Thesis (M.Med.Sc.)--University of Adelaide, Dept. of Anaethesia and Intensive Care, 2002. / "April 2002" Bibliography: leaves 190-202.

Thesis (M.S.)--University of Michigan, Ann Arbor, 1957. / Typescript (photocopy). Includes bibliographical references (leaves 76-78). Also issued in print.

Thesis (M.S.)--University of Michigan, Ann Arbor, 1957. / Typescript (photocopy). eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 76-78).

Thesis (M.S.)--Virginia Polytechnic Institute and State University, 1993. / Vita. Abstract. Includes bibliographical references (leaves 94-100). Also available via the Internet.

No description available.

Orientador: Valéria Nobre Leal de Souza Oliva. / Resumo: Amplos conhecimentos existem a respeito da anestesia em mulheres gestantes, mas na medicina veterinária há escassez de informação científica a respeito deste tema. Este trabalho estudou as alterações cardiocirculatórias e respiratórias decorrentes da gestação em cadelas, comparando os efeitos da anestesia inalatória na cadela não-gestante e aos 45 dias de gestação. Foram avaliados os efeitos da anestesia inalatória com a utilização do sevofluorano por meio do monitoramento dos sistemas cardiorrespiratório da mãe e cardíaco dos fetos, além da realização de exames laboratoriais como: hemogasometria, hemograma e bioquímicos séricos. Para tanto foram utilizadas nove cadelas, sem raça definida, adultas, com 1 a 5 anos de idade. Os animais foram submetidos ao mesmo procedimento anestésico utilizando os fármacos acepromazina, propofol e sevofluorano, em dois períodos distintos, sendo o primeiro período na condição não-gestante e o segundo aos 45 dias de gestação. Não ocorreram alterações significativas na f, ETCO2, SatO2, nas variáveis hemogasométricas com exceção do pH, na concentração de sevofluorano no vaporizador e no tempo de recuperação anestésica entre os grupos ou entre os momentos. A freqüência cardíaca materna elevou-se na paciente gestante apenas no momento basal e 15 minutos após a MPA. Observou-se diminuição significativa da pressão arterial na paciente gestante, assim como da temperatura retal. Os valores de eritrócitos, hemoglobina, volume globular e albumina também diminuíram significativamente na paciente com 45 dias de gestação. Concluiu-se que o protocolo anestésico com o sevofluorano causa poucas alterações nas variáveis cardiocirculatórias e respiratórias na cadela com 45 dias de gestação, podendo ser utilizado no caso de necessidade de intervenção cirúrgica e/ou anestésica. / Abstract: Extensive human data have been published about anesthesia in pregnant women, but in veterinary medicine there are few articles about this subject. The aim of this study was to investigate the cardiocirculatory and respiratory alterations produced by pregnancy in bitches, comparing the effects of inhalatory anesthesia in nonpregnant bitch and that with 45 days of pregnancy. The effects of inhalatory anesthesia with sevoflurane were measured through the monitoring of cardiorespiratory systems of the mother and cardiac system of the fetus and by arterial blood samples for evaluate the acid-base and gases values, venous blood samples for haematology and serum biochemistry. For this were used 9 adults mongrel bitches from 1 to 5 years old. These animals were submitted to the same anesthetic procedure with acepromazine, propofol and sevoflurane in two different times. The first one was in nonpregnant bitch and the second in 45 days of pregnancy. There were no important differences in respiratory rate, ETCO2, pulse oximetry, some hemogasometric parameters (PaCO2, PaO2, HCO3-,CO2T, SatO2, BE), anesthetic concentration of sevoflurane and time of recovery of anesthesia either in time of each group, or among the groups. The arterial blood pressure, rectal temperature, red cell mass, hemoglobin, packed cell volume, albumin reduced in pregnant patient with 45 days of pregnancy. It was also noticed a marked increase in heart rate of mother during the first moments of the study. It was concluded that anesthetic protocol with sevoflurane cause few alterations in the cardiocirculatory and respiratory parameters in bitch with 45 days of pregnancy, which can used in case of need surgical and/or anaesthetic procedure to pregnant bitch and to the fetuses. / Mestre

The United States is ranked first for health care expenditure and 11th for quality of care. Surgical care is complex, multifactorial, and medical expenses continue to increase. The necessity for surgery normally disconnects the patient from their primary care provider, frequently resulting in uncoordinated care between medical providers regarding surgical care. A fragmented healthcare system results in unnecessary diagnostic labs and tests, insufficient surgical care resources, and patients experiencing a lapse in their medical care. If adopted, the Perioperative Surgical Home (PSH) model has the opportunity to improve patient outcomes by increasing patient satisfaction rates while decreasing surgical complications and hospital stay duration. The PSH model is patient-centered, and directed by anesthesia providers coordinating surgical care by adequately optimizing patients for surgery. The five model components are: patient involvement, comprehensiveness, coordination of care, accessibility, and commitment to quality and safety. Purpose: The purpose of this project was to perform a needs assessment at a Central Phoenix Hospital to identify if there was a need to implement the PSH model to decrease surgical complications and 30-day surgical hospital readmission rates. Methods: This was a non-experimental needs assessment. Retrospective data collection was used to explore and identify if the PSH model was needed at this Phoenix hospital. A needs assessment tool was created guided by the Rothwell and Kazana's needs assessment model utilizing their five key phases. The General Systems Theory was used to assess the complexity of an open surgical system to identify gaps in performance and results. Results: Data collected from fiscal year 2015 demonstrated a total of 7,829 surgical cases were performed at this hospital. The number of patients with a surgical complication was 826 (10.6%). A reported 147 (1.9%) patients had a surgical hospital readmission at this facility. Data from fiscal year 2016 demonstrated 7,778 (10.3%) total surgical cases. The number of surgical complications reported was 800 (1.5%). A reported 116 patients had a hospital surgical readmission at this facility. Conclusion: The reported high health care expenditure and low quality of care received in the U.S. supports the need to improve our health care delivery system with models such as the PSH. There was not an obvious problem in performance of surgical complications and 30-day surgical hospital readmission rates. There were identified system gaps in data collection of surgical reporting that correlate with clinical practice. These findings were the starting point for a needs analysis to follow by focusing on development and implementation of the PSH model if adopted.

No description available.

Background and Purpose: Percutaneous transhepatic biliary drainage remains a painful procedure in many cases despite the routine use of large amounts of intravenous sedation. We present a feasibility study of thoracic paravertebral blocks in an effort to reduce pain during and following the procedure and reduce requirements for intravenous sedation. Methods: Ten consecutive patients undergoing biliary drainage procedures received fluoroscopically guided paravertebral blocks and then had supplemental intravenous sedation as required to maintain patient comfort. Levels T8-T9 and T9-T10 on the right were targeted with 10-20 ml of 0.5% bupivacaine. Sedation requirements and pain levels were recorded. Results: Ten biliary drainage procedures in 8 patients were performed for malignancy in 8 cases and for stones in 2. The mean midazolam use was 1.13 mg IV, and the mean fentanyl requirement was 60.0 μg IV in the block patients. Two episodes of hypotension, which responded promptly to volume replacement, may have been related to the block. No serious complications were encountered. The mean pain score when traversing the chest wall, liver capsule, and upon entering the bile ducts was 0.1 on a scale of 0 to 10, with 1 patient reporting a pain level of 1 and 9 reporting 0. The mean peak pain score, encountered when manipulating at the common bile duct level or when addressing stones there, was 5.4 and ranged from 0 to 10. Conclusions: Thoracic paravertebral block with intravenous sedation supplementation appears to be a feasible method of pain control during biliary interventions.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2018. / Undergoing surgery without having general anaesthesia has become an option for many surgical patients. Awake patients are able to communicate with the surgical team which allows the surgical team to gain understanding of the patient’s experience. This is an important aspect of perioperative care and is in line with the theory of Human Becoming according to Parse, (2011). Literature suggests that patients who have received information preoperatively about their planned perioperative journey experience less anxiety and fear relating to their surgery. The purpose of this study was to explore the perioperative experiences and needs of patients undergoing awake surgery. A qualitative exploratory descriptive three step design of data collection was implemented for this study. In step one an integrative review identified patient experiences of the perioperative journey. The literature was critically analysed for relevance and inclusion. This information formed the basis for inclusion in step two. Step two explored the perioperative experience of participants who had undergone awake surgery by interviewing a group of participants using interviews and probe questions extracted from the literature. The information gleaned from the interviews was grouped for content similarity and was used to create an information pamphlet which informed participants about their perioperative journey. In step three the information pamphlet was handed to participants preoperatively and the same participants rated the usefulness of the information pamphlet postoperatively by answering a dichotomous question. Participants had the opportunity to add comments. The population for this study was all patients who were scheduled for ophthalmic, orthopaedic, urological or plastic, surgery using awake surgery in four large private hospitals in Gauteng and Mpumalanga. Patients younger than 18 years of age as well as those receiving sedation or general anaesthesia were excluded from the population. This study showed that participants had positive experiences of being awake during surgery. A number of participants found the experience of being awake during surgery interesting and enjoyed being able to ask questions and participate in dialogue. Participants rated the information pamphlet as useful. Two areas of concern was elicited, namely communication and nursing care within the operating theatre environment. The objectives for this study were met. Key words: perioperative journey, awake surgery, regional and local anaesthesia, nursing / LG2018