protect the operating room staff, it is vital to filter the released aerosol. METHODS: The assemblage of two easily available and low-cost filter systems to prevent potential dissemination of Coronavirus via the aerosol is described. RESULTS: Forty-nine patients underwent laparoscopic surgeries with the use of one of the two described tools, both of which proved to be effective in smoke evacuation, without affecting laparoscopic visualization. CONCLUSION: The proposed systems are cost-effective, easily assembled and reproducible, and provide complete viral filtration during intra- and postoperative release of CO2.


Assuntos
Infecções por Coronavirus , Filtração/métodos , Controle de Infecções/métodos , Laparoscopia , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Serviços Médicos de Emergência/métodos , Desenho de Equipamento , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Salas Cirúrgicas/métodos , Salas Cirúrgicas/tendências , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumoperitônio Artificial/métodos , Gestão da Segurança/métodos
6.
Rev Col Bras Cir ; 47: e20202558, 2020 Jun 03.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32578821

RESUMO

The coronavirus infection, also known as SARS-COV2, has proven to be potentially fatal, representing a major global health problem. Its spread after its origin in the city of Wuhan, China has resulted in a pandemic with the collapse of the health system in several countries, some with enormous social impact and expressive number of deaths as seen in Italy and Spain. Extreme intra and extra-hospital measures have been implemented to decrease the transmission and dissemination of the COVID-19. Regarding the surgical practice, a huge number of procedures considered non-essential or elective were cancelled and postponed until the pandemic is resolved. However, urgent and oncological procedures have been carried out. In this publication, we highlight and teach adaptations to be made with commonly used materials in laparoscopy to help prevent the spread and contamination of the healthcare team assisting surgical patients.


Assuntos
Aerossóis/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Laparoscopia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Operatórios/normas , Betacoronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Período Intraoperatório , Salas Cirúrgicas/métodos , Pneumoperitônio Artificial/normas , Equipamentos de Proteção/normas , Punções/métodos , Instrumentos Cirúrgicos/normas
7.
Anesthesiology ; 133(2): 332-341, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32541549

RESUMO

BACKGROUND: While 4 to 10% of medications administered in the operating room may involve an error, few investigations have prospectively modeled how these errors might occur. Systems theoretic process analysis is a prospective risk analysis technique that uses systems theory to identify hazards. The purpose of this study was to demonstrate the use of systems theoretic process analysis in a healthcare organization to prospectively identify causal factors for medication errors in the operating room. METHODS: The authors completed a systems theoretic process analysis for the medication use process in the operating room at their institution. First, the authors defined medication-related accidents (adverse medication events) and hazards and created a hierarchical control structure (a schematic representation of the operating room medication use system). Then the authors analyzed this structure for unsafe control actions and causal scenarios that could lead to medication errors, incorporating input from surgeons, anesthesiologists, and pharmacists. The authors studied the entire medication use process, including requesting medications, dispensing, preparing, administering, documenting, and monitoring patients for the effects. Results were reported using descriptive statistics. RESULTS: The hierarchical control structure involved three tiers of controllers: perioperative leadership; management of patient care by the attending anesthesiologist, surgeon, and pharmacist; and execution of patient care by the anesthesia clinician in the operating room. The authors identified 66 unsafe control actions linked to 342 causal scenarios that could lead to medication errors. Eighty-two (24.0%) scenarios came from perioperative leadership, 103 (30.1%) from management of patient care, and 157 (45.9%) from execution of patient care. CONCLUSIONS: In this study, the authors demonstrated the use of systems theoretic process analysis to describe potential causes of errors in the medication use process in the operating room. Causal scenarios were linked to controllers ranging from the frontline providers up to the highest levels of perioperative management. Systems theoretic process analysis is uniquely able to analyze management and leadership impacts on the system, making it useful for guiding quality improvement initiatives.


Assuntos
Anestesiologia/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Erros de Medicação/prevenção & controle , Salas Cirúrgicas/normas , Melhoria de Qualidade/normas , Teoria de Sistemas , Anestesiologistas/normas , Humanos , Salas Cirúrgicas/métodos , Farmacêuticos/normas , Estudos Prospectivos , Cirurgiões/normas
8.
Anesth Analg ; 131(3): 677-689, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32502132

RESUMO

Current evidence suggests that coronavirus disease 2019 (COVID-19) spread occurs via respiratory droplets (particles >5 µm) and possibly through aerosol. The rate of transmission remains high during airway management. This was evident during the 2003 severe acute respiratory syndrome epidemic where those who were involved in tracheal intubation had a higher risk of infection than those who were not involved (odds ratio 6.6). We describe specific airway management principles for patients with known or suspected COVID-19 disease for an array of critical care and procedural settings. We conducted a thorough search of the available literature of airway management of COVID-19 across a variety of international settings. In addition, we have analyzed various medical professional body recommendations for common procedural practices such as interventional cardiology, gastroenterology, and pulmonology. A systematic process that aims to protect the operators involved via appropriate personal protective equipment, avoidance of unnecessary patient contact and minimalization of periprocedural aerosol generation are key components to successful airway management. For operating room cases requiring general anesthesia or complex interventional procedures, tracheal intubation should be the preferred option. For interventional procedures, when tracheal intubation is not indicated, cautious conscious sedation appears to be a reasonable approach. Awake intubation should be avoided unless it is absolutely necessary. Extubation is a high-risk procedure for aerosol and droplet spread and needs thorough planning and preparation. As updates and modifications in the management of COVID-19 are still evolving, local guidelines, appraised at regular intervals, are vital in optimizing clinical management.


Assuntos
Manuseio das Vias Aéreas/métodos , Betacoronavirus , Infecções por Coronavirus/terapia , Salas Cirúrgicas/métodos , Equipamento de Proteção Individual , Pneumonia Viral/terapia , Adulto , Extubação/métodos , Extubação/normas , Manuseio das Vias Aéreas/normas , Infecções por Coronavirus/prevenção & controle , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Salas Cirúrgicas/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
9.
Can J Ophthalmol ; 55(3 Suppl 1): 17-21, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32448408

RESUMO

Ergonomics has gained increasing recognition as an integral component of career longevity in ophthalmology. Residents and fellows may encounter unique ergonomic challenges when learning surgical techniques. A systematic review of the literature, specifically looking for recommendations on optimizing ergonomics in the operating room (OR) and articles that explicitly mentioned suggestions for trainees, was conducted. Of the identified 41 pieces of literature, 31 specifically mentioned ergonomics in the OR, 10 discussed vitreoretinal surgery, 2 mentioned strabismus surgery, and 2 described ergonomics in oculoplastics surgeries. Only 9 of the 41 articles explicitly mentioned either residents or fellows. Based on this review, as well as anecdotal experience, recommendations for residents, fellows, and staff ophthalmologists while working in the OR were compiled. To help offset risk for musculoskeletal injury, recommendations related to relaxation, movement, and maintenance of ergonomic focus are proposed. In addition, methods to optimize ergonomics for the patient, surgeon, surgical bed, foot pedals, surgeon's chair, and the microscope are identified. Trainees may be at particular risk for injury owing to their placement at the surgical bed, and the fact that they may be less likely to get set up ergonomically either owing to a lack of awareness and teaching on the subject, or secondary to perceived time pressures in the OR. Ergonomics should ideally be considered across all domains of life, including in the OR, clinic, and office and at home. The earlier proper positioning is adopted and becomes habitual, the less likely potentially career-threatening musculoskeletal disorders will develop.


Assuntos
Ergonomia/métodos , Salas Cirúrgicas/métodos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Humanos , Doenças Musculoesqueléticas/prevenção & controle , Oftalmologistas
11.
J Neurointerv Surg ; 12(7): 643-647, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32434798

RESUMO

BACKGROUND: Infection from the SARS-CoV-2 virus has led to the COVID-19 pandemic. Given the large number of patients affected, healthcare personnel and facility resources are stretched to the limit; however, the need for urgent and emergent neurosurgical care continues. This article describes best practices when performing neurosurgical procedures on patients with COVID-19 based on multi-institutional experiences. METHODS: We assembled neurosurgical practitioners from 13 different health systems from across the USA, including those in hot spots, to describe their practices in managing neurosurgical emergencies within the COVID-19 environment. RESULTS: Patients presenting with neurosurgical emergencies should be considered as persons under investigation (PUI) and thus maximal personal protective equipment (PPE) should be donned during interaction and transfer. Intubations and extubations should be done with only anesthesia staff donning maximal PPE in a negative pressure environment. Operating room (OR) staff should enter the room once the air has been cleared of particulate matter. Certain OR suites should be designated as covid ORs, thus allowing for all neurosurgical cases on covid/PUI patients to be performed in these rooms, which will require a terminal clean post procedure. Each COVID OR suite should be attached to an anteroom which is a negative pressure room with a HEPA filter, thus allowing for donning and doffing of PPE without risking contamination of clean areas. CONCLUSION: Based on a multi-institutional collaborative effort, we describe best practices when providing neurosurgical treatment for patients with COVID-19 in order to optimize clinical care and minimize the exposure of patients and staff.


Assuntos
Betacoronavirus , Infecções por Coronavirus/cirurgia , Infecções por Coronavirus/transmissão , Pessoal de Saúde/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Procedimentos Neurocirúrgicos/normas , Pneumonia Viral/cirurgia , Pneumonia Viral/transmissão , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Salas Cirúrgicas/métodos , Salas Cirúrgicas/normas , Pandemias , Equipamento de Proteção Individual/normas
12.
J Trauma Acute Care Surg ; 89(2): 265-271, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32404630

RESUMO

BACKGROUND: The COVID-19 virus is highly contagious, and thus there is a potential of infecting operating staff when operating on these patients. This case series describes a method of performing open tracheostomy for COVID-19 patients while minimizing potential aerosolization of the virus using typically available equipment and supplies. METHODS: This is a case series of 18 patients who were COVID-19-positive and underwent open tracheostomy in the operating room under a negative pressure plastic hood created using readily available equipment and supplies. Patients had to be intubated for at least 14 days, be convalescing from their cytokine storm, and deemed to survive for at least 14 more days. Other indications for tracheostomy were altered mental status, severe deconditioning, respiratory failure and failed extubation attempts. RESULTS: There were 14 men and 4 women with severe SARS-CoV2 infection requiring long-term intubation since March 23 or later. The mean age was 61.7 years, body mass index was 32.6, and the pretracheostomy ventilator day was 20.4 days. The indications for tracheostomy were altered mental status, severe deconditioning and continued respiratory with hypoxia. Failed extubation attempt rate was 16.7% and hemodialysis rate was 38.9%. All patients were hemodynamically stable, without any evidence of accelerating cytokine storm. To date there was one minor bleeding due to postoperative therapeutic anticoagulation. CONCLUSION: This report describes a method of performing open tracheostomy with minimal aerosolization using readily available equipment and supplies in most hospitals. LEVEL OF EVIDENCE: Therapeutic/care management, Level V.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Controle de Infecções/métodos , Pandemias , Pneumonia Viral , Respiração Artificial , Insuficiência Respiratória/terapia , Traqueostomia , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Síndrome da Liberação de Citocina/etiologia , Síndrome da Liberação de Citocina/terapia , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/prevenção & controle , Salas Cirúrgicas/métodos , Salas Cirúrgicas/tendências , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Insuficiência Respiratória/etiologia , Traqueostomia/efeitos adversos , Traqueostomia/métodos
14.
J Cardiothorac Vasc Anesth ; 34(9): 2331-2337, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32303395

RESUMO

The outbreak of coronavirus disease 2019 (COVID-19), a respiratory disease from a novel coronavirus that was first detected in Wuhan City, Hubei Province, China, is now a public health emergency and pandemic. Singapore, as a major international transportation hub in Asia, has been one of the worst hit countries by the disease. With the advent of local transmission, the authors share their preparation and response planning for the operating room of the National Heart Centre Singapore, the largest cardiothoracic tertiary center in Singapore. Protection of staff and patients, environmental concerns, and other logistic and equipment issues are considered.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/prevenção & controle , Pessoal de Saúde/normas , Salas Cirúrgicas/normas , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/cirurgia , Humanos , Salas Cirúrgicas/métodos , Pandemias , Equipamento de Proteção Individual/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/cirurgia , Singapura/epidemiologia , Fluxo de Trabalho
17.
Can J Anaesth ; 67(7): 885-892, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32212103

RESUMO

Coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization on 11 March 2020 because of its rapid worldwide spread. In the operating room, as part of hospital outbreak response measures, anesthesiologists are required to have heightened precautions and tailor anesthetic practices to individual patients. In particular, by minimizing the many aerosol-generating procedures performed during general anesthesia, anesthesiologists can reduce exposure to patients' respiratory secretions and the risk of perioperative viral transmission to healthcare workers and other patients. To avoid any airway manipulation, regional anesthesia should be considered whenever surgery is planned for a suspect or confirmed COVID-19 patient or any patient who poses an infection risk. Regional anesthesia has benefits of preservation of respiratory function, avoidance of aerosolization and hence viral transmission. This article explores the practical considerations and recommended measures for performing regional anesthesia in this group of patients, focusing on control measures geared towards ensuring patient and staff safety, equipment protection, and infection prevention. By doing so, we hope to address an issue that may have downstream implications in the way we practice infection control in anesthesia, with particular relevance to this new era of emerging infectious diseases and novel pathogens. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not the first, and certainly will not be the last novel virus that will lead to worldwide outbreaks. Having a well thought out regional anesthesia plan to manage these patients in this new normal will ensure the best possible outcome for both the patient and the perioperative management team.


Assuntos
Anestesia por Condução/métodos , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Anestesiologistas , Anestesiologia/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Surtos de Doenças , Humanos , Controle de Infecções/métodos , Exposição Ocupacional/prevenção & controle , Salas Cirúrgicas/métodos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
18.
Transplant Proc ; 52(2): 625-629, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32029313

RESUMO

BACKGROUND: Erythropoietic protoporphyria is a rare disease of heme biosynthesis resulting in excessive accumulation of protoporphyrin in various organs. The most typical symptom is photosensitivity caused by activated protoporphyrins (wavelength ~400 nm). Accumulated protoporphyrin in the liver also causes liver failure, and liver transplantation is the only life-saving treatment. Phototoxic injury to abdominal organs has been reported during liver transplantation. Thus, to avoid phototoxic injury during liver transplantation, it has previously been conducted with only shadowless lights and ceiling lights off in the operating theater. Here, we report a case of a safe and successful liver transplantation in a patient with erythropoietic protoporphyria where the operating theater lights were covered with polyimide film. CASE PRESENTATION: A 50-year-old man presented with hepatic failure owing to erythropoietic protoporphyria. Before liver transplantation, the shadowless lights and ceiling lights in the operating theater were covered entirely with polyimide film. This filter completely blocked the harmful wavelength of light (400-470 nm). Orthotopic liver transplantation was safely and successfully performed with adequate illumination and patient monitoring. The patient followed a normal postoperative course without phototoxic injuries or protoporphyrin re-accumulation. CONCLUSION: Covering not only shadowless lights but also all ceiling lights in the operating theater with the polyimide film allowed safe surgery, safe anesthesia, and safe monitoring of the patient who underwent liver transplantation for severe liver failure owing to erythropoietic protoporphyria.


Assuntos
Iluminação/métodos , Transplante de Fígado/métodos , Salas Cirúrgicas/métodos , Transtornos de Fotossensibilidade/prevenção & controle , Protoporfiria Eritropoética/cirurgia , Humanos , Falência Hepática/etiologia , Falência Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , Transtornos de Fotossensibilidade/etiologia , Protoporfiria Eritropoética/complicações
19.
Anesth Analg ; 130(2): 382-390, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31306243

RESUMO

BACKGROUND: Many hospitals have implemented surgical safety checklists based on the World Health Organization surgical safety checklist, which was associated with improved outcomes. However, the execution of the checklists is frequently incomplete. We reasoned that aviation-style computerized checklist displayed onto large, centrally located screen and operated by the anesthesia provider would improve the performance of surgical safety checklist. METHODS: We performed a prospective before and after observational study to evaluate the effect of a computerized surgical safety checklist system on checklist performance. We created checklist software and translated our 4-part surgical safety checklist from wall poster into an aviation-style computerized format displayed onto a large, centrally located screen and operated by the anesthesia provider. Direct observers recorded performance of the first part of the surgical safety checklist that was initiated before anesthetic induction, including completion of each checklist item, provider participation and distraction level, resistance to use of the checklist, and the time required for checklist completion before and after checklist system implementation. We compared trends of the proportions of cases with 100% surgical safety checklist completion over time between pre- and postintervention periods and assessed for a jump at the start of intervention using segmented logistic regression model while controlling for potential confounding variables. RESULTS: A total of 671 cases were observed before and 547 cases were observed after implementation of the computerized surgical safety checklist system. The proportion of cases in which all of the items of the surgical safety checklist were completed significantly increased from 2.1% to 86.3% after the computerized checklist system implementation (P < .001). Before computerized checklist system implementation, 488 of 671 (72.7%) cases had <75% of checklist items completed, whereas after a computerized checklist system implementation, only 3 of 547 (0.5%) cases had <75% of checklist items completed. CONCLUSIONS: The implementation of a computerized surgical safety checklist system resulted in an improvement in checklist performance.


Assuntos
Anestesia/normas , Lista de Checagem/normas , Competência Clínica/normas , Pessoal de Saúde/normas , Procedimentos Cirúrgicos Operatórios/normas , Terapia Assistida por Computador/normas , Adulto , Idoso , Anestesia/métodos , Aviação/normas , Lista de Checagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas/métodos , Salas Cirúrgicas/normas , Estudos Prospectivos , Procedimentos Cirúrgicos Operatórios/métodos , Terapia Assistida por Computador/métodos
20.
Trials ; 20(1): 782, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31882015

RESUMO

BACKGROUND: Advancements in virtual reality (VR) technology have resulted in its expansion into health care. Preliminary studies have found VR to be effective as an adjunct to anesthesia to reduce pain and anxiety for patients during upper gastrointestinal endoscopies, dental procedures and joint arthroplasties. Current standard care practice for upper extremity surgery includes a combination of regional anesthesia and intraoperative propofol sedation. Commonly, patients receive deep propofol sedation during these cases, leading to potentially avoidable risks of over-sedation, hypotension, upper airway obstruction, and apnea. The objective of this study is to evaluate the effectiveness of VR technology to promote relaxation for patients undergoing upper extremity surgery, thereby reducing intraoperative anesthetic requirements and improving the perioperative patient experience. METHODS: In this single-center, randomized controlled trial, 40 adult patients undergoing upper extremity orthopedic surgery will be randomly allocated to either intraoperative VR immersion or usual care. VR immersion is designed to provide patients with a relaxing virtual environment to alleviate intraoperative anxiety. All patients receive a peripheral nerve block prior to surgery. Patients in the intervention group will select videos or immersive environments which will be played in the VR headset during surgery. An anesthesia provider will perform their usual clinical responsibilities intraoperatively and can administer anesthetic medications if and when clinically necessary. Patients in the control arm will undergo perioperative anesthesia according to standard care practice. The primary outcome is the difference in intraoperative propofol dose between the groups. Secondary outcomes include postoperative analgesia requirements and pain scores, length of stay in the postanesthesia care unit, overall patient satisfaction and postoperative functional outcomes. DISCUSSION: It is unknown whether the use of VR during upper extremity surgery can reduce intraoperative anesthetic requirements, reduce perioperative complications, or improve the postoperative patient experience. A positive result from this clinical trial would add to the growing body of evidence that demonstrates the effectiveness of VR as an adjunct to anesthesia in reducing intraoperative pain and anxiety for multiple types of procedure. This could lead to a change in practice, with the introduction of a nonpharmacologic intervention potentially reducing the burden of over-sedation while still providing a satisfactory perioperative experience. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03614325. Registered on 9 July 2018.


Assuntos
Anestesia por Condução/métodos , Ansiedade , Procedimentos Ortopédicos , Dor Processual , Terapia de Relaxamento/métodos , Realidade Virtual , Adulto , Anestésicos Intravenosos/administração & dosagem , Ansiedade/etiologia , Ansiedade/prevenção & controle , Humanos , Salas Cirúrgicas/métodos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/psicologia , Avaliação de Resultados em Cuidados de Saúde , Dor Processual/prevenção & controle , Dor Processual/psicologia , Propofol/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
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