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Results for “Intraoperative communication”

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At least 19 recordsLinked to original sources

PubMed1991

Prophylaxis of endophthalmitis with topical povidone-iodine.

The authors conducted an open-label nonrandomized parallel trial to examine whether the preoperative application of povidone-iodine to the ocular surface reduces the incidence of endophthalmitis after intraocular surgery. During an 11-month period, topical 5% povidone-iodine was used to prepare the conjunctiva in 1 set of 5 operating rooms, while silver protein solution was used in another set of 5 rooms. In all cases, surgeons continued to use their customary prophylactic antibiotics. A significantly lower incidence of culture-positive endophthalmitis (P less than 0.03) was observed in the operating rooms using povidone-iodine (2 of 3489 or 0.06%) compared with those using silver protein solution (11 of 4594 or 0.24%). Use of topical povidone-iodine in over 3000 cases was not associated with any adverse reactions. In a majority of the observed cases of endophthalmitis, some form of intraoperative communication with the vitreous cavity existed.

Administration, Topical↗

PubMed1991

A case-control study of risk factors for postoperative endophthalmitis.

The authors conducted a case-control study to identify risk factors for postoperative endophthalmitis. Fifty-four cases of patients who developed endophthalmitis after intraocular surgery at the New York Eye and Ear Infirmary during the period from January 1988 through October 1990 were identified. A control group of 228 patients was randomly selected from the 24,105 patients who underwent intraocular surgery during this same period. Logistic regression analysis identified significant independent risks associated with intraoperative communication with the vitreous cavity (risk ratio 13.7, P less than 0.001) and use of an intraocular lens with haptics made of polypropylene (risk ratio 4.5, P = 0.007). The study predicts that there would be approximately 700 fewer cases of postoperative endophthalmitis annually in the United States (approximately a 50% decrease in incidence) if intraocular lenses with haptics made of polymethyl-methacrylate, rather than polypropylene, were used exclusively.

Adolescent↗

PubMed1992

Intraoperative anatomical studies in patients with aneurysms of the anterior communicating artery complex.

The intraoperative anatomical findings of the anterior communicating artery (ACoA) complex in 46 patients with anatomical variations were compared to those in an equal number of patients without variations in order to determine the visualization of the elements of the vascular complex. All patients underwent radical surgery for an ACoA aneurysm by one of three different surgical approaches: transsylvian, anterior interhemispheric, or basal interhemispheric. Visualization of the vascular elements was similar in patients with or without anatomical variations. The differences observed were dependent on the surgical approach selected and on the projection of the aneurysm. It was found that, even when the intraoperative anatomical field and the number of vascular elements visualized are different from those obtained in autopsy studies, the vascular microanatomical characteristics can be confirmed with each surgical approach to the extent necessary to ensure safe clipping of aneurysms in patients both with and without anatomical variations.

Cerebral Arteries↗

PubMed1991

Managing burns in children. An intraoperative nursing care plan.

Explore the source record for details and available documents.

Body Temperature↗

PubMed1990

An operative complication in a patient with a true posterior communicating artery aneurysm: case report and review of the literature.

Intraoperative oculomotor nerve injury in a patient with a true posterior communicating artery aneurysm is reported in detail. A comparison of internal carotid artery aneurysms at the posterior communicating artery junction with true posterior communicating artery aneurysms deserves special attention, because the vascular relationships of the aneurysm are more complex. A clip along the internal carotid artery does not occlude blood flow to the aneurysm, and the aneurysmal neck and the distal posterior communicating artery are closer to the oculomotor nerve. This is the 27th reported case of a true posterior communicating artery aneurysm. The incidence of true posterior communicating artery aneurysms ranges from 0.1 to 2.8% of all aneurysm patients. Such aneurysms constitute 4.6 and 11% of so-called posterior communicating aneurysms in two series. Difficulty associated with a preoperative diagnosis has been documented in at least 4 cases. An awareness of this rare aneurysm is stressed in order to avoid operative complications.

Cerebral Angiography↗

PubMed1991

Anatomy of the venous drainage of the human testis: testicular vein cast, microdissection and radiographic demonstration. A new anatomical concept.

The venous drainage of the testis was identified and described in an autopsy, radiographic and operative series of 30, 28 and 7 adult males, respectively. Testicular vein cast--right and left--was prepared in autopsy specimens to identify the course, tributaries and communications of the testicular vein. Intraoperative spermatic venography was done in 17 men with and in 11 men without varicocele. The retrograde spermatic venography showed the precise anatomy of the pampiniform plexus. Antegrade spermatic venography was done to identify the valves. During cystectomy in 7 adult men, the whole tree of the spermatic vein was taken and microdissected. Our findings show that the venous drainage of the testis cannot be looked upon as it is in the standard anatomy; on the contrary, it deviates from the description in the text. We demonstrated that the venous drainage of the testis is via the pampiniform plexus, which is primarily drained by the testicular and external pudendal veins. The testicular vein--midway between the internal inguinal ring and the lower pole of the kidney--divides into the medial and lateral branch to form a delta. The medial branch communicates with the ureteral and contralateral veins; there, it terminates in the left renal vein or inferior vena cava on the right side. The lateral branch communicates with colonic and renal capsular veins and terminates in the perinephric space. There is no cross-communication between the left and right testicular venous systems in the scrotal, retropubic or pelvic areas. The only cross-communication is in the abdomen, and is seen in only 50% of men. The testicular vein has no valves.

Adult↗

PubMed1990

Anesthetic considerations for gynecologic cancer surgery.

Preoperative, intraoperative, and postoperative anesthetic considerations in gynecologic cancer surgery are discussed. Preoperatively, the anesthetist must document the patient's disease state, physical condition, responses to prior chemotherapeutic regimens and toxic side effects, particularly from Adriamycin and bleomycin. Laboratory studies should include electrolytes, hepatic, renal, and hematologic indices. The anesthetist should also recognize that patients may be under great emotional stress, which may require prescribing anti-anxiety medications for several days prior to surgery. Planning the anesthetic includes consultation with the surgeon relative to procedure planned, positioning requirements, anticipated blood loss, monitoring and postoperative care requirements. Intraoperative considerations again involve close communication with the surgeon. The use and benefits of a combined regional/general anesthetic technique are discussed. Postoperative considerations are directed toward hemodynamic stability and control of postoperative pain. Techniques of epidural narcotic and local anesthetic administration, as well as patient-controlled analgesia (PCA) are discussed.

Anesthesia, Conduction↗

PubMed2026

Standardized visual overlays enhance laparoscopic instruction: A mixed-methods evaluation.

Effective communication during laparoscopic procedures is frequently undermined by spatial disorientation and inconsistent terminology between instructors and trainees. This study examined whether standardized visual overlays on endoscopic monitors could enhance communication and learning. We conducted a three-phase mixed-methods study: qualitative observation of 20 laparoscopic teaching cases; a randomized trial of 63 second-year medical students assigned to control, clock, or alphanumeric grid (AG) overlays during three trials of a standardized transfer task; and intraoperative implementation in 44 cases (30 AG, 14 clock) with post-case surveys and qualitative feedback. In simulation, the clock overlay produced the fastest completion times, whereas the AG yielded the lowest error scores, and both overlays outperformed the control. Intraoperatively, the AG was rated higher than the clock for communication clarity, spatial orientation, perceived operative efficiency, and trainee confidence. Standardized visual overlays, particularly the AG, appear to support intraoperative teaching by providing a shared spatial frame of reference.

Laparoscopy↗

PubMed1992

Iliopsoas bursal distension caused by acetabular loosening after total hip arthroplasty. A rare complication of total hip arthroplasty.

In a 58-year-old woman, a cystic mass at the ileocecal region communicated with the loosened hip prosthesis 20 years after total hip arthroplasty (THA). The preoperative arthrogram of the hip and the intraoperative cystogram suggested a one-way communication from the hip to the cystic mass. The mass was diagnosed as an iliopsoas bursitis distended by the influx of the synovial fluid from the loosened THA.

Abdominal Neoplasms↗

PubMed1991

Intraoperative monitoring of the somatosensory evoked potentials and cerebral blood flow during aneurysm surgery--safety evaluation for temporary vascular occlusion.

Somatosensory evoked potentials (SEPs) and cerebral blood flow (CBF) were monitored during temporary vascular occlusion in 67 aneurysm operations to evaluate the usefulness of SEP as an indicator for cerebral ischemia. The SEP N20 component completely disappeared during temporary vascular occlusion in 24 cases, 23 of which demonstrated complete recovery following recirculation and had no postoperative neurological sequelae. The only one with postoperative sequelae demonstrated rapid, within 1 minute, loss of N20 followed by no recovery. Another eight cases showed prolongation of central conduction time during vascular occlusion and had no postoperative sequelae. The SEP N20 attenuation reflected the CBF reduction in the middle cerebral artery (MCA) territory during MCA occlusion. However, CBF changes in the internal carotid artery (ICA) territory during ICA occlusion greatly varied. No detectable changes in SEP were found during anterior cerebral artery occlusion for anterior communicating artery aneurysms. This study indicates that intraoperative SEP monitoring is useful to detect ischemia in the MCA territory and that rapid disappearance of the N20 component is a danger signal.

Brain Ischemia↗

PubMed1990

Multilevel spine fractures: intraoperative nursing management.

Stabilization of multiple level spine fractures in blunt trauma victims is an extensive and complicated surgical procedure. A multidisciplinary approach to the thoracolumbar anatomy and subsequent stabilization poses a variety of challenges to the neurosurgical operating room staff. Transfer to the operating table and positioning for the procedure are dictated by the following treatment protocol for vertebral fractures: immobilization and stabilization of fractures with skin or skeletal traction, administration of parenteral muscle relaxants and analgesics, assessment and documentation of neurologic status, maintenance of bone and joint alignment and provision of skin care. Standard preoperative preparation and intraoperative nursing diagnoses and interventions are discussed. The importance of communication and psychological support to family members is stressed.

Humans↗

PubMed1992

Effects of intraoperative progress reports on anxiety of elective surgical patients' family members.

The purpose of this experimental study was to examine the effects of intraoperative progress reports on family members' state anxiety level (STAI S-Anxiety), mean arterial pressure (MAP), and heart rate during elective surgical procedures. Family members of randomly selected surgical patients were eligible to participate. Control group family members (n = 50) received usual care. Family members in the experimental group (n = 50) received a 5- to 10-minute progress report protocol about halfway through a surgical procedure. Families' STAI S-Anxiety scores, MAP, and heart rates were compared between the control and experimental groups using multivariate analysis of variance (MANOVA). Family members in the experimental group reported lower STAI S-Anxiety scores (p < .001), and had significantly lower MAP and heart rates than did the control group (p < .001). Progress reports appear to be a beneficial nursing intervention for reducing anxiety in family members during the intraoperative period.

Adolescent↗

PubMed1991

Coordinating clinical research. A collaborative approach for perioperative nurses.

Overall, the study progressed smoothly during the six months it took to collect data on 125 patients. A number of factors contributed to the success of the study. By using a collaborative approach, we assembled a team with expertise in the content area, the clinical setting, and research design and methodology. This diverse mixture of knowledge, experience, and skills enabled us to plan carefully and anticipate many problems when writing the proposal and designing the study. While planning and implementing the study, we made an effort to keep communication flowing at all levels so problems could be quickly detected and addressed. We worked from the premise that we were collaborating with all of the OR nursing staff. We tried to use their time wisely, give them a meaningful role, respect their other responsibilities and commitments, and provide them with opportunities to share in the positive feelings that come from successfully completing a difficult job. We believe we achieved some measure of success. Since finishing the study, many staff members expressed an interest in participating in future studies--a good indication that they find research less formidable. They view participation in studies as a way to progress through the clinical ladder system and realize a full professional role. Most importantly, they see participating in research as a way to improve the quality of patient care they provide.

Clinical Nursing Research↗

PubMed1989

Postoperative recovery of third nerve palsy due to posterior communicating aneurysms.

Postoperative recovery of third nerve palsy due to a posterior communicating artery aneurysm was correlated with pre- and intraoperative factors. The only significant factor determining recovery was the degree of preoperative deficit. The presence of subarachnoid haemorrhage, timing of surgery and aspiration of the aneurysmal sac did not influence recovery.

Adolescent↗

PubMed1986

[Surgical treatment of AVMs occluding these feeders during removal--utilizing the intraoperative balloon catheter and brain protective substances ("Sendai cocktail"].

The ideal treatment of cerebral arteriovenous malformations (AVMs) is thought to be the total resection of nidus. We have been reporting the importance of temporary occlusion of the feeding arteries with the aid of the brain protective substances to prolong the permissible time of occluding these arteries. Because of the difficulty of access to the feeding arteries, some cases are difficult or even impossible to operate. In this communication, four cases of AVM which were successfully resected utilizing intraoperative balloon occlusion of feeders under the administration of the brain protective substances are reported. Case 1. A 14-year-old female was admitted to our clinic because of subarachnoid hemorrhage with ventricular rupture and left cerebellar hemorrhage. Angiography disclosed a large left cerebellopontine angle AVM fed by left anterior inferior cerebellar artery (AICA) and left superior cerebellar arteries (SCAs). Prior to the operation, two balloon catheters were introduced via transfemoral approach; one into the AICA and the other into the basilar artery where left SCAs originated. To prolong the permissible time of occluding these arteries, "Sendai cocktail" (20% mannitol, vitamin E and dexamethazone) and perfluorochemicals were administered. Auditory brain stem response (ABR) was monitored continuously during the operation. The nidus was resected totally with safe using temporary inflation of these balloon catheters. The patient returned to normal life. Case 2. A 35-year-old male was admitted to our clinic complaining of the attack of generalized convulsive seizure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

[Perforated tubular duplication of the sigmoid colon in adults].

Intestinal duplications are rare malformations and a diagnostic challenge. The case presented herein relates to a perforated tubular duplication of the sigmoid colon in a 23-year-old man with intermittent abdominal pain during 3 months and a bout of peritonitis which resolved spontaneously. This case is unusual since duplications generally spare adults, are seldom found in the colon, and do not perforate. The only cases of duplication which can be suspected preoperatively belong to the communicating type or those containing ectopic gastric mucosa. The intraoperative finding in this case of a malformative mesenteric cyst reminds us that duplications can be found in association with other intestinal, vertebral, or genitourinary tract malformations. In conclusion, intestinal duplications should be resected even when they are asymptomatic, as occasional cancerous transformation associated with a poor prognosis have been reported.

Abscess↗

PubMed1992

Intrapancreatic duodenal duplication associated with pancreatic pseudocysts.

A rare case of intrapancreatic duodenal duplication causing pancreatitis is reported. At 2 years of age, the patient presented with a recurrent pancreatic pseudocyst. Intraoperative pancreatogram showed the presence of cystic duodenal duplication in the aberrant lobe of the pancreas communication with the pancreatic duct. Since the resection of the duplication, she has been free from recurrence of pancreatitis. In this case, intraoperative pancreatography was of great value.

Duodenum↗

PubMed1991

Intraoperative anaesthetic management of the liver transplant patient.

Orthotopic liver transplantation has become an established method of treating end-stage liver disease. Anaesthesia for patients undergoing this procedure can be complicated because end-stage liver disease is often associated with dysfunction of other physiological systems. Rapid haemodynamic, metabolic and coagulation changes can occur intraoperatively requiring aggressive haemodynamic monitoring backed by on-line laboratory facilities. The increased understanding of the pathophysiology of the procedure and the use of dedicated rapid infusion systems and intraoperative blood salvage have helped to improve the intraoperative management of the liver transplant patient. Co-operation and communication between the blood bank, haematology, biochemistry, surgical and anaesthesia services are vital.

Acid-Base Equilibrium↗