The Ochsner journal
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The Ochsner journal · Jan 2013
Importance of vigilant monitoring after continuous nerve block: lessons from a case report.
Continuous peripheral nerve block achieves good pain control. However, uncontrolled pain despite an effective block in the target areas of the nerve can be an early sign of ischemia. We report a case of iatrogenic injury to the axillary artery during shoulder surgery in a patient who had continuous supraclavicular block and demonstrate how vigilant monitoring helped the diagnosis and resulted in timely management of upper limb ischemia. ⋯ Iatrogenic injuries to vessels or nerves sometimes occur during orthopedic surgical procedures. Regional anesthesia can mask and delay the onset of these symptoms. Postoperative monitoring and the ability to differentiate between the effects of local anesthetics and the body's response to ischemia are important for avoiding postoperative complications. This case report aims to improve awareness about the need for vigilant monitoring of the distal pulses after peripheral nerve blocks.
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The Ochsner journal · Jan 2013
Implementation of a surgical safety checklist: impact on surgical team perspectives.
The World Health Organization (WHO) surgical safety checklist has been shown to decrease mortality and complications and has been adopted worldwide. However, system flaws and human errors persist. Identifying provider perspectives of patient safety initiatives may identify strategies for improvement. The purpose of this study was to determine provider perspectives of surgical safety checklist implementation in an effort to improve initiatives that enhance surgical patients' safety. ⋯ Implementation of a surgical safety checklist improves perceptions of surgical safety. Barriers to implementation exist, but staff feedback may be used to enhance the sustainability and success of patient safety initiatives.
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The Ochsner journal · Jan 2013
ReviewAnesthetic considerations in robotic-assisted gynecologic surgery.
Robotic-assisted surgery has evolved over the past 2 decades with constantly improving technology that assists surgeons in multiple subspecialty disciplines. The surgical requirements of lithotomy and steep Trendelenburg positions, along with the creation of a pneumoperitoneum and lack of direct access to the patient all present management challenges in gynecologic surgery. Patient positioning requirements can have significant physiologic effects and can result in many complications. ⋯ Good communication among team members and knowledge of the nuances of robotic surgery have the potential to improve patient outcomes, increase efficiency, and reduce complications.
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The Ochsner journal · Jan 2013
Patient Preferences for Doctor Attire: The White Coat's Place in the Medical Profession.
The white coat's place in the medical profession is a heavily debated topic. Five years after the bare-below-the-elbow policy took effect in England, we reexamined the evidence about coats' potential to transmit infection, reviewed previous studies, and explored our patients' opinions on doctor attire. ⋯ These findings suggest patients prefer white coats, and they contribute to greater comfort and confidence in their physicians, despite knowledge of theoretic concerns of disease transmission.