Chapter 10 Moving Surgery out of the Main Operating Room with Evidence-Based Field Sterility

2022 ◽  
2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Somchai Amornyotin ◽  
Prapun Aanpreung

Objectives. To review our sedation practice and to evaluate the clinical effectiveness of an anesthesiologist-administered intravenous sedation outside of the main operating room for pediatric upper gastrointestinal endoscopy (UGIE) in Thailand.Subjects and Methods. We undertook a retrospective review of the sedation service records of pediatric patients who underwent UGIE. All endoscopies were performed by a pediatric gastroenterologist. All sedation was administered by staff anesthesiologist or anesthetic personnel.Results. A total of 168 patients (94 boys and 74 girls), with age from 4 months to 12 years, underwent 176 UGIE procedures. Of these, 142 UGIE procedures were performed with intravenous sedation (IVS). The mean sedation time was minutes. Propofol was the most common sedative drugs used. Mean dose of propofol, midazolam and fentanyl was  mg/kg/hr,  mg/kg/hr, and  mcg/kg/hr, respectively. Complications relatively occurred frequently. All sedations were successful. However, two patients became more deeply than intended and required unplanned endotracheal intubation.Conclusion. The study shows the clinical effectiveness of an anesthesiologist-administered IVS outside of the main operating room for pediatric UGIE in Thailand. All complications are relatively high. We recommend the use of more sensitive equipments such as end tidal and carefully select more appropriate patients.


Author(s):  
Alex Macario ◽  
Deepak Sharma

What does a manager need to think about when scheduling cases requiring anesthesia outside the operating room (OOOR)? This chapter aims to answer that question by discussing some key strategic points that can facilitate a more efficient workday. The concepts of block scheduling and utilization apply in the OOOR setting as they do in the operating room, but there are added challenges given the increased physical distance to the main operating room suite. These challenges will be identified and recommendations will be provided on how to evaluate and improve OOOR efficiency. With more procedures being done OOOR, it is important for anesthesia groups to be mindful of these challenges and position themselves appropriately.


2019 ◽  
Vol 7 (7) ◽  
pp. e2298 ◽  
Author(s):  
Anna K. Steve ◽  
Christaan H. Schrag ◽  
Alice Kuo ◽  
A. Robertston Harrop

Author(s):  
James P. Hovis ◽  
Stephanie N. Moore-Lotridge ◽  
Ashton Mansour ◽  
Breanne H.Y. Gibson ◽  
Douglas R. Weikert ◽  
...  

AbstractPrevious studies have demonstrated that sterile equipment is frequently contaminated intraoperatively, yet the incidence of miniature c-arm (MCA) contamination in hand and upper extremity surgery is unclear. To examine this incidence, a prospective study of MCA sterility in hand and upper extremity cases was performed in a hospital main operating room (MOR) (n = 13) or an ambulatory surgery center operating room (AOR) (n = 16) at a single tertiary care center. Case length, MCA usage parameters, and sterility of the MCA through the case were examined. We found that MOR surgical times trended toward significance (p = 0.055) and that MOR MCAs had significantly more contamination prior to draping than AOR MCAs (p < 0.001). In MORs and AORs, 46.2 and 37.5% of MCAs respectively were contaminated intraoperatively. In MORs and AORs, 85.7 and 80% of noncontaminated cases, respectively, used the above hand-table technique, while 50 and 83.3% of contaminated MOR and AOR cases, respectively, used a below hand-table technique. Similar CPT codes were noted in both settings. Thus, a high-rate of MCA intraoperative contamination occurs in both settings. MCA placement below the hand-table may impact intraoperative contamination, even to distant MCA areas. Regular sterilization of equipment and awareness of these possible risk factors could lower bacterial burden.


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