Perioperative Management in Parturient with Severe Preeclampsia, Obesity, and COVID-19

<p>The elevated cases of pregnant women infected with COVID-19 who needed to undergo caesarean section is a great challenge to anesthesiologists. Morbid obesity and preeclampsia in pregnancy are also another challenge to medical practice especially when the patient requires caesarean section. To describe the perioperative management of a morbidly obese preeclamptic patient with COVID-19. A pregnant woman with mild case of COVID-19, severe preeclampsia and obesity underwent an emergency caesarean section. Spinal anesthesia was performed using a Whitacre 26G spinal needle with 76 mm length, bupivacaine 0.5% 12.5 mg as spinal anesthesia agent and fentanyl 25 mcg as adjuvant. All operating teams use PPE according to COVID-19 guidelines and standard procedures. The operation went with a good outcome without any transmission to the operating team. The patient underwent treatment without postoperative complications. Spinal anesthesia is considered safe to be a usual technique for parturient with preeclampsia and morbid obesity. A proper COVID-19 surgery protocol is crucial in order to protect health workers handling COVID-19 patients.</p>

Time Consumption and Productivity in Wood Extraction Using Traditional Cable Car

Forests are a very important component for the environment in Albania considering the fact that they occupy more than 36% of the country's surface. The evaluation of the working time consumption and productivity of the various sub-phases of wood extraction work, in a beech forest in Albania, with traditional methods and old equipment’s, was considered of interest in this study to highlight the weaknesses to be corrected. Considering the slope in our study site, a traditional cable car Austrian Type R-Gander (A 6832 SULZ) manufactured in 1985 was used for the extraction of timber. Trunks from a distance of 800 - 900 m were extracted using this equipment. The operating team consisted of 3 workers. 10 - 15 working days are required for the assembly and disassembly of the equipment. During the work performed, data regarding working times were collected, paying special attention to dead times, where avoidable times are high 61,0 %. The extracted volume was 31.46 m3, which corresponds to a weight of 41.82 t.

Protocol of perioperative and post-exposure antimicrobial prophylaxis in Morozovskaya Children City Clinical Hospital of Moscow Healthcare Department

In order to improve the clinical use of antibiotics in surgical departments of Morozovskaya Children City Clinical Hospital of Moscow Healthcare Department authors prepared, discussed and agreed upon a protocol for perioperative and post-exposure antimicrobial prophylaxis. The choice of antibiotics for systemic use was made according to the Antimicrobial Stewardship Program (ASP) stratification both for patients of type I (community-acquired infection without risk for shedding of polyresistant infectious agents) and type II (community-acquired infections with risk factors for shedding of polyresistant infectious agents). Study determined indications for post-exposure antimicrobial prophylaxis within the approved protocol. Following that the Chief Physician issued an Order On Division of Responsibility of all Members of the Operating Team and On Approval of the Protocol for Conducting Perioperative and Post-Exposure Antimicrobial Prophylaxis. As a result of the implementation of the protocol, by the end of 2020 clinical use of antibiotics in surgical departments has improved.

Aerosols, airflow, and airspace contamination during laparoscopy

Lay summary Laparoscopic surgery has been undermined throughout the COVID-19 pandemic by concerns that it may generate an infectious risk to the operating team through aerosolization of peritoneal particles. There is anyway a need for increased awareness and understanding of the occupational hazard for surgical teams regarding unfiltered escape of pollutants generated by surgical smoke and other microbials. Here, the aerosol-generating nature of this access modality was confirmed through repeatable real-time methodology both qualitatively and quantitively to inform best practice and additional engineering solutions to optimize the operating room environment.

Teaching and learning robotic surgery at the dual console: a video-based qualitative analysis

Robotic-assisted surgery (RAS) involves training processes and challenges that differ from open or laparoscopic surgery, particularly regarding the possibilities of observation and embodied guidance. The video recording and the dual-console system creates a potential opportunity for participation. Our research, conducted within the department of visceral surgery of a big Swiss, public, academic hospital, uses a methodology based on the co-analysis of video recordings with surgeons in self-confrontation interviews, to investigate the teaching activity of the lead surgeon supervising a surgeon in training at the dual console. Three short sequences have been selected for the paper. Our analysis highlights the skills-in-construction of the surgeon in training regarding communication with the operating team, fluency of working with three hands, and awareness of the whole operating site. It also shows the divergent necessities of enabling verbalization for professional training, while ensuring a quiet and efficient environment for medical performance. To balance these requirements, we argue that dedicated briefing and debriefing sessions may be particularly effective; we also suggest that the self-confrontation video technique may be valuable to support the verbalization on both the mentor’s and the trainee’s side during such debriefing, and to enhance the mentor’s reflexivity regarding didactic choices.

Timeout procedure in paediatric surgery: effective tool or lip service? A randomised prospective observational study

BackgroundFor over a decade, the preoperative timeout procedure has been implemented in most paediatric surgery units. However, the impact of this intervention has not been systematically studied. This study evaluates whether purposefully introduced errors during the timeout routine are detected and reported by the operating team members.MethodsAfter ethics board approval and informed consent, deliberate errors were randomly and clandestinely introduced into the timeout routine for elective surgical procedures by a paediatric surgery attending. Errors were randomly selected among wrong name, site, side, allergy, intervention, birthdate and gender items. The main outcome measure was how frequent an error was reported by the team and by whom.ResultsOver the course of 16 months, 1800 operations and timeouts were performed. Errors were randomly introduced in 120 cases (6.7%). Overall, 54% of the errors were reported; the remainder went unnoticed. Errors were pointed out most frequently by anaesthesiologists (64%), followed by nursing staff (28%), residents-in-training (6%) and medical students (1%).ConclusionErrors in the timeout routine go unnoticed by the team in almost half of cases. Therefore, even if preoperative timeout routines are strictly implemented, mistakes may be overlooked. Hence, the timeout procedure in its current form appears unreliable. Future developments may be useful to improve the quality of the surgical timeout and should be studied in detail.

Influence of music on work performance during joint replacement surgery, attitudes of surgical team members

Progress is constantly being made in almost all areas of life, including medicine. For this reason, various measures are being introdu-ced to make any work done more efficient, easier, more productive. Music can be used in medicine, especially in the operating room, as its effect on the members of the operating team is extremely positive. And while this is acknowledged, there is not much research on this topic – the impact of music on members of the operating team.Object – is the influence of music on work performance during joint replacement, from the point of view of surgical team members.Problem – is whether music during endoprosthesis surgery can increase the productivity of surgical team members?Aim – to analyze the influence of music on the performance of work during endoprosthesis operations, from the point of view of the members of the operating team – was aimed at implementing the research objectives:1) to review the peculiarities of joint endoprosthesis operations; 2) to reveal the influence of music on work in the operating room from the point of view of team members;3) to study the influence of music on the quality of work during joint arthroplasty.Methods: The method of questionnaire survey was chosen to study the attitude of the members of the operating team to the influence of music on the work productivity in the operating room. The questionnaire is considered to be the most appropriate method for explaining people’s opinions and behavior, and it is based on reliability.This was related to the aims of this study - to analyze the impact of music on performance during endoprosthesis operations. The study was conducted by submitting questionnaires to 100 members of the operating team (surgeon-operator, anesthesiologist, resuscitator, anesthesiologist, resident, anesthesia and intensive care nurse, operating nurse, and operating assistant) working in health care facilities. It should be noted that during the data collection, the members of the operational team filled in the questionnaires remotely - links to the online uploaded questionnaire were sent to each respondent. This method of conducting the study was chosen due to the current situation in Lithuania - the COVID-19 pande-mic.Results of the study. The study revealed that joint replacement surgery is seen as a complicated procedure, which is complicated by team changes, because it often increases tension, affects everyone’s joint work, feels general discomfort, becomes more difficult to concentrate, increa-ses the likelihood of errors. In order to make teamwork smoother, attention should be paid to the organization of work, the fostering of interperso-nal relationships, the assessment of one’s own characteristics and peculiarities of communication, and the stronger fostering of the work envi-ronment. Music can be an effective and valuable tool for making a positive impact on operational team members. Music can help reduce anxiety, encourage relaxation, suppress the response to stressful situations, and increase the effectiveness of actions. It is very important that the music is selected in the right genre to suit the members of the operating team.

Patient safety in the operating theatre

Introduction Patient safety in the operating theatre depends on the multi-track activities of the entire medical team. Guaranteeing total patient safety will allow the patient to meet his expectations, will be a source of satisfaction for the whole team, which provides care and treatment, and helps avoid legal consequences. Aim The aim of the study was to investigate which factors, according to the operating team, guarantee patient safety in the time period from the admission to the operating theatre until the transfer to the specialist ward. Material and methods The diagnostic survey method and analysis of literature were used. A propriety questionnaire created by the authors was used in order to verify the hypotheses. Results and Conclusions There were no significant correlations between age, level of education and length of service and the assessment of the impact of other activities on patient’s safety in the operating theatre. Gender and workplace did not significantly influence the evaluation of the significance of other analysed factors. The profession did not significantly differ in the evaluation of the analysed factors for the patient safety in an operating theatre. Compliance with standards and procedures before, during and after the procedure guarantees patient safety in the operating theater to a large extent in the respondents’ opinion.

The timeout procedure in pediatric surgery - effective tool or lip service? A randomized prospective observational study

ABSTRACTBackgroundFor over a decade, the preoperative timeout procedure has been implemented in most pediatric surgery units. In our hospital, a standardized team-timeout is performed before every operation. However, the impact of this intervention has not been systematically studied.PurposeThis study evaluates whether purposefully-introduced errors during the timeout routine are picked up by the operating team members.MethodsAfter ethics board approval and informed consent, deliberate errors were randomly and clandestinely introduced into the timeout routine for elective surgical procedures by a pediatric surgery attending. Errors were randomly selected among wrong name, site, side, allergy, intervention, birthdate, and gender items. The main outcome measure was how frequent an error was picked up by the team, and by whom.ResultsOver the course of 16 months, 1800 operations and timeouts were performed. Errors were randomly introduced in 120 cases (6.7%). Overall, 54% of the errors were picked up, the remainder went unnoticed. Errors were picked up most frequently by an anesthesiologists (64%), followed by nursing staff (28%), residents-in-training (6%) and medical students (1%).ConclusionsErrors in the timeout routine go unnoticed by the team in almost half of cases. Therefore, even if preoperative timeout routines are strictly implemented, mistakes may be overlooked. Hence, the timeout procedure in its current form appears unreliable. Future developments may be useful to improve the quality of the surgical timeout and should be studied in detail.