Being admitted to hospital
Devinder Rana, Dominic Upton in Psychology for Nurses, 2013
There are many obvious potential threats for the surgical patient: anaesthesia, pain, physical restriction, life-threatening procedures, being away from home, disruption of routines and sleep deprivation, post-operative pain, incapacitation, financial strain, and fear of death and the actual surgery (Egan et al., 1992; Kindler et al., 2000; Stirling, 2006). To some extent each of these contributes a similar amount but Volicer (1977), in an early study of the anxiety levels in surgical patients, found them to be more distressed by the unfamiliarity of their surroundings, loss of independence, the threat of severe illness and, as a consequence, an inability to cope (Michell, 2000). More recent evidence suggests that the lack of predictability and control are significant contributors to the stressful experience of surgical patients (Michell, 2000; Slangen et al., 1993). There is a high proportion of people who experience anxiety prior to surgery and the prevalence has been reported to range from 11 per cent to 80 per cent among adult patient populations (Hollaus et al., 2003; Maranets and Kain, 1999). It is usually the case that we need to be able to predict an event in order to be able to control it: how much is this the case with surgery? What about elective surgery? How does this relate to Mrs Sharma and her experience? Control does not always imply predictability. Such is the case for elective surgery, which accounts for the vast majority of surgical interventions.
Optimizing Patient Safety in Surgery
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Elective surgery also carries risks to patients for adverse outcomes. Each of the complex phases of surgical management (Table 2.1) introduces unique risks for errors with slightly different etiologies. In a recent review, Krizek identified surgical errors and adverse events in 480 (45.8%) of 1047 patients. There were a total of 2138 incidents that included 164 (7.5%) diagnostic errors (of which 5.2% were judged to be serious), 230 (10.5%) errors that occurred during the surgical procedure (17.9% serious), and 693 (29.3%) that occurred during monitoring and daily care (17.1% serious).19 The root causes of these errors involve a combination of surgical competency, technical skill, team performance, communication, and decision-making.20
Cardiac disease
Daryl Dob, Griselda Cooper, Anita Holdcroft, Philip Steer, Gwyneth Lewis in Crises in Childbirth Why Mothers Survive, 2018
For case conferences, the most important issue to be agreed is whether it is preferable for the baby to be born by vaginal delivery or elective Caesarean section. Unfortunately, it is always possible that emergency Caesarean section may be necessary if vaginal delivery is planned. If immediate operative delivery is required, the anaesthetic risk may be considerable and, in order to avoid this difficult situation, elective surgery may be chosen even though this may be of greater risk than vaginal delivery. Faced with such a dilemma, the likelihood of successful spontaneous birth should be balanced against the increased risks of surgery. The risk of intervention is increased if labour is induced, and where possible this should be avoided. However, spontaneous labour is unpredictable, and relevant clinicians may not always be available. The location of delivery should be decided. For labour, the choice lies between the delivery suite and a high-dependency or intensive-care unit. The latter may be preferred if invasive monitoring is to be used, although midwifery and obstetric staff need to be in attendance. If elective Caesarean section is planned, this may be performed on the delivery suite. However, if the high-dependency or intensive-care unit is not in close proximity, the location of surgery may need to be reviewed.
Scar versus shape: patient-reported outcome after different surgical approaches to gynecomastia measured by modified BREAST Q®
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Anna Burger, Amelie Sattler, Lisanne Grünherz, Pietro Giovanoli, Nicole Lindenblatt, Ulrich Michael Rieger
According to literature research, the data on whether smoking is a statistically significant risk factor in breast surgery [17–19] or not [16,20] are controversial. Experimental studies by Ueng et al. showed an impairment of granulation tissue formation due to the vasoconstrictive influence of nicotine [18,21]. Nicotine inhibits capillary blood flow through its direct cutaneous vasoconstrictive effect and indirect release of catecholamines [18,22]. At our institution, patients are, therefore, encouraged to quit tobacco use prior to surgery, ideally at least one month prior to surgery. There is no clear evidence in the literature concerning the ideal time range for quitting smoking prior to surgery. Some studies say 4 week while other studies suggest quitting smoking 2–4 weeks prior to surgery [18,19,22]. At our institution, the surgeon in charge is required to critically question the indications for any elective surgery in every patient and is free to define conditions that must be fulfilled before elective surgery [18].
Anticipating and preventing complications in spinal cord stimulator implantation
Published in Expert Review of Medical Devices, 2023
Steven M. Falowski, Hao Tan, Joseph Parks, Alaa Abd-Elsayed, Ahmed Raslan, Jason Pope
Ensuring successful SCS trial and implantation, and optimal patient outcomes begins prior to surgery. It begins with appropriate patient selection before proceeding with the procedure. NACC has provided selection criteria for candidates seeking pain control with implantation of neuromodulation devices, which the authors endorse as an appropriate starting point in clinical practice [3,4,22]. As with all surgical procedures, there are known modifiable risk factors that can be optimized prior to elective surgery and reduce risk of the above mentioned complications. Optimization of nutritional status, smoking cessation, glycemic control in diabetic patients, pre-operative cardiac clearance in patients with known or at risk for cardiovascular disease, screening for active signs or symptoms of ongoing infection and ensuring the patient has adequately completed treatment prior to surgery, addressing psychological preparedness of the patient, and appropriately holding therapeutic anti-coagulation for an appropriate length of time based on medication half-life after discussion with the managing clinician are a few appropriate clinical measures to mitigate risk of SCS procedure-related complications [8,11]. Patient selection leads to appropriate choice of system. taking into account that certain systems may affect supra-spinal and cortical changes addressing different patient factors [47]. In addition, diagnosis may dictate use of system such as the use of dorsal root ganglion stimulation in phantom limb pain secondary to poor topographic selectivity with SCS in this patient group [22].
Impact of chronic medications in the perioperative period –anesthetic implications (Part II)
Published in Postgraduate Medicine, 2021
Ofelia Loani Elvir-Lazo, Paul F White, Hillenn Cruz Eng, Firuz Yumul, Raissa Chua, Roya Yumul
Since almost half of all patients presenting for elective surgery in the USA are taking prescription medications, over-the-counter medication, herbal (e.g. phytopharmaceuticals), alcohol, nicotine, undisclosed medications on a regular basis, the management of chronic medications during the perioperative period has assumed increasing importance, in particular when caring for high-risk and elderly surgical patients[1]. Physicians must decide whether to continue, reduce the dosage, or discontinue the patient’s chronic medication prior to elective surgery. Management guidelines in the perioperative period varies greatly due to the lack of high-quality outcome data regarding the impact of chronic medications during and after surgery[2]. Patients taking multiple chronic medications, in particular the elderly population (who are typically taking the largest number of chronic medications), and those with diminished organ function are at the highest risk of adverse drug interactions with anesthetics and analgesics during the perioperative period[3].
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