The Total Intra Venous Anesthesia Effect Versus Volatile Anesthesia, on Stress and Pain Levels, in Patients Undergoing Breast Reconstruction in Ambulatory Surgery Center Total Intra Venous Anesthesia Protocol and Stress Response

AIM

To compare pain and stress response through cortisol and DHEA levels, implementing. Total intra venous anesthesia (TIVA) versus general anesthesia with volatile anesthetics (VOL).

DESIGN

This is a prospective randomized correlation study with consecutive measurements.

METHODS

In an ambulatory surgical center from October of 2019 to August of 2020, patients who underwent breast reconstruction with autologous fat grafting were randomized into 2 groups. Patients in the TIVA group (n = 23) received intravenous anesthesia and those in the VOL group (n = 23) received volatile anesthesia (desflurane). Demographic, anthropometric and clinical data were recorded. Arterial systolic (SP) and diastolic (DP) blood pressure, heart rate and oxygen saturation were recorded. Pain and stress levels were evaluated through salivary cortisol and DHEA levels at 4 different time points: T0) 1 hour before induction, T1) during the induction, T2) during anesthesia maintenance, and T3) in recovery phase. Statistical analysis was performed with SPSS 25.0 at significant level α = .05.

FINDINGS

There were no statistically significant differences between the 2 groups regarding demographic features. Interestingly that there was a statistically significant difference in the vital sign monitoring where patients in the TIVA group reported with higher levels of SP(T2) and DP (T2), whilst DHEA (T1) levels was correlated positively with patient's age and cortisol (T1) levels and negatively with DP (T3).

CONCLUSIONS

This study supports the use of TIVA as a safe and effective option for anesthesia in patients undergoing breast reconstruction with autologous fat grafting.

Adaptation and Validation of Diabetes Knowledge Questionnaire (DKQ- 24 item) within Greek Population

Background: The Michigan Diabetes Research and Training Centre develop, during the 80s, the Diabetes Knowledge Questionnaire in order to determine the level of diabetes knowledge. Providing insights both to researchers and health professionals as an aid to intervening and improving diabetes self-management. Aim: The aim of this study was to translate, adapt and validate the Diabetes Knowledge Questionnaire (DKQ) to Greek Language. Method and Material: The 24-item DKQ was administrated to a preselected sample of 40 patients with type 2 diabetes. The validation study was conducted from February to March 2020, in the diabetes clinic of a major Greek general hospital. The questionnaire was transcribed in Greek using “forward–backward” translation by two independent translators. Individuals’ demographic data were recorded. The data is expressed as mean ± SD, in significant level 0.05. Results: DKQ Cronbach’s alpha had an adequate value. The intraclass correlation coefficient for average measures was significant, based on the 95% confident interval. Gender, profession and educational level did not correlate with the total score of the DKQ, individual’s age though was correlated. Conclusions: The Greek version of the DKQ is a reliable and credible instrument for assessing the level of diabetes knowledge in Greece.

Implementation of lean management/Six Sigma in patients’ perioperative care

Aim: During healthcare management in hospitals, many unforeseen events can affect patient's surgical safety and experience, causing discomfort both him and his family, simultaneously wasting surgery resources and reducing its efficiency.Healthcare professionals in every hospital should consider perioperative care of patient as an important issue and its systematic improvement should be required. The aim of this review was to highlight the Lean Management and Six Sigma methods in patients’ perioperative care. Material-Method: A systematic review was conducted in the electronic databases Medline / Pubmed,Scopus, Embase and Cochrane Library from 2015 to 2020. The keywords were lean management, six sigma, lean / six sigma surgery, lean / six sigma perioperative care. The inclusion criteria were studies directly related to the subject in English, published in peer-reviewed journals. Results: The search strategy was applied to 896 studies, 889 of which were excluded and 7 of which met the inclusion criteria.Lean and Six Sigma methodologies increased the efficiency of the operating room staff, as well as the financial performance of the entire operating unit. Process mapping, leadership, and staff satisfaction are keys to enhancepatient’s safety. Conclusions: The implementation of Lean / Six Sigma in health services has great potential. It is proposed the institutional adoption of this methodology, with additional research of its practical, educational and financial benefits after wide implementation.

Effects of the Enhanced Recovery Program on the Recovery and Stress Response in Patients With Cancer Undergoing Pancreatoduodenectomy

Aim the study was the comparison of enhanced recovery after surgery (ERAS) versus conventional care (CON) protocols in patients undergoing pancreatoduodenectomy with regard to pain intensity, emotional response (optimism/sadness/stress), and stress biomarker levels (adrenocorticotropopic hormone, cortisol). We conducted a prospective two-group randomized controlled study with repeated measures in 85 patients with cancer pancreatoduodenectomy. In the ERAS group (N = 44), the ERAS protocol was followed, compared with the CON group (N = 41). We assessed pain with the numeric rating scale and a behavioral scale (Critical Care Pain Observation Tool), emotional responses (numeric rating scale), and serum adrenocorticotropopic hormone and cortisol levels at three time points: T1, admission day; T2, day of surgery; and T3, discharge day (ERAS) or the fifth day of stay (CON). Data were analyzed by linear mixed modeling to account for repeated measurements. We observed decreased postoperative pain in ERAS patients after adjusting for confounders (p = .002) and a trend for less complications. No significant associations with stress/emotional responses were noted. Only age, but not protocol, appeared to have a significant effect on adrenocorticotropopic hormone levels despite a significant interaction with time toward increased adrenocorticotropopic hormone levels in the ERAS group. In conclusion, despite its fast track nature, ERAS is not associated with increased stress in patients undergoing pancreatoduodenectomy and is associated with decreased pain.

The 1st Hellenic Conference of Perianeshtesia Care

Pandemic Covid-19 had a major impact on PeriAnesthesia Nurses worldwide. PACU Nurses had to deal with unfamiliar conditions. In Greece, this pandemic has highlighted the importance of PeriAnesthesia Nursing in all areas, such as Intensive Care Units, Emergency Rooms and Clinics. Major intention of the Hellenic PeriAnesthesia Nursing Organization through this conference is to strengthen its members continuing education and the promotion of PeriAnesthesia Nursing, as well as Perioperative Nursing in Emergency Room and Intensive Care Unit. Organizing the 1st Hellenic Conference of PeriAnesthesia Care in 2021 will boost Nurses participation, contribution and development in this very important scientific fields, such as: • Ethical dilemmas in Perianesthesiology Nursing • Pre-hospital Anesthesia • Cardiopulmonary Resuscitation • Vascular access • Management of acute and chronic pain • Minimally Invasive Surgery and postoperative pain management Clinical Scenarios and roundtables with international participation will provide information and knowledge in various topic, as well as sessions with experts in the field of PeriAnesthesia Nursing will give the opportunity to advance and generate interaction between the speakers and the delegates.

Evaluating Preoperative Anxiety Levels in Patients Undergoing Breast Cancer Surgery

OBJECTIVE

Patients' anxiety and stress levels are increased after the surgery. High levels of anxiety and stress could increase postoperative complications, as well as to prolong postoperative hospitalization and postoperative morbidity. This prospective, cross-sectional study was to evaluate the preoperative stress levels in patients undergoing breast cancer surgery.

METHODS

In the study participated 165 female patients who underwent breast cancer surgery, in a major oncological hospital in Greece. Demographic and clinical data were collected, and anxiety and stress levels assessed using the State-Trait Anxiety Inventory (STAI) Scale, which was a self-report questionnaire consisting of 40, 4 Likert Scale questions. The first 20 questions, STAI-X-1, were concerned to how the patient felt while answering the questionnaire (anxiety as a condition) and the remaining 20 questions, STAI-X-2, based on how the patient felt overall (stress as a personality trait). Descriptive statistics and nonparametric tests were performed at a significance level alpha = 0.05.

RESULTS

In the present study, 165 females were enrolled who underwent breast cancer surgery. The mean age of the participants was 55.86 years, whereas the mean body mass index was 26.85. The 60.6% of patients underwent a lumpectomy and 28.5% had mastectomy. The 35.8% experienced moderate levels of anxiety, and the 17.6% experienced high levels. The two scales were positively correlated (rho = 0.643, P < 0.001), at the significance level P = 0.01. Furthermore, the Stai-X-2 Scale was negatively correlated with body height (rho = -0.1188, P = 0.016).

CONCLUSIONS

The present study showed that patients' personality influenced their anxiety levels. Thus, the role of the nurse is a cornerstone in their psychological support preoperatively, to reduce the anxiety and stress levels.

Degree of Nurses’ Compliance to the Guidelines of Occupational Exposure to Pathogenic Micro-organisms; A Review of Literature

Biological infectious hazards are the main factors which nursing staff deal with. It is fundamental rule, nurses to apply the guidelines of occupational exposure to pathogenic micro-organisms. The aim of this review was to examine the current literature on the degree of nurses’ compliance to the guidelines of occupational according to exposure to pathogenic micro-organisms. A review of literature was conducted on the Medline / PubMed, Cochrane, Scopus, and Google Scholar databases from 2000 to 2018. The keywords used in the bibliography search were, health care professionals, nurses’ attitudes, occupational exposure, and safety guidelines. The inclusion criteria were: a) studies that were directly related to the topic, and b) studies in English and Greek language, published in peer-reviewed journals. The search strategy revealed 1287 studies, 1260 excluded. Finally 27 studies were included. Nurses' compliance to the guidelines of occupational exposure to pathogenic microorganisms is described as unsatisfactory, and an emergency situation has been shown to be the major obstacle to follow the guidelines. It is necessary to understand the factors which contribute to nurse’s noncompliance. The results show that there is a need to propose measures that will positively affect the nurses’ performance. Keywords: Health care professionals; Nurses’ attitudes; Occupational exposure; Safety guidelines.

A Comparison of 2 Venous Puncture Sites for Peripheral Implanted Ports

The use of peripheral implanted ports to administer parenteral nutrition in a number of patient cohorts is increasingly seen as a safe alternative to chest ports with equivalence in long-term outcomes. Two insertion sites on the upper arm were compared using the zone insertion method (ZIM), which was developed as an approach to optimize and reduce catheter-related exit site complications. The ZIM divides the medial upper arm into 3 main colors, red, green, and yellow, which are based on musculoskeletal, skin, and vessel characteristics. The optimal exit site is considered to be the green zone, the middle third of the upper arm. Thirty-five patients were allocated to vein puncture at the yellow/green zone (group A) and 35 patients at the yellow zone near the axilla (group B). All devices were implanted in the distal green zone. Successful peripheral port implantation was 91.4% (n = 35) for group A and 100.0% (n = 35) for group B (P = .07). No procedural or postprocedural complications were observed.

Factors Affecting Stress Levels in Hospitalized Patients after Implementation of Fast-Track Protocol in Hepatopancreatobiliary Surgery

Objective:

The objective was to explore factors affecting stress levels in hospitalized patients after implementation of fast-track (FT) protocol in hepatopancreatobiliary surgery.

Methods:

This was a prospective cross-sectional study, where 90 patients were included. Exploration of environmental postoperative stress levels was conducted by serum adrenocorticotropic hormone and cortisol levels, the Intensive Care Unit Environmental Stressor Scale, and three self-reported Numeric Analog Scale questions, with regard to emotional/stress level, specifically “How sad do you feel right now?” “How stressed do you feel right now?” and “How optimistic do you feel right now, about the future?” at 3 time points: (T₁) Before surgery, (T₂) the day of surgery, and (T₃) the 3^rd postoperative day. The trial profile is conformed according to the CONSORT guidelines. Statistical analysis was carried out by SPSS software version 22 (IBM SPSS software, Chicago, Illinois, USA) at a significance level of 0.05.

Results:

Serum cortisol T₂ levels were positively correlated with the day of removal the drainage tube (rho = 0.235, P = 0.027). Furthermore, serum cortisol T₃ levels were positively correlated with age and body mass index and negatively with the day of drainage tube removal (rho = 0.231, P = 0.028, rho = 0.235, P = 0.026, and rho = −0.279, P = 0.008, respectively).

Conclusions:

The findings of this study highlight that after evaluation of stress levels; nurses could interfere and reduce stress levels, knowing the factors which cause the increased stress levels, after the implementation of FT protocols.

Impact of the Enhanced Recovery Program after Hepato-Pancreato-Biliary Surgery

Enhanced Recovery after Surgery (ERAS) is a multicentric program that includes the fields of nursing and anesthesia, nutrition and fluid management, and minimally invasive surgery. ERAS protocols focus on reducing the postoperative complications and stress response, optimizing the postoperative recovery. They have been implemented in many surgical fields, such as cardiac, gastric, and urologic, as they were shown to be effective in reducing morbidity and the overall health costs and in improving patient satisfaction. The aim of this minireview was to investigate the impact of ERAS programs on patients' postoperative outcome after hepato-pancreato-biliary surgery.

Peripherally inserted central catheter ports: A vascular access specialist's systematic approach

Implanted ports are an important vascular access device for patients with malignancies requiring long-term chemotherapy. Peripherally placed ports are increasing in use as they are a safe, cost-effective alternative to chest-placed ports. Most peripheral ports can be placed bedside by specialist nurses in designated clinical areas rather than costly operating rooms or interventional radiology suites. Peripheral ports are considered less invasive compared with chest port placement because of reduced procedural risk. To enhance the success rate of peripheral port placement and minimize risks, we provide vascular access specialists with a systematic approach along with some technical advice tips and tricks to help avoid mechanical complications such as repeated puncture of the vein, excessive bleeding, thrombosis or skin dehiscence, as well as latent complications such as catheter migration and catheter-related blood stream infection.

Cross-Correlation Among Visual Analog, Observational, and Behavioral Pain Scales of Oncological Patients Undergoing Major Abdominal Surgery

PURPOSE

To determine the perception of postoperative pain intensity between nurses and oncology patients undergoing major abdominal surgery.

DESIGN

A prospective cross-correlation study with 173 oncology patients undergoing major abdominal surgery, such as hepatectomy or pancreatectomy.

METHODS

Postoperative pain intensity was evaluated by clinical pain assessment tools such as critical-care pain observation tool (CPOT) and behavioral pain scale (BPS) recorded by the researcher, whereas the visual analog scale was completed by patients. Demographic and clinical data were recorded.

FINDINGS

The Cronbach's α for CPOT and BPS was α = 0.738 for each. There was a significant correlation between CPOT and BPS (ρ = 0.796, P < .001), whereas the visual analog scale was correlated with CPOT and BPS (ρ = 0.351, P < .001 and ρ = 0.352, P < .001, respectively), showing that nurses did not underestimate patients' pain levels.

CONCLUSIONS

The management of postoperative pain intensity after major abdominal surgery requires clinical comprehension by nurses to achieve the reduction or suppression of pain.

Fast-Track Recovery Program After Major Liver Resection: A Randomized Prospective Study

The objective of this study was to compare fast-track (FT) recovery protocol with the conventional one in patients treated with major liver resection by evaluating perioperative morbidity, length of hospitalization, and readmission rate. Sixty-two patients suffering from malignant liver tumors were surgically treated from May 2012 to April 2014. After randomization, they were prospectively divided into two groups: Group A patients (n = 32) followed FT recovery protocol and Group B patients (n = 30) were treated with the conventional (CON) protocol. Postoperative morbidity, readmission rate, and median hospital stay in the two groups were studied. Fast-track protocol was associated with a decreased complication (25%, p = .002), whereas the risk of postoperative morbidity was 2.4 times higher in patients treated with the CON protocol (60%, p = .002). Readmission rate was not significantly different between the two groups (6.25%, p = .35). Age (p = .382) and body mass index (p = .818) were not a suspending factor for following the FT protocol. Overall length of stay (postoperative days) in the FT group was (mean ± SD) 5.75 ± .5 and in the CON group was 13.5 ± 6.7 (p < .001). Fast-track recovery protocol seems to be safe and particularly efficient in patients undergoing major liver resections.

Postoperative stress and pain response applying fast-track protocol in patients undergoing hepatectomy

Aim

To assess the clinical parameters and compare the stress and pain response between fast-track recovery protocol and conventional treatment in patients undergoing major liver resection.

Methods

Eighty-eight patients suffering from malignant liver tumours were surgically treated from May 2012 to March 2015. After randomisation, they were prospectively divided into two groups: group fast-track patients (n = 46) and group conventional treatment patients (n = 42). Demographic and clinical data were collected and patients were assessed with pain scale (behavioural observation scale and visual analog scale), while depression levels were evaluated with Zung self-rating depression scale and three Numeric Analog Scale self-reported questions. Peripheral blood samples were collected at time points: T1 on the admission day, T2 on the day of surgery and T3 on the day of discharge examining serum levels of adrenocorticotropic hormone and cortisol.

Conclusion

Fast-track recovery protocols seem to be associated with improvement in several clinical parameters, without compromising, biologic or emotional stress in patients undergoing major liver resection.

Comparative Evaluation of Pain, Stress, Neuropeptide Y, ACTH, and Cortisol Levels Between a Conventional Postoperative Care Protocol and a Fast-Track Recovery Program in Patients Undergoing Major Abdominal Surgery

BACKGROUND

Fast-track (FT) postoperative protocol in oncological patients after major abdominal surgery reduces complications and length of postoperative stay compared to the conventional (CON) protocol. However, stress and pain responses have not been compared between the two protocols.

OBJECTIVES

To compare stress, pain, and related neuropeptidic responses (adrenocorticotropic hormone [ACTH], cortisol, and neuropeptide Y [NPY]) between FT and CON protocols.

METHOD

A clinical trial with repeated measurements was conducted (May 2012 to May 2014) with a sample of 63 hepatectomized or pancreatectomized patients randomized into two groups: FT ( n = 29) or CON ( n = 34). Demographic and clinical data were collected, and pain (Visual Analog Scale [VAS] and Behavioral Pain Scale [BPS]) and stress responses (3 self-report questions) assessed. NPY, ACTH, and cortisol plasma levels were measured at T1 = day of admission, T2 = day of surgery, and T3 = prior to discharge.

RESULTS

ACTH_T1 and ACTH_T2 levels were positively correlated with self-reported stress levels (ρ = .43 and ρ = .45, respectively, p < .05) in the FT group. NPY levels in the FT group were higher than those in the CON group at all time points ( p ≤ .004); this difference remained significant after adjusting for T1 levels through analysis of covariance for age, gender, and body mass index ( F = .003, F = .149, F = .015, respectively, p > .05).

CONCLUSIONS

Neuropeptidic levels were higher in the FT group. Future research should evaluate this association further, as these biomarkers might serve as objective indicators of postoperative pain and stress.

The impact of laparoscopic Nissen fundoplication on the long-term quality of life in patients with gastroesophageal reflux disease

Laparoscopic Nissen fundoplication is now the most common surgical procedure for treatment of gastroesophageal reflux disease (GERD), offering promising long-term outcomes. Outcomes for 46 patients with GERD who underwent Nissen fundoplication during the last 5 years (November 2007-June 2012) were prospectively studied using a structured questionnaire that evaluated clinical symptom scores for heartburn, dysphagia, and satisfaction with clinical outcomes. Postoperative care of the patients including analgesia, median hospital stay, overall cost, and complications was also studied. Clinical follow-up data for 2 years after surgery were available for all 46 patients. Forty-two patients (91.3%) were satisfied with their quality of life and only eight patients (17.4%) continued to receive antacids after surgery. Dysphagia to solid and liquid occasionally appeared in 26.1% (N = 12) and 17.4% (N = 8) of patients, respectively. Laparoscopic Nissen fundoplication was an effective long-term treatment for GERD. The operation resulted in a significant reduction of symptoms and minimized the use of antacid drugs with a high degree of patient satisfaction. Although some patients may have returned to antacid treatment at late follow-up or continued to complain of mild discomfort, they were overall pleased with the outcome.