Postoperative recovery process following laparoscopic cholecystectomy depends on many factors such as pain, fatigue and exhaustion. The objective of this study was to investigate whether the administration of dexamethasone, a glucocorticoid, has positive effects of postoperative patient comfort in patients who underwent laparoscopic cholecystectomy in our clinic. MethodsPatients who presented to the general surgery clinic of our hospital and scheduled for laparoscopic cholecystectomy due to cholelithiasis were included in this study. Patients in Group 1 received dexamethasone 90 minutes before the skin incision, while patients in Group 2 were given placebo (normal saline). Pain scores, presence of nausea and vomiting in the postoperative period were compared between the study and control groups. ResultsNo statistically significant difference was observed between the groups in terms of incisional pain at rest and in motion and visceral pain at rest at postoperative 6th, 12th and 24th hours. Although there was a difference between the groups in terms of visceral pain in motion at the postoperative 12th and 24th hours, this was not statistically significant (p > 0.05). Although the need for additional analgesics and antiemetic drugs was lower in the study group compared to the control group, the difference between the groups was not statistically significant (p > 0.05). ConclusionWe can expect better results with the use of multimodal analgesic and anti-emetic combination instead of a single agent in studies to be performed about the prevention of postoperative pain, nausea and vomiting.
Introduction: Percutaneous endoscopic gastrostomy (PEG) is regarded as the standard enteral feeding procedure for patients requiring long-term enteral nutrition. Although it is considered as a safe procedure, PEG may be associated with severe cardiorespiratory complications, especially in patients with sedation-induced respiratory compromise. This article is a retrospective analysis of 49 patients at high-risk of complications, who undergone unsedated peroral PEG tube placement.Materials and Methods: PEG was placed in 49 patients through the peroral endoscopic way without sedation. The patients were given pharyngeal anesthesia and the PEG tubes were inserted using the 'pull ' technique. The comorbidities, PEG indications, pharyngeal anesthesia indications, arterial oxygen saturations throughout the procedure, the comfort and the tolerability score and complications were recorded.Results: Of all patients 27 (55.1%) were female and 22 (44.9%) were male. The mean age of the patients was 81 (range: 33-99) years. PEG procedure was performed due to the loss of swallowing reflex and dysphagia in 24 (48.9%), replacement of the previously inserted PEG tube in 11 (22.5%), malnutrition in 9 (18.3%) and nasogastric tube intolerance in 5 (10.2%) patients. Unsedated procedure was performed due to aspiration pneumonia in 21 (42.8%), chronic pulmonary disease in 10 (20.4%), request from patient relatives in 15 (30.6%), and on patient's own request in 3 (6.1%). Modified Gloucester Comfort Scale was used to evaluate the comfort and the tolerability of the patients. According to the scale, 24.4% of the patients showed no signs of discomfort, 42.8% showed mild signs of discomfort yet well tolerated the procedure. Only 8.1% showed significant discomfort. As complications, tube dislodgement was observed in 3 patients and wound infections were recorded in 4 patients. Conclusion:PEG placement using a peroral route without sedation is a safe and well-tolerated method in patients with high sedation risk.
This study aimed to evaluate intraoperative interruptions by frequency, type, interference and source, and preventive measures. The interruptions in the operating theatre were evaluated for 52 surgical procedures based on real-time recordings and divided into routine operative procedures (ROP, n = 26, without intervention) and intervened operative procedures (IOP, n = 26, observed after team brief and placement of a warning sign for unnecessary door openings) groups. Intervened operative procedures vs. routine operative procedures was associated with a significantly lower number of interruptions (p = 0.014). Implementation of preventive measures was associated with a significantly lower number of entrances and exits (p = 0.001) and equipment issues (p = 0.003), interruptions that affected the circulating nurse or anaesthesia technician/associate (p = 0.003) and those caused by team members other than assisting surgeon and scrub nurse (p-value ranged from 0.015 to 0.009). Our findings revealed significantly reduced interruptions after a simple preventive measure including team brief and the placement of a warning sign for unnecessary door openings.
Rationale, aims and objectives: This study was designed to evaluate intraoperative case irrelevant communications (CICs) by content, initiator, recipient and interference via a real-time operative room analysis Method: The CICs in the operative room across a purposive sample of 52 surgical procedures were evaluated as recorded by a tripod-capable camera in the operative room in this prospective observational study. The CICs were evaluated by initiator, recipient and interference. Results: Overall
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