Seit Mitte der 1990er Jahre haben sich Fast-Track-Behandlungskonzepte in der Kardioanästhesie etabliert. Diese zielen darauf ab, unter Verwendung kurzwirksamer Anästhetika eine frühzeitige postoperative, tracheale Extubation der Patienten zu gewährleisten, und folgend die Dauer der postoperativen Behandlung auf der Intensivstation und im Krankenhaus sowie die Inzidenz an Komplikationen zu senken. Kernstück eines multimodalen, kardioanästhesiologischen Fast-Track-Konzeptes am Herzzentrum in Leipzig (HZL) ist eine postanästhesiologische Aufwacheinheit (PACU) mit 3 Patientenplätzen, in der Patienten postoperativ betreut werden, ohne dass eine Aufnahme auf die Intensivstation (ICU) erfolgen muss. Ziel dieser Arbeit ist, den Einfluss der PACU im Rahmen des Fast-Track-Konzeptes im Vergleich zur Behandlung auf der Intensivstation zu untersuchen. Hierzu führten wir eine prospektiv-randomisierte kontrollierte Studie mit insgesamt 200 elektiven, kardiochirurgischen Patienten durch. Resultat der Studie war eine signifikant kürzere Dauer bis zur Extubation in der PACU im Vergleich zur Kontrollgruppe, zudem war die Verweildauer in der PACU im Median signifikant kürzer als auf der ICU. Hinsichtlich der postoperativen Mortalität und Morbidität zeigten sich keine wesentlichen Unterschiede. Hieraus lässt sich schlussfolgern, dass eine postoperative Fast-Track-Behandlung in einer dedizierten PACU im Vergleich zur ICU zur früheren Extubation und Verlegung auf die weiterversorgenden Stationen führt, ohne dass die Sicherheit der Patienten beeinträchtigt wird.

Seit Mitte der 1990er Jahre haben sich Fast-Track-Behandlungskonzepte in der Kardioanästhesie etabliert. Diese zielen darauf ab, unter Verwendung kurzwirksamer Anästhetika eine frühzeitige postoperative, tracheale Extubation der Patienten zu gewährleisten, und folgend die Dauer der postoperativen Behandlung auf der Intensivstation und im Krankenhaus sowie die Inzidenz an Komplikationen zu senken. Kernstück eines multimodalen, kardioanästhesiologischen Fast-Track-Konzeptes am Herzzentrum in Leipzig (HZL) ist eine postanästhesiologische Aufwacheinheit (PACU) mit 3 Patientenplätzen, in der Patienten postoperativ betreut werden, ohne dass eine Aufnahme auf die Intensivstation (ICU) erfolgen muss. Ziel dieser Arbeit ist, den Einfluss der PACU im Rahmen des Fast-Track-Konzeptes im Vergleich zur Behandlung auf der Intensivstation zu untersuchen. Hierzu führten wir eine prospektiv-randomisierte kontrollierte Studie mit insgesamt 200 elektiven, kardiochirurgischen Patienten durch. Resultat der Studie war eine signifikant kürzere Dauer bis zur Extubation in der PACU im Vergleich zur Kontrollgruppe, zudem war die Verweildauer in der PACU im Median signifikant kürzer als auf der ICU. Hinsichtlich der postoperativen Mortalität und Morbidität zeigten sich keine wesentlichen Unterschiede. Hieraus lässt sich schlussfolgern, dass eine postoperative Fast-Track-Behandlung in einer dedizierten PACU im Vergleich zur ICU zur früheren Extubation und Verlegung auf die weiterversorgenden Stationen führt, ohne dass die Sicherheit der Patienten beeinträchtigt wird.:Vorbemerkung Erklärung zum wissenschaftlichen Beitrag des Promovenden zur Publikation Bibliographische Beschreibung I. Einführung I. 1. Einführung und Grundlagen der Fast-Track-Rehabilitation I. 2. Entwicklung des Fast-Track in der Kardioanästhesie (FTCA) I. 3. Wesentliche Elemente der FTCA und deren Evidenz I. 4. Fast-Track-Behandlung am Herzzentrum Leipzig I. 5. Zielstellung der Arbeit II. Publikation III. Zusammenfassung III. 1. Hintergrund III. 2. Zielsetzung III. 3. Methode III. 4. Ergebnisse III. 5. Schlussfolgerung IV. Anlagen IV. 1. Literaturverzeichnis IV. 2. Verzeichnis der verwendeten Abkürzungen IV. 3. Eigenständigkeitserklärung

Background: Post anesthesia care unit (PACU) nurses provide patient care during the vulnerable postoperative period when patients are at greatest risk of experiencing respiratory management issues and postoperative pulmonary complications (PPCs). In rural facilities such as Canyon Vista Medical Center (CVMC) in Sierra Vista, Arizona, limited staff and resource shortages can lead to suboptimal patient care conditions in the PACU setting. To compound the issue, PACU nurses in rural facilities rely on facility training and have little guidance on important patient care issues such as post anesthesia respiratory management. Quality improvement initiatives aimed at resolving knowledge deficits in settings such as these can improve both quality and patient safety via a more competent and educated PACU nursing staff. Purpose: To address an educational need among the CVMC PACU nursing staff with the implementation of a post anesthesia respiratory management educational intervention. Methods: A quasi-experimental one group pretest-posttest design using a targeted intervention based upon the knowledge to action (KTA) framework. The PACU setting was used to conduct the intervention with the nurse participants (N = 9). Descriptive statistics and the Wilcoxon signed rank test were used to determine intervention efficacy. Intervention: One 75-minute educational intervention divided into three consecutive phases. Results: A significant improvement in the nurses’ knowledge (p < .05) and perception of understanding of PACU respiratory management following the intervention (p < .05).

Ineffective pain management in the post anesthesia care unit (PACU) increases patients' risk of adverse effects including decreased mobility, infection, chronic pain, depression, cardiopulmonary complications, increased length of stay, insomnia, fatigue, and overall decrease in quality of life. The PACU in a community hospital did not provide an evidence-based pain management guideline for nurses treating postoperative patients, resulting in nurses' concerns about providing pain management. The purpose of this project was to translate evidence on pain management into an evidence-based guideline for improved nursing practice in a PACU. Evidence was obtained from a detailed literature search using multiple databases and professional organizations' guidelines. Nursing practice guidelines were developed and evaluated by 3 expert panelists using the Agree II guidelines. The panelists selected included; Two anesthesiologists, one who is trained in pain management and is also a pharmacist. The third expert is a practicing nurse practitioner in an acute setting who is also a surgical first assist and the associate director of robotics. The panel endorsed the guidelines for advancement through the hospital's review committees. Implementation of the evidence-based pain management guideline in the PACU might provide nurses with tools to guide their interventions and improve patient outcomes. Social changes resulting from the use of evidence-based pain management guidelines include decreased time to opiate administration, decreased adverse effects, improved assessment of pain, and an increase in the number of patients who receive proper pain management.

Aim: The overall aim of the thesis was to describe the experiences of awake patients during surgery under regional anesthesia. In addition, the aim was to develop a model for intraoperative care that can support and enhance patients’ well-being during the intraoperative period.   Methods: Study I was a patient interview study guided by a reflective lifeworld approach. In study II a philosophical reflection of the findings from study I was carried out. In study III a hermeneutic approach inspired by Ricoeur and Gadamer was used in order to interpret video recorded material. In study IV a hermeneutic approach inspired by Gadamer was used to synthesize the findings in studies I-III transformed into an intraoperative caring model.  Overall main findings: The analysis shows that being awake during surgery can be compared with walking a tightrope because of ambiguous feelings. The proximity and presence of the nurse anesthetist (NA) anchors the patient in the present and strengthens the patient’s feeling of trust. The temporary disruption in the relationship between the body and the world due to regional anesthesia means that the patient’s being in the world is exposed to revolutionary experiences. Gaps between the patient’s experiences and the situation can be bridged over when the NA acts as the patient’s bodily extension and links the patient as a subject to the world in the intraoperative situation. From the patient’s perspective this calls for the NA’s proximity and genuine presence in the ‘intraoperative caring space’. When the NA’s performance of his/her professional duties clashes with the patient’s existential being in the intraoperative situation the need of present presence from the NA is crucial. Conclusions: The findings contribute to knowledge development about intraoperative care and raise awareness that care for the awake patient cannot be performed on formal routines that might disregard the uniqueness of each patient’s situation. The model can be used as a tool to encounter awake patients’ existential needs in the intraoperative situation and to further enlighten NAs about the possible impact of their proximity, interaction and communication behavior in the delivery of intraoperative nursing care.

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Patient safety is one of the top priorities of anesthesia and perioperative care in the operating room. The patient safety is greatly compromised due to administered medication and the actual operating performance in the perioperative care. The risks of anesthesia and the operational performance are many, starting with the fall of the patient, the possible wrong- site, wrong-procedure, wrong-patient errors, adverse reactions to administered medication, difficult airway management or an unexpected perioperative bleeding. Patient harm in hospital care leads not only to increased costs for additional treatment, prolongation of the hospitalization time, but also significantly affects the subsequent quality of life. Most adverse events are preventable, since most of them are caused by susceptible factors, such as incomplete or incorrect information or the lack of communication between the members of the operating team. Due to the increasing number of such adverse events around the world, including those of the most serious, The World Health Organization has created a program called The Save Surgery Saves Lives, whose aim was the identification of key risk areas in ensuring the safety of patients. On the basis of the identified risk areas the Surgical Safety Checklist was introduced in 2008. It is aimed...

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