The Surgical clinics of North America
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Surg. Clin. North Am. · Dec 2005
Review Comparative StudyPatient safety practices in the operating room: correct-site surgery and nothing left behind.
Not until the late 1990s, after the publication of the National Academy of Medicine's treatise "To Err Is Human," did safety standards specifically for patients begin to be considered in operating room practices. This report and other studies documented operating room mistakes including, for example, operations on the wrong hand or limb, operations on the wrong patient, and the performance of wrong procedures. ⋯ Poor communication is the most common root cause of errors. This article explores these issues and explains procedures and protocols developed to reduce surgical errors.
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Reactions to latex rubber products are a growing problem. The danger of latex allergy has been noted for many years, but it has gained significantly more attention since the institution of so-called"universal precautions" following the identification of AIDS and other transmitted viral diseases. Recognition of the various latex reactions ranging from contact dermatitis to true latex allergy is required to prevent unnecessary morbidity and mortality among health-care workers and patients. Several approaches to the problem of latex allergy are reviewed and guidelines for minimizing exposure are recommended.
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Despite many medical advances, the incidence of postoperative nausea and vomiting (PONV) and postdischarge nausea and vomit-ing (PDNV) remains high. Sequelae such as dehydration, wound dehiscence, bleeding and others, contributed to increased healthcare costs and patient dissatisfaction. This article reviews the literature regarding the anatomy of emesis, the predictors of PONV and various treatments.
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Surg. Clin. North Am. · Dec 2005
Review Comparative StudyPerioperative pain control: a strategy for management.
A thorough understanding of the anatomy and neurophysiology of the pain response is necessary for the effective treatment of perioperative pain. This article describes the mechanisms that produce pain,including those related to inflammation. Other topics include the pharmacologies of nonopioid and opioid analgesics. ⋯ The pharmacology of local anesthesia is discussed. The six major adverse reactions to local anesthetics are cardiac arrhythmias, hypertension, direct tissue toxicity, central nervous system toxicity, methemoglobinemia and allergic reactions. Methods for measuring pain are described.
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Surg. Clin. North Am. · Dec 2005
Review Comparative StudyStandardization of perioperative management: clinical pathways.
Many initiatives have been introduced in the past decades to standardize and improve clinical perioperative care and thereby improve patient care. Clinical pathways (also known as integrated care pathways, critical pathways, critical paths, care paths) are structured multidisciplinary care plans that detail essential steps in the care of patients with a specific clinical problem. They are designed to support the implementation and translation of national guidelines into local protocols and their subsequent application to clinical practice. In surgery, clinical pathways are standardized protocols for the management of patients who have common conditions undergoing common surgical procedures.