| 1. |
- Björkman Björkelund, Karin, et al.
(författare)
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Factors at admission associated with 4 months outcome in elderly patients with hip fracture.
- 2009
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Ingår i: AANA Journal. - 0094-6354. ; 77:1, s. 49-58
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this descriptive cohort study was to describe patients with hip fracture on the basis of ASA physical status and to identify preoperative risk factors associated with postoperative outcome up to 4 months after surgery. Data were collected prospectively through the Swedish National Hip Fracture and Anesthetic registers and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Risk factors for a poorer 4-month survival after hip fracture were ASA physical status 3 and 4, more extensive fractures, 85 years or older, male sex, and dependency in living. Mortality within 4 months was significantly associated with ASA physical status 3 and 4, age 85 years or older, male sex, dementia diagnosis, fewer than 8 correct answers on the Short Portable Mental Status Questionnaire, 4 or more prescribed drugs, hemoglobin level less than 100 g/L, creatinine level more than 100 micromol/L, dependency in living, inability to walk alone, and fracture other than undisplaced intracapsular. Elderly patients with hip fracture should be identified immediately at admission regarding risk factors leading to a poorer survival and more complications.
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| 2. |
- Björkman Björkelund, Karin, et al.
(författare)
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The influence of perioperative care and treatment on the 4-month outcome in elderly patients with hip fracture.
- 2011
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Ingår i: AANA Journal. - 0094-6354. ; 79:1, s. 51-61
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this descriptive cohort study was to identify perioperative risk factors associated with postoperative outcome up to 4 months after surgery in elderly patients with hip fracture. Data were collected prospectively through the Swedish National Hip Fracture, the local Acute and Emergency, and Anesthesia registers, and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Perioperative risk factors predicting death within 4 months after surgery were fasting time of 12 or more hours and blood transfusion of 1 U or more. Risk factors predicting postoperative confusion were postoperative oxygen saturation less than 90% and fasting time 12 hours or longer. Risk factors predicting in-hospital complications were transfusion of 1 or more units of blood, preoperative oxygen saturation less than 90%, and fasting time 12 hours or more. Risk factor predicting length of stay longer than 10 days was blood transfusion of 1 U or more. To minimize morbidity and mortality, providers should increase efforts to optimize the patients' oxygen saturation and hemoglobin level and reduce fasting time and waiting time for surgery.
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| 3. |
- Enekvist, Bruno, et al.
(författare)
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Pulse perfusion values to predict eye opening after intravenous anesthesia : An explorative study
- 2016
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Ingår i: AANA Journal. - 0094-6354. ; 84:4, s. 255-259
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Tidskriftsartikel (refereegranskat)abstract
- Variables measured in modern pulse oximetry apparatuses include a graphic pulse curve and a specified perfusion value (PV) that could be a sensitive marker for detecting differences in sympathetic activity. We hypothesized that there is a correlation between a reduction of PV and the time to eye opening after anesthesia with propofol-remifentanil. This study includes 29 patients, ASA physical status 1 or 2, scheduled for elective thyroid surgery. Main outcome measures were PV measured by pulse oximetry, heart rate, and noninvasive mean arterial blood pressure recorded before anesthesia, 15 minutes after induction, and at start of surgery, end of surgery, and eye opening at the end of anesthesia. Carbon dioxide (PETCO2) and oxygen inspiratory (FI-PO2) and expiratory (FE-PO2) concentrations were measured at all times except before anesthesia. Results demonstrated that PVs before anesthesia and at eye opening were lower than 15 minutes after induction and at end of surgery (P <.05). The PETCO2 and difference of FI-PETO2 increased at eye opening compared with the end of surgery (P <.05). We conclude that the pulse oximetry PV and the increased PETCO2 could be useful variables to predict timing of recovery in terms of eye opening after intravenous anesthesia.
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| 4. |
- Enekvist, Bruno, et al.
(författare)
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Ventilation with increased apparatus dead space vs positive end-expiratory pressure : Effects on gas exchange and circulation during anesthesia in a randomized clinical study
- 2014
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Ingår i: AANA Journal. - 0094-6354. ; 82:2, s. 114-120
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Tidskriftsartikel (refereegranskat)abstract
- Atelectasis formation can be reduced by positive endexpiratory pressure (PEEP), but resulting increases in intrathoracic pressure could affect circulation. We have earlier demonstrated that increased tidal volumes with larger apparatus dead space improves oxygenation and sevoflurane uptake. In the present study, we hypothesize that isocapnic ventilation with increased tidal volumes increases oxygen and sevoflurane uptake similar to ventilation with PEEP, but with less impact on cardiac output. Thirty patients, with ASA physical status 1 or 2, scheduled for elective open colon surgery were randomly assigned to be ventilated with either PEEP at 10 cm H2O (PEEP, 15 patients) or increased tidal volumes achieved with larger apparatus dead space but with zero end-expiratory pressure (DS group, 15 patients). Oxygen tension and arterial sevoflurane concentration were significantly higher in the DS group (P < .05). Cardiac output decreased significantly less in the DS group compared with the PEEP group (5% and 33%, respectively; P < .05). Consequently, isocapnic ventilation with increased tidal volumes using apparatus dead space increased oxygen and sevoflurane tensions in arterial blood and preserved cardiac output better than did PEEP.
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| 5. |
- Hedberg, Pia, 1972-, et al.
(författare)
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Identification of a Very High Cuff Pressure byManual Palpation of the External Cuff Balloonon an Endotracheal Tube
- 2015
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Ingår i: Journal of american association of nurse anesthtists. - 0094-6354. ; 83:3, s. 179-182
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Tidskriftsartikel (refereegranskat)abstract
- The most common complication due to intubation isa high cuff pressure. A high cuff pressure can causepostanesthetic tracheal mucosal injuries in patientsundergoing surgery. The aim of this cross-sectionalstudy was to describe whether anesthetic nurses andanesthesiologists identified a very high cuff pressureby manual palpation of the external cuff balloon onan endotracheal tube. An airway device was intubatedwith an endotracheal tube cuffed to 95 cm H2O. Eachparticipant palpated the external cuff balloon and thenfilled out a questionnaire, including estimation of thecuff pressure and user frequency of the cuff pressuremanometer. The results showed that 89.1% estimatedthat the cuff pressure was high. Among the participantswho rated the cuff pressure as high, 44.8% ratedthe pressure as quite high and 60.6% rated the pressureas very high. There was no significant relationshipbetween profession and skill in identifying a veryhigh cuff pressure (P = .843) or between work experienceand skill in terms of identifying a very high cuffpressure (P = .816). These findings indicate that 10%of patients are at risk of tracheal erosion because of ahigh cuff pressure.
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| 6. |
- Jaensson, Maria, 1967-, et al.
(författare)
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Risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women : a secondary analysis
- 2012
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Ingår i: AANA: American Association of Nurse Anesthetists. - West Sussex, United Kingdom : American Association of Nurse Anesthesiology. - 0094-6354 .- 2162-5239. ; 80:4, s. S67-S73
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Tidskriftsartikel (refereegranskat)abstract
- Postoperative sore throat and hoarseness are common and disturbing complications following endotracheal intubation, and women are more frequently affected by these symptoms. This study explores risk factors associated with postoperative sore throat and hoarseness in women following intubation.In this prospective cross-sectional study, 97 patients undergoing elective ear, nose, and throat surgery or plastic surgery were included. Eight different variables were analyzed to detect possible associations for the development of postoperative sore throat or hoarseness. For data analysis, the f} test and the odds ratio were used.Three variables were found to be significant risk factors for postoperative sore throat: age greater than 60 years (P = .01), the use of a throat pack (P = .04), and endotracheal tube No. 7.0 (size 7 mm; P = .02). The only risk factor found to be significantly associated with developing hoarseness was an endotracheal cuff pressure below 20 centimeters of water (P = .04). Larger studies are needed to confirm these risk factors.
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| 7. |
- Kollberg, Sandra E., et al.
(författare)
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Accuracy of visually estimated blood loss in surgical sponges by members of the surgical team
- 2019
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Ingår i: AANA Journal. - : American Association of Nurse Anesthetists. - 0094-6354. ; 87:4, s. 277-284
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Tidskriftsartikel (refereegranskat)abstract
- It is important that operating room personnel monitor the correct amount of blood loss during surgery in order to properly replace lost volume. The aim of this study was to investigate the accuracy of operating room personnel in visually estimating blood loss in surgical sponges. We performed an observational study with comparative descriptive design at a university hospital including all members of the surgical team. In total, 163 observations were completed. The participants estimated the amount of blood in surgical sponges in 4 stations with varying amounts of blood and/or numbers of sponges. Data were analyzed using the Wilcoxon signed rank, Kruskal-Wallis, and Mann-Whitney tests. Both overestimations and underestimations occurred. Underestimations dominated and tended to increase with major amounts of blood. Operating room personnel miscalculated the amount of blood by a median value of 30% regardless of profession, years of experience, and self-assessed ability about visual estimation. This study highlights that assessments of patients’ conditions can be partially based on methods often demonstrated to be inaccurate. Inaccurate visual estimation of blood loss might endanger patient safety.
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| 8. |
- Larsson-Mauleon, Annika
(författare)
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Newly graduated nurse anesthetists' experiences and views on anesthesia nursing -- a phenomenographic study
- 2002
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Ingår i: AANA Journal. - Park Ridge, IL, USA : AANA Publishing, Inc.. - 0094-6354. ; 70:4, s. 281-287
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Tidskriftsartikel (refereegranskat)abstract
- This qualitative study identifies and describes different ways in which newly graduated nurse anesthetist (NAs) experience and perceive nurse anesthesia. It explains different approaches to nurse anesthesia care and, thus, to clinical nursing care ( in an anesthesia and surgical context), provided by new NAs. One month after graduation, all NAs who had completed an anesthesia program responded to 4 open-ended questions. A phenomnographic method was used to analyze their responses. The results were divided into 3 categories, which describe nurse anesthesia from the perspectives of (1) maintaining physical well-being; (2) being protectors and advocates; and (3) ability to perform good nurse anesthesia given all the demands placed on the NAs. The results indicate that, for new NAs, the nurse anesthesia care situation was largely influenced by context and generated feelings of inadequacy because the NAs could not provide the emotional support that they believed their patients required.
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| 9. |
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| 10. |
- Warrén-Stomberg, Margareta, et al.
(författare)
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Assessing Pain Responses During General Anesthesia
- 2001
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Ingår i: AANA Journal. - : American Association of Nurse Anesthetists. - 0094-6354. ; 69:3, s. 218-222
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Tidskriftsartikel (refereegranskat)abstract
- Major technical and pharmacological achievements in recent years have greatly influenced the practice of anesthesia. Clinical signs related to the main aspects of anesthesia, i.e., hypnosis, analgesia, and muscular relaxation, are increasingly obtainable from variables supplied by the monitoring equipment. It is not known, however, to what extent more indirect, patient-associated clinical signs of pain/depth of anesthesia are still considered of importance and relied on in the intraoperative management of surgical patients. The aims of the present study were to assess what clinical signs, indirect as well as monitor-derived, are considered indicative of intraoperative pain or depth of anesthesia by nurse anesthetists during general anesthesia. In connection with anesthetic management of surgical patients, Swedish nurse anesthetists (N = 40) were interviewed about clinical signs that they routinely assessed and were asked if the observed signs were considered indicative mainly of intraoperative pain or depth of anesthesia. It was found that skin-associated responses (temperature, color, moisture/stickiness) were commonly considered to indicate intraoperative pain rather than depth of anesthesia. Respiratory movements, eye reactions, and circulatory responses were considered to be indicative of either pain or insufficient depth of anesthesia. The present data indicate that indirect physiological signs are still considered of major importance by anesthesia nurses during the anesthetic management of surgical patients.
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