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Operating Theatre (operating + theatre)
Selected AbstractsOperating theatre , the patient is listeningACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2000A. Yli-Hankala No abstract is available for this article. [source] Randomized comparison of the SLIPA (Streamlined Liner of the Pharynx Airway) and the SS-LM (Soft Seal Laryngeal Mask) by medical studentsEMERGENCY MEDICINE AUSTRALASIA, Issue 5-6 2006Cindy Hein Abstract Objective:, The aim of the study was to compare the Streamlined Liner of the Pharynx Airway (SLIPA; Hudson RCI), a new supraglottic airway device, with the Soft Seal Laryngeal Mask (SS-LM; Portex) when used by novices. Methods:, Thirty-six medical students with no previous airway experience, received manikin training in the use of the SLIPA and the SS-LM. Once proficient, the students inserted each device in randomized sequence, in two separate patients in the operating theatre. Only two insertion attempts per patient were allowed. Students were assessed in terms of: device preference; success or failure; success at first attempt and time to ventilation. Results:, Sixty-seven per cent of the students preferred to use the SLIPA (95% confidence interval 49,81%). The SLIPA was successfully inserted (one or two attempts) in 94% of patients (34/36) and the SS-LM in 89% (32/36) (P = 0.39). First attempt success rates were 83% (30/36) and 67% (24/36) in the SLIPA and SS-LM, respectively (P = 0.10). Median time to ventilation was shorter with the SLIPA (40.6 s) than with the SS-LM (66.9 s) when it was the first device used (P = 0.004), but times were similar when inserting the second device (43.8 s vs 42.9 s) (P = 0.75). Conclusions:, In the present study novice users demonstrated high success rates with both devices. The SLIPA group achieved shorter times to ventilation when it was the first device they inserted, which might prove to be of clinical significance, particularly in resuscitation attempts. Although the Laryngeal Mask has gained wide recognition for use by both novice users and as a rescue airway in failed intubation, the data presented here suggest that the SLIPA might also prove useful in these areas. [source] The design of supervisory rule-based control in the operating theatre via an anaesthesia simulatorEXPERT SYSTEMS, Issue 1 2002M. Mahfouf The development of online drug administration strategies in operating theatres represents a highly safety-critical situation. The usefulness of different levels of simulation prior to clinical trials has been shown in previous studies in muscle relaxant anaesthesia. Thus, in earlier work on predictive self-tuning control for muscle relaxation a dual computer real-time simulation was undertaken, subsequent to algorithm validation via off-line simulation. In the present approach a supervised rule-based control algorithm is used. The control software was implemented on the actual machine to be used in theatre, while another computer acted as a real-time patient simulator. This set-up has further advantages of providing accurate timing and also finite data accuracy via the ADC/DAC interface, or the equivalent digital lines. Also, it provides for controller design fast simulation studies compared to the real-time application. In this paper, a new architecture which combines several hierarchical levels for control (a Mamdani-type fuzzy controller), adaptation (self-organizing fuzzy logic control) and performance monitoring (fault detection, isolation and accommodation) is developed and applied to a computer real-time simulation platform for muscle relaxant anaesthesia. Experimental results showed that the proposed algorithm fulfilled successfully the requirements for autonomy, i.e. automatic control, adaptation and supervision, and proved effective in dealing with the faults and disturbances which are normally encountered in operating theatres during surgery. [source] Constrained closed-loop control of depth of anaesthesia in the operating theatre during surgeryINTERNATIONAL JOURNAL OF ADAPTIVE CONTROL AND SIGNAL PROCESSING, Issue 5 2005M. Mahfouf Abstract The constrained version of generalized predictive control (GPC) which employs the quadratic programming (QP) approach is evaluated for on-line administration of an anaesthetic drug in the operating theatre during surgery. In the first instance, a patient simulator was developed using a physiological model of the patient and the necessary control software was validated via a series of extensive simulation experiments. Such a validated system was then transferred into the operating theatre for a series of clinical evaluation trials. The clinical trials, which were performed with little involvement of the design engineer, led to a good regulation of unconsciousness using fixed-parameters as well the adaptive version of the algorithm. Furthermore, the constrained algorithm displayed good robustness properties against disturbances such as high stimulus levels and allowed for safe and economically effective administration of the anaesthetic agent isoflurane. Copyright © 2005 John Wiley & Sons, Ltd. [source] Personnel breathing zone sevoflurane concentration adherence to occupational exposure limits in conjunction with filling of vaporisersACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010H. HEIJBEL Background: Work place pollution during filling of anaesthetic vaporisers has been a matter of concern. We studied personnel breathing zone ambient air sevoflurane concentrations during filling of sevoflurane with three different filling systems: Quik-FilÔ for Abbott and Dräger FillÔ resp. Easy-FilÔ adapters for Baxter sevoflurane bottles, referred to as ,Abbott and Baxter filling systems'. Method: Sequential filling of three vaporisers was performed for a 15-min period, once with each of Abbott and Baxter filling systems, by four nurses. Ambient-air sevoflurane p.p.m. concentration in the breathing zone was continuously measured using a Miran 1a device during filling, and the mean 15 min sevoflurane concentration was calculated. Results: All eight measured (4 × 2 sequences) 15-min mean breathing zone sevoflurane concentrations covering filling of three vaporisers were well below the recommended short-term value (STV) provided by the Swedish Work Environment Authority (STV 20 p.p.m.). Conclusion: The breathing zone sevoflurane concentration during filling of sevoflurane with Baxter or Abbott filling systems, in an ordinary operating theatre, was found to be reassuringly below the Swedish recommended STV (20 p.p.m. average for a 15-min period). [source] Penetrating injuries in children: Is there a message?JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2002AJA Holland Objectives: To determine the frequency, management and outcome of penetrating trauma in children. Methods: A retrospective review of penetrating injuries in children under 16 years of age admitted to the Children's Hospital at Westmead (CHW), and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry, from January 1988 to December 2000. Patient details, circumstances of trauma, injuries identified, management and outcome were recorded. Results: Thirty-four children were admitted to the CHW with penetrating injuries during the 13-year period. This represented 0.2% of all trauma admissions, but 3% of those children with major trauma. The injury typically involved a male, school-age child that fell onto a sharp object or was assaulted with a knife or firearm by a parent or person known to them. Twenty-five children (75%) required operative intervention for their injuries and 14 survivors (42%) suffered long-term morbidity. Thirty children were reported to the NPTD Registry over the same interval, accounting for 2.3% of all trauma deaths in New South Wales. Of these, a significant minority was injured by falls from a mower or a tractor towing a machine with blades. Conclusions: Penetrating injuries are uncommon, but cause serious injury in children. There are two clear groups: (i) those dead at the scene or moribund on arrival, in whom prevention must be the main aim; and (ii) those with stable vital signs. Penetrating wounds should be explored in the operating theatre to exclude major injury. Young children should not ride on mowers or tractors. [source] How can we prepare medical students for theatre-based learning?MEDICAL EDUCATION, Issue 10 2007Nishan Fernando Context, The quality of medical undergraduate operating theatre-based teaching is variable. Preparation prior to attending theatre may support student learning. Identifying and agreeing key skills, competences and objectives for theatre-based teaching may contribute to this process of preparation. Methods, We carried out a cross-sectional survey of consultant surgeons and students using a forced choice questionnaire containing 16 skills and competences classified as ,essential', ,desirable' or ,not appropriate', and a choice of 6 different teaching methods, scored for perceived effectiveness on a 5-point Likert scale. Questionnaire content was based on the findings from an earlier qualitative study. Results, Comparative data analyses (Mann, Whitney and Kruskal,Wallis tests) were carried out using spss Version 14. A total of 42 consultant surgeons and 46 students completed the questionnaire (46% and 100% response rates, respectively). Knowledge of standard theatre etiquette and protocols, ability to scrub up adequately, ability to adhere to sterile procedures, awareness of risks to self, staff and patients, and appreciation of the need for careful peri-operative monitoring were considered ,essential' by the majority. Student and consultant responses differed significantly on 5 items, with students generally considering more practical skills and competences to be essential. Differences between students on medical and surgical attachments were also identified. Conclusions, Consultant surgeons and medical students agree on many aspects of the important learning points for theatre-based teaching. Compared with their teachers, students, particularly those on attachment to surgical specialties, are more ambitious , perhaps overly so , in the level of practical skills and risk awareness they expect to gain in theatre. [source] Assessing the performance of doctors in teams and systemsMEDICAL EDUCATION, Issue 10 2002Elizabeth A Farmer Introduction, Increasing attention is being directed towards finding ways of assessing how well doctors perform in clinical practice. Current approaches rely on strategies directed at individuals only, but, in real life, doctors' work is characterised by multiple complex professional interactions. These interactions involve different kinds of teams and are embedded within the overall context and systems of care. In addition to individual factors, therefore, we propose that the performance of doctors in health care teams and systems will also impact on the overall quality of patient care. Assessing these dimensions, however, poses a number of challenges. Strategies, Taking a profile of a National Health Service, UK surgeon as an example, the team structures to which he or she may relate are illustrated. These include formal teams such as those found in the operating theatre, and those formed through various professional and collegial partnerships. The authors then propose a model for assessing doctors' performances in teams and systems, which incorporates the educational principles of continuous feedback to enhance future performance. Discussion, To implement the proposed model, a wide range of professional, educational and regulatory bodies must collaborate. This raises a number of important implications for the future roles and relationships of these bodies, which are discussed. A strong and constructive partnership will be essential if the full potential of a more inclusive and representative assessment approach is to be realised. [source] rFV11a and paediatric open-heart surgery: thrombosis in the cardiopulmonary bypass circuit in spite of adequate markers of anticoagulationANAESTHESIA, Issue 6 2009N. A. Chambers Summary Recombinant activated factor V11 (rFV11a) is a relatively new procoagulant agent and its place in surgical practice continues to be investigated. We report the use of rFV11a to help manage bleeding in the operating theatre in a neonate, following weaning from cardiopulmonary bypass for arterial switch procedure, when bleeding continued in spite of maximal medical therapy and apparent exclusion of a surgical cause of bleeding. In this patient administration of rFV11a failed to facilitate haemostasis and cardiopulmonary bypass was re-instituted allowing location and repair of a small awkward surgical source. Separation from this additional 20 min of bypass was successful but a large thrombus was noted in the membrane oxygenator of the extracorporeal circuit in spite of the presence of adequate ,laboratory' markers of anticoagulation in the pump blood. No adverse sequelae to the patient occurred. [source] Thyroid storm prior to induction of anaesthesiaANAESTHESIA, Issue 10 2004E. A. Hirvonen Summary A 53- year-old woman without a previous history of thyroid disease was scheduled for mastectomy. On arrival in the operating theatre unpremedicated she appeared restless and tachycardic. Midazolam and fentanyl was administered intravenously. Concomitantly, sinus tachycardia developed and a flush reaction was observed in the skin of the thoracic region and neck. The blood pressure increased to 265/160 mmHg and the patient lost consciousness and became apnoeic. Unconsciousness and apnoea lasted for approximately 25 min and the operation was postponed. Further investigations revealed an elevated serum free thyroxine level and suppressed serum thyrotropin diagnostic of hyperthyroidism. The serum TSH receptor antibody concentration was elevated, indicating that the patient was suffering from Graves' disease. We present a case of a previously unknown hyperthyroid patient, with breast cancer, presenting as a thyroid crisis on induction of anaesthesia. Although being quite a rare occurrence, unsuspected thyroid disease should be borne in mind when an agitated patient enters the operating theatre. [source] Monitoring pollution by proton-transfer-reaction mass spectrometry during paediatric anaesthesia with positive pressure ventilation via the laryngeal mask airway or uncuffed tracheal tubeANAESTHESIA, Issue 7 2002J. Rieder Summary Twenty children aged 2,66 months were randomly allocated for airway management with either the laryngeal mask airway or uncuffed tracheal tube using intermittent positive pressure ventilation with a tidal volume of 8 ml.kg,1 and a respiratory rate adjusted to maintain end-expiratory carbon dioxide concentration at 5.3 kPa. Induction was with fentanyl/propofol and maintenance was with sevoflurane 2.5% in oxygen/air. The airway device was removed when the patients were awake and the patients were transferred to the postanaesthesia care unit 10 min later. Air was sampled from a point 1.5 m above the floor at a location remote from the ventilation outlet and analysed using a proton-transfer-reaction mass spectrometer capable of continuous trace gas analysis at the parts per billion volume (ppbv) level. The concentration of sevoflurane was recorded every minute during three consecutive phases: for 5 min before the introduction of sevoflurane (background); after introduction of sevoflurane until removal of the airway device (intra-operative); and every minute after removal until the concentration returned to background levels. Median (interquartile range [range]) intra-operative sevoflurane concentrations were 200,400 times higher than background values for the laryngeal mask airway 1 (1,2 [0,3]) ppbv vs. 404 (278,523 [83,983]) ppbv, respectively, and the tracheal tube 2 (1,3 [0,5]) ppbv vs. 396 (204,589 [107,1735]) ppbv (both p <,0.0001), and returned to background values within 5 min of removal. There were no differences in sevoflurane concentration between devices intra-operatively or after removal. The performance of the proton-transfer-reaction mass spectrometer was identical at the start and end of the 30-day study. We conclude that peri-operative sevoflurane concentration in a modern operating theatre is similar for the laryngeal mask airway and the uncuffed tracheal tube in paediatric patients receiving intermittent positive pressure ventilation. Intra-operative sevoflurane concentrations are five times lower than occupational safety limit requirements, and 1000 times lower 5 min after removal of the airway device with the patient awake. The proton-transfer-reaction mass spectrometer has potential for monitoring air quality in the operating theatre. [source] Noise in the operating theatre: how much is too much?ANZ JOURNAL OF SURGERY, Issue 6 2010Michael Barakate MS FRACS No abstract is available for this article. [source] Smoking is a major risk factor for wound dehiscence after midline abdominal incision; case,control studyANZ JOURNAL OF SURGERY, Issue 4 2009Saleh M. Abbas Abstract Background:, The incidence of acute fascial wound dehiscence (AFWD) after major abdominal operations is as high as 3%. AFWD is associated with mortality rates of 15,20%. Male gender, advanced age and numerous systemic factors including malignancy hypoproteinemia and steroid use have been associated with increased risk. The aim of the present study was to investigate the association between smoking prevalence and AFWD. Methods:, Middlemore Hospital records were retrieved from the 1997,2006 period for patients who had undergone midline abdominal surgery and developed AFWD. A return to the operating theatre for closure of the fascial dehiscence was required for study group inclusion. Each patient in the study group was matched to two control patients who had been admitted in the same year for surgery and who had a similar initial surgical intervention. Conditional logistic regression was used to calculate odds ratios with 95% confidence intervals, representing the risk of developing fascial wound dehiscence in smokers compared with the non-smoking group. Results:, There were 52 patients (32 male, 20 female) and 104 controls (64 male, 40 female). Median age for both groups was 63 years. A history of heavy tobacco use (,20 pack-years) was more prevalent in those who had AFWD (46%) compared with the control group (16%; P = 0.0002; odds ratio 3.7). Conclusions:, Smoking is associated with an increased incidence of acute fascial wound dehiscence following laparotomy. It is not known whether smoking is a causal or a surrogate factor. [source] Acute-care surgical service: a change in cultureANZ JOURNAL OF SURGERY, Issue 1-2 2009Andrew D. Parasyn The provision of acute surgical care in the public sector is becoming increasingly difficult because of limitation of resources and the unpredictability of access to theatres during the working day. An acute-care surgical service was developed at the Prince of Wales Hospital to provide acute surgery in a more timely and efficient manner. A roster of eight general surgeons provided on-site service from 08.00 to 18.00 hours Monday to Friday and on-call service in after-hours for a 79-week period. An acute-care ward of four beds and an operating theatre were placed under the control of the rostered acute-care surgeon (ACS). At the end of each ACS roster period all patients whose treatment was undefined or incomplete were handed over to the next rostered ACS. Patient data and theatre utilization data were prospectively collected and compared to the preceding 52-week period. Emergency theatre utilization during the day increased from 57 to 69%. There was a 11% reduction in acute-care operating after hours and 26% fewer emergency cases were handled between midnight and 08.00 hours. There was more efficient use of the entire theatre block, suggesting a significant cultural change. Staff satisfaction was high. On-site consultant-driven surgical leadership has provided significant positive change to the provision of acute surgical care in our institution. The paradigm shift in acute surgical care has improved patient and theatre management and stimulated a cultural change of efficiency. [source] GS14P ROUTINE USE OF MEDICAL EMERGENCY TEAMS IN MANAGING SURGICAL EMERGENCIESANZ JOURNAL OF SURGERY, Issue 2007H. K. Kim Introduction Trauma teams and cardiac arrest teams provide an urgent and expert multi-disciplinary response to time critical emergencies. The present study documents the contribution of a medical emergency team (MET) to managing non-trauma surgical emergencies. Materials and Methods Data was prospectively collected over a two year period concerning the contribution of medical emergency teams to the resuscitation of all patients with non-trauma surgical emergencies and altered vital signs in hospital wards. Results Over the study period, the details of 19 patients with surgical emergencies were recorded. 63% of emergencies occurred outside of normal working hours. In 53% of cases, the surgical registrar was off-site or physically unavailable to attend the emergency immediately. In 11% of cases, the medical emergency team was activated prior to the arrival of the surgical registrar. In 26% of cases, the patient was left unattended whilst awaiting arrival of the surgical registrar. The medical emergency team provided resuscitation procedures and arranged urgent investigations in all patients, physically transported the patient to the operating theatre in 16% of patients and prepared for general anaesthetic in the operating theatre in 11% of cases. The surgical registrar complemented the medical emergency team response by liaising with consultant surgeons, anaesthetists and operating theatre staff in all cases. All patients received definitive treatment within 30 minutes of MET response. Conclusion Routine use of medical emergency teams in the initial resuscitation of patients with surgical emergencies expedites definitive management. [source] Breast intraoperative ultrasound: prospective study in 112 patients with impalpable lesionsANZ JOURNAL OF SURGERY, Issue 3 2005Sarah J. Buman Background: Preoperative hookwire localizations have been used for some years to guide excision of subclinical breast lesions. With the availability of ultrasonography in the operating theatre, these localizations can be done intraoperatively. Methods: One hundred and thirty lesions in 112 consecutive patients with impalpable breast lesions were intraoperatively localized and excised, obviating the need for preoperative localizations. Results: All 130 lesions were detected intraoperatively and excised. Forty-four patients elected to have their benign lesions excised and there were 32 cancers removed. Ultrasonography was used to ensure complete local excisions in the majority of the cancers. Conclusion: Intraoperative breast ultrasound is a reliable, rapid and cost-effective adjunct in the management of both benign and malignant breast lesions. [source] Postoperative surgical site infections in cardiac surgery ,an overview of preventive measuresAPMIS, Issue 9 2007BENGT GÅRDLUND Postoperative surgical site infections are a major cause of postoperative morbidity and mortality in cardiac surgery. A surgical site infection occurs when the contaminating pathogens overcome the host defense systems and an infectious process begins. Bacteria may enter the operating site either by direct contamination from the patient's skin or internal organs, through the hands and instruments of the surgical staff or by bacteria-carrying particles that float around in the operating theatre and may land in the wound. The ability to withstand the contaminating bacteria depends on both local and systemic host defense. Successful preventive strategies are multiple and must include: 1) Minimizing the bacterial contamination of the surgical site (skin preparation, operating room ventilation, scrubbing, double gloving, etc.), 2) Minimizing the consequences of virulent contaminating bacteria by antibiotic prophylaxis (adequate dose, sort, timing, duration), 3) Minimizing injury to local host defense (atraumatic surgery, no excessive electrocautery, meticulous hemostasis, etc.), and 4) Optimizing general host defense (nutrition, tobacco smoking, weight loss, etc.). Compliance with these preventive procedures must be enforced through regular reviews of performance. Non-compliance with hygiene routines is often due to ignorance and poor planning. Education of personnel in these issues is a continuous process. [source] Vaginal birth after Caesarean section: A survey of practice in Australia and New ZealandAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2003Jodie Dodd Abstract Aims: Women with a single prior Caesarean section (CS) in a subsequent pregnancy will be offered either a planned elective repeat CS or vaginal birth after Caesarean (VBAC). Recent reports of VBAC have highlighted risks of increased morbidity, including uterine rupture, and adverse infant outcome. A survey of practice was sent to fellows and members of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists to determine current care for women in a subsequent pregnancy with a single prior CS, and to assess variations by length and type of obstetric practice. Methods: Questions asked about the safety of VBAC, induction of labour with a uterine scar, and requirements to conduct VBAC and elective repeat CS. Results: A total of 1641 surveys were distributed, with 1091 (67%) returned, 844 from practicing obstetricians (51% of college membership). Almost all respondents (96%) agreed or strongly agreed that VBAC should be presented as an option to the woman, varying from 90% where the indication for primary CS was breech, 88% for fetal distress, and 55% for failure to progress. Forty percent of respondents agreed or strongly agreed that VBAC was the safest option for the woman, and associated with fewer risks than CS. In contrast, 44% of respondents disagreed or strongly disagreed that VBAC was the safest option for the infant, and opinions varied as to whether risks of VBAC outweighed those of CS for the infant. Almost two-thirds of practitioners would offer induction of labour to a woman with a prior CS in a subsequent pregnancy, one-third indicating a willingness to use vaginal prostaglandins, and 77% syntocinon. Most respondents preferred to conduct VBAC in a level two or three hospital (86%); required the availability within 30 min of an anaesthetist (81%), a neonatologist (84%), and operating theatre (97%); recommended continuous electronic fetal heart rate monitoring (86%); intravenous access (90%); and routine group and hold (79%) during labour. For an elective repeat CS, most practitioners request routine blood for group and hold (78%), a neonatologist in theatre (77%), the use of an in-dwelling urinary catheter (96%), and the use of intraoperative antibiotics (82%). Conclusions: Most obstetricians indicated VBAC to be the safest option for the woman, but were less certain about benefits and risks for the infant. The consensus of practice is to present VBAC as an option and induce labour if needed. Vaginal birth after Caesarean is preferred in a level two or three hospital, with an anaesthetist, neonatologist and operating theatre available within 30 min. The use of continuous electronic fetal heart rate monitoring and intravenous access are recommended. In planned CS, a neonatologist in theatre is preferred, and an in-dwelling urinary catheter and intraoperative antibiotics will be used. [source] The cost of microwave endometrial ablation under different anaesthetic and clinical settingsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2003Janelle Seymour Objective To compare the costs of microwave endometrial ablation under local anaesthetic and general anaesthetic in an operating theatre and to estimate the cost of performing treatment under local anaesthetic in a dedicated clinic setting. Design The costing study was undertaken alongside a randomised controlled trial comparing the acceptability of microwave endometrial ablation using local versus general anaesthetic in a theatre setting. Setting Department of Gynaecology, Aberdeen Royal Infirmary, Scotland. Sample One hundred and twenty-seven women undergoing microwave endometrial ablation who had been randomly allocated to general or local anaesthetic. Methods Health and non-health service resource use was recorded prospectively. Data on resource use were combined with unit costs estimated using standardised methods to determine the cost per patient for microwave endometrial ablation under local or general anaesthetic in theatre. A model was developed to estimate the health service cost of microwave endometrial ablation under local anaesthetic in a clinic setting. Main outcome measures Health and non-health service costs. Results There was little difference in cost when treatments were performed under local or general anaesthetic in theatre. The median health and non-health cost of microwave endometrial ablation was £440 and £120, respectively, under general anaesthetic and £428 and £125 per women under local anaesthetic. The health service cost of microwave endometrial ablation using local anaesthetic in a clinic setting was estimated to be £432 per treatment; however, this varied from £389 to £491 in the sensitivity analysis. Conclusion There are minimal cost savings to the patient or health service from using local rather than general anaesthetic for microwave endometrial ablation in a theatre setting. Cost modelling suggests that in a clinic setting microwave endometrial ablation has a similar cost to theatre based treatment once re-admissions for treatment under general anaesthetic are considered. Sensitivity analysis indicated that these findings were sensitive to assumptions in the model. [source] Unexpected reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period: was this the Hawthorne effect?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2003W.C. Leung Objective The study was originally designed to identify the risk factors that could predict those difficult instrumental deliveries resulting in birth trauma and birth asphyxia. Design A prospective study on all singleton deliveries in cephalic presentation with an attempt of instrumental delivery over a 12-month period (13 March 2000 to 12 March 2001). Setting A local teaching hospital. Sample Six hundred and seventy deliveries. Methods A codesheet was designed to record the demographic data, characteristics of first and second stages of labour and neonatal outcome. In particular, the doctor had to enter the pelvic examination findings before the attempt of instrumental delivery. Main outcome measures Birth trauma and birth asphyxia. Results There was a significant reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period (0.6%) when compared with that (2.8%) in the pre-study period (1998 and 1999) (RR 0.27, 95% CI 0.11,0.70). There was more trial of instrumental deliveries in the operating theatre although this was not statistically significant (RR 1.19, 95% CI 0.88,1.60). The instrumental delivery rate decreased during the study period (RR 0.88, 95% CI 0.82,0.94). The caesarean section rate for no progress of labour, the incidence of direct second stage caesarean section and the incidence of failed instrumental delivery did not increase during the study period. Conclusions Apart from the merits of regular audit exercise and increasing experience of the staff, the Hawthorne effect might be the major contributing factor in the reduction of birth trauma and birth asphyxia related to instrumental deliveries during the study period. [source] Assessment of surgical competence at carotid endarterectomy under local anaesthesia in a simulated operating theatre,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2010S. A. Black Background: Methods of surgical training that do not put patients at risk are desirable. A high-fidelity simulation of carotid endarterectomy under local anaesthesia was tested as a tool for assessment of vascular surgical competence, as an adjunct to training. Methods: Sixty procedures were performed by 30 vascular surgeons (ten junior trainees, ten senior trainees and ten consultants) in a simulated operating theatre. Each performed in a non-crisis scenario followed by a crisis scenario. Performance was assessed live by means of rating scales for technical and non-technical skills. Results: There was a significant difference in technical skills with ascending grade for both generic and procedure-specific technical skill scores in both scenarios (P < 0·001 for all comparisons). Similarly, there was also a significant difference in non-technical skill with ascending grade for both scenarios (P < 0·001). There was a highly significant correlation between technical and non-technical performance in both scenarios (non-crisis: rs = 0·80, P < 0·001; crisis: rs = 0·85, P < 0·001). Inter-rater reliability was high (,, 0·80 for all scales). Conclusion: High-fidelity simulation offers competency-based assessment for all grades and may provide a useful training environment for junior trainees and more experienced surgeons. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] 1253: Technique and role of biopsies in intraocular tumoursACTA OPHTHALMOLOGICA, Issue 2010BE DAMATO Purpose To discuss the roles of various forms of biopsy of intraocular tumours, to describe the techniques and to highlight the main pitfalls and complications. Methods Intraocular tumours can be sampled by exo- or endo-biopsy. Exo-biopsy can consist of excisional biopsy (e.g., iridocyclectomy), trans-scleral incisional biopsy, or trans-scleral fine-needle aspiration biopsy. Endo-biopsy comprises vitreous biopsy and retinal or choroidal biopsy performed with a fine needle or vitreous cutter. In rare cases, enucleation is the most pragmatic method of establishing the diagnosis, especially if the eye is blind and painful. Results For many years, biopsy was performed mostly for diagnostic purposes the main reasons being to distinguish melanoma from metastasis and lymphoma from various forms of uveitis. Recently, prognostic biopsy has become more popular, the objective being to determine whether or not a uveal melanoma is likely to be life-threatening. Biopsy can profoundly influence the management of an individual patient but requires special expertise both in the operating theatre and in the laboratory. There are many possible complications, which include endophthalmitis, extraocular seeding of tumour, rhegmatogenous retinal detachment, cataract, haemorrhage, inconclusive result, and mis-diagnosis. Conclusion Biopsy of intraocular tumours is invaluable in the management of selected patients, but requires special expertise to ensure that good results are obtained without causing complications. [source] Fine-needle aspiration biopsy and other biopsies in suspected intraocular malignant disease: a reviewACTA OPHTHALMOLOGICA, Issue 6 2009Nils Eide Abstract. Ocular oncologists require a strong indication for intraocular biopsy before the procedure can be performed because it carries a risk for serious eye complications and the dissemination of malignant cells. The purpose of this review is to evaluate the extent to which this restricted practice is supported by evidence from previous reports and to outline our main indications and contraindications. The different intraocular biopsy techniques in the anterior and posterior segment are discussed with a focus on our preferred method, fine-needle aspiration biopsy (FNAB). In the literature, complications are typically under-reported, which reduces the possibilities of evaluating the risks correctly and of making fair comparisons with other biopsy methods. In FNAB, the exact placement of the needle is critical, as is an accurate assessment of the size of the lesion. Fine-needle aspiration biopsy is usually not a reliable diagnostic tool in lesions < 2 mm in thickness. It is very advantageous to have a cytopathologist present in the operating theatre or close by. This ensures adequate sampling and encourages repeated biopsy attempts if necessary. This approach reduces false negative results to < 3%. Adjunct immunocytochemistry is documented to increase specificity and is essential for diagnosis and management in about 10% of cases. In some rare pathological processes the diagnosis depends ultimately on the identification of specific cell markers. An accurate diagnosis may have a decisive influence on prognosis. The cytogenetic prognostications made possible after FNAB are reliable. Biopsy by FNA has a low complication rate. The calculated risk for retinal detachment is < 4%. Intraocular haemorrhage is frequently observed, but clears spontaneously in nearly all cases. Only a single case of epibulbar seeding of malignant cells at the scleral pars plana puncture site of transvitreal FNAB has been documented. Endophthalmitis has been reported and adequate standard preoperative preparation is obligatory. An open biopsy is still an option in the anterior segment, but has been abandoned in the posterior segment. Although vitrectomy-based procedures are becoming increasingly popular, we recommend using FNAB as part of a stepwise approach. A vitrectomy-assisted biopsy should be considered in cases where FNAB fails. In any adult patient with suspected intraocular malignancy in which enucleation is not the obvious treatment, the clinician should strive for a diagnosis based on biopsy. When the lesion is too small for biopsy or the risks related to the procedure are too great, it is reasonable to be reluctant to biopsy. The standards applied in the treatment of intraocular malignant diseases should be equivalent to those in other fields of oncology. Our view is controversial and contrary to opinion that supports current standards of care for this group of patients. [source] Long term outcome of bleb needling revisions following mitomycin C trabeculectomy in Afro-Caribbean eyesACTA OPHTHALMOLOGICA, Issue 2007TA WILLIAMS Purpose: To assess the frequency, risk factors and outcome of patients requiring bleb needling revisions (BNR)following Mitomycin-C (MMC) augmented trabeculectomies in Afro-Caribbean eyes in Birmingham, United Kingdom. Methods: ReGAE (Research in Glaucoma and Ethinicity) is a UK based multidisciplinary based research group whose research is aimed at preventing glaucomatous blindness in the diverse ethnic population of the West Midlands. A prospective study of consecutive Afro-Caribbean patients with refractory advanced glaucoma who had undergone Mitomycin C augmented trabeculectomy (modified Cairns type trabeculectomy with fornix based conjunctival flap mitomycin C 0.1-0.4mg/ml) was completed. Bleb needling revisions in the operating theatre with subconjunctival 5 fluro-uracil (5FU) 0.1ml 25mg/ml) were required in a subset of eyes. The frequency, timing, complications and outcome of BNRs was studied. Results: 38 eyes (35 patients) were included in the study; mean age 52 years (range 11-77 years); male:female 21:14. 9 of 38 eyes (24%)required BNR. Aetiology of glaucoma POAG 44%; JOAG 23%; traumatic 11%; fuchs 11%; pseudoexfoliation 11%. Of the patients requring BNR 6 eyes required BNR within 1 month of MMC- trabeculectomy. BNRs were performed 1-48 months postopereratively. Number of BNRs required 1.7 per eye (range 1-4) over a 2 year post operative follow up period. No complications occurred during BNR. Conclusions: Afro-Caribbean patients have a significant risk of requiring BNR following MMC trabeculectomy. Although such bleb manipulations are most commonly required during the early postoperative period, late subtenon's fibrosis may necessitate late BNR in this ethnic group. [source] The design of supervisory rule-based control in the operating theatre via an anaesthesia simulatorEXPERT SYSTEMS, Issue 1 2002M. Mahfouf The development of online drug administration strategies in operating theatres represents a highly safety-critical situation. The usefulness of different levels of simulation prior to clinical trials has been shown in previous studies in muscle relaxant anaesthesia. Thus, in earlier work on predictive self-tuning control for muscle relaxation a dual computer real-time simulation was undertaken, subsequent to algorithm validation via off-line simulation. In the present approach a supervised rule-based control algorithm is used. The control software was implemented on the actual machine to be used in theatre, while another computer acted as a real-time patient simulator. This set-up has further advantages of providing accurate timing and also finite data accuracy via the ADC/DAC interface, or the equivalent digital lines. Also, it provides for controller design fast simulation studies compared to the real-time application. In this paper, a new architecture which combines several hierarchical levels for control (a Mamdani-type fuzzy controller), adaptation (self-organizing fuzzy logic control) and performance monitoring (fault detection, isolation and accommodation) is developed and applied to a computer real-time simulation platform for muscle relaxant anaesthesia. Experimental results showed that the proposed algorithm fulfilled successfully the requirements for autonomy, i.e. automatic control, adaptation and supervision, and proved effective in dealing with the faults and disturbances which are normally encountered in operating theatres during surgery. [source] Category-1 caesarean section: a survey of anaesthetic and peri-operative management in the UK,ANAESTHESIA, Issue 4 2010S. M. Kinsella Summary A national survey of anaesthetic and peri-operative management of category-1 caesarean section was sent to 245 consultant-led maternity units. There was a 70% response rate. The median (IQR [range]) general anaesthetic rate was 51% (29%,80% [6%,100%]), 12% (9%,16% [3%,93%]), 4% (2%,5% [<1%,18%]), for category-1 caesarean section, categories 1,3 (non-elective/emergency) and category-4 (elective) caesarean section, respectively. The main operating theatre for caesarean section is on the delivery suite in 151 (88%) units, and 112 (66%) units also have a second theatre in the same location. One hundred and thirty-nine (81%) use the standard urgency classification described in the NICE caesarean section guideline. However, only 72 (42%), 24 (14%), and 16 (9%) units comply with this guideline's recommended decision-delivery intervals for category-1 (, 30 min), category-2 (, 30 min) and category-3 (, 75 min) caesarean sections, respectively. Practice in the smaller units was similar to that in the larger units, although there was less availability of a dedicated anaesthetist, intra-uterine resuscitation guidelines and operating theatres on the delivery suite in the smaller units. [source] A national survey of the provision for patients with latex allergyANAESTHESIA, Issue 8 2003G. M. Yuill Summary The prevalence of latex allergy has increased since the 1980s. As latex is found throughout hospitals and operating theatres, careful planning is required for latex-allergic patients who present pre-operatively. We conducted a postal survey of 269 departments of anaesthesia in England and Wales; responses were received from 208 (77%). Of these, 198 (95%) had a latex allergy protocol and 181 (87%) had a store of latex-free equipment. Only 113 (54%) had a named nurse and 58 (28%) had a named consultant responsible for the update of latex allergy provisions. Access to allergy clinics and further investigations were available to 189 (91%). Many respondents called for national guidelines. We are reassured that the majority of trusts have an up-to-date latex allergy protocol and latex-free equipment store. However, relatively few have nominated members of staff responsible for these and peri-operative care of susceptible patients. [source] Audit of the utilization of time in an orthopaedic trauma theatreANZ JOURNAL OF SURGERY, Issue 4 2010Christopher L. Delaney Abstract Background:, The efficient use of operating theatres is important to ensure optimum cost,benefit for the hospital and to clear waiting lists. This audit uses the orthopaedic trauma theatre as a model to assess the theatre efficiency at our institution. Methods:, We performed a retrospective audit using data gathered from the operating theatre database at our institution. We considered each component of the operating theatre process and integrated them to give a combined value for surgical and anaesthetic time (end utilization) and total theatre efficiency (operating theatre utilization). Results:, Results showed that relative to the standards set, changeover time and start times were sub-standard, with consistently prolonged changeovers and late starts. End utilization and operating theatre utilization were 78.8 and 81%, against a standard of 77 and 85,90%, respectively. However, these figures may be misleading due to sub-standard performance in changeover time and other variables. Conclusions:, We have highlighted inefficiency in the orthopaedic trauma theatre at our institution and suggest various strategies to improve this that may be applied universally. [source] | ||||||||||||||||||||||||||||