ANZ journal of surgery
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ANZ journal of surgery · Jul 2014
ReviewDo medical procedures in the arm increase the risk of lymphoedema after axillary surgery? A review.
Lymphoedema of the arm is a potentially serious consequence of any axillary procedure performed during the management of breast cancer. In an attempt to reduce its incidence and severity, patients are instructed to avoid venepunctures and blood pressure measurements on the treated arm. These precautions are not possible in some patients and attempts to adhere to them can cause discomfort, anxiety and stress for both patients and their health-care workers. ⋯ With this evidence generally being anecdotal in nature, there appears to be no rigorous evidence-based support for the risk-reduction behaviours of avoiding blood pressure monitoring and venepuncture in the affected arm in the prevention of lymphoedema after axillary procedure. A clinical trial was proposed to investigate whether such avoidance measures were valuable, but failed during its inception. There remains a need for research from prospective trials on this controversial topic to determine the most appropriate patient recommendations that should be provided after axillary procedure regarding the risks for development of lymphoedema.
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ANZ journal of surgery · Jul 2014
ReviewMultidisciplinary team simulation for the operating theatre: a review of the literature.
Analyses of adverse events inside the operating theatre has demonstrated that many errors are caused by failure in non-technical skills and teamwork. While simulation has been used successfully for teaching and improving technical skills, more recently, multidisciplinary simulation has been used for training team skills. We hypothesized that this type of training is feasible and improves team skills in the operating theatre. ⋯ Multidisciplinary operating room team simulation is feasible and widely accepted by participants. More studies are required to assess the impact of this type of training on operative performance and patient safety.
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ANZ journal of surgery · Jul 2014
Perioperative hypothermia in patients undergoing major colorectal surgery.
Perioperative hypothermia occurs frequently and can have serious health-related and financial consequences. Despite multiple warming methods available, perioperative hypothermia remains prevalent. To be effective, preventative measures must be timely and target patients most at risk. The aim of this retrospective review was to document the incidence and patterns of hypothermia in patients undergoing major colorectal surgery. ⋯ Mild hypothermia in patients undergoing major colorectal surgery is common, despite preventative measures. Core temperatures prior to commencement of the operation should be optimized with both active and passive warming measures, particularly for older patients and those arriving with lower core temperatures. Elective patients should also have their temperatures monitored as closely, if not more closely, than emergency patients. Preventing early declining trends in core temperature may positively influence later perioperative temperatures and improve outcomes.
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ANZ journal of surgery · Jul 2014
Are Australian and New Zealand trauma service resources reflective of the Australasian Trauma Verification Model Resource Criteria?
The Australasian Trauma Verification Program was developed in 2000 to improve the quality of care provided at services in Australia and New Zealand. The programme outlines resources required for differing levels of trauma services. This study compares the human resources in Australia and New Zealand trauma services with those recommended by the Australasian College of Surgeons Trauma Verification Program. ⋯ Human resources in Australian and NZ trauma services are not reflective of those recommended by the Australasian Trauma Verification Program. This impacts on the ability to coordinate trauma monitoring and performance improvement. Review of the Australasian Trauma Verification Model Resource Criteria is required. Injury surveillance in Australia and NZ is hampered by insufficient trauma registry resources.
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ANZ journal of surgery · Jul 2014
Factors related to post-operative metabolic acidosis following major abdominal surgery.
Metabolic acidosis is frequently observed in perioperative patients, especially those who undergo major surgery. The aim of this study was to evaluate the factors related to post-operative metabolic acidosis and to attempt to identify the clinical effect of metabolic acidosis following major abdominal surgery. ⋯ Post-operative metabolic acidosis following major abdominal surgery was closely related to both hyperchloremic acidosis associated with large saline infusion and lactic acidosis caused by lactataemia.