Bakgrund: Kejsarsnitt, en kirurgisk metod då barnet blir förlöst via ett snitt i bukväggen, medför risker vare sig det är elektivt eller akut. Sjuksköterskans roll i omvårdnaden av patienten postoperativt blir central för att främja egenvård och stärka patientens delaktighet.  Syfte: Att undersöka vilka komplikationer som uppstår, hur många som drabbas av dessa samt att kartlägga eventuella riskfaktorer för komplikationer hos kvinnorna som genomgått kejsarsnitt. Studien syftar också till att undersöka vilken upplevelse dessa kvinnor har angående proceduren pre-, intra - och postoperativt. Metod: Litteraturstudie av vetenskapliga artiklar med både kvalitativ och kvantitativ design. Sökningen skedde på databaserna Statens Beredning för medicinsk och social Utvärdering (SBU), Cochrane, Cinahl, PsychINFO och Pubmed. Sammanlagt 15 artiklar inkluderades efter kvalitetsgranskning. Resultat: Risken för att få en postoperativ komplikation, exempelvis sårinfektion, var liten. Förekomsten var cirka 10 %, men detta varierade kraftigt mellan artiklarna. Risken var dock större vid högt BMI, tobaksanvändning, högre ålder och hypertoni. Smärta var den mest frekvent förekommande komplikationen. För kvinnorna var det viktigt att vara välinformerade och att känna sig inkluderade under proceduren. Slutsats: Kvinnornas upplevelse av kejsarsnitten var främst förknippad med tiden innan kejsarsnittet. Rädslan för smärtan preoperativt var problematisk för kvinnorna som genomgick kejsarsnitt. Majoriteten av de postoperativa komplikationerna var smärta och sårinfektioner. Att ge patienten trygghet och strategier för coping inför kejsarsnittet var det som efterfrågas för att stärka patientens delaktighet och autonomi. / Background: Caesarean section, a surgical procedure whereas the child is delivered by an incision through the abdominal wall. The procedure entails some risks whether it is done electively or by emergency. The nurse’s part in the care of the patient becomes essential in the postoperative stage to support in the self-care and to make the patient participate in his/her own treatment. Purpose: The purpose was to look into which complications may occur, and to identify possible risk factors causing complications in the women undergoing a caesarian section. The purpose of this study was also to find out what kind of perception these women have of the procedure before, during and after the caesarean surgery. Method: A literature review of scientific studies and articles of both quantitative and qualitative design. The search was preformed on the databases: SBU, Cochrane, Cinahl, PsychINFO and Pubmed, after assessing the quailty, 15 articles were selected for inclusion. Results: The risk of having a postoperative infection was small, circa 10 % occurence, although varying a lot between articles. The risk was increased with high BMI, age, tobacco use and hypertension. Physical pain was the most experienced postoperative complication. Women felt that it was very important to be well-informed and for them to feel included in the caesarean procedure. Conclusion: Women’s experiences of a caesarean section were mostly influenced by the time before surgery. The fear of pain before surgery was problematic for women undergoing caesarean section. The majority of complications were postoperaitve pain and wound infections. Giving the patient strategies for coping and security was important to strengthen her participation and autonomy.

Sverige och resterande länder av världen har upplevt och fortsätter uppleva ett ökande antal utförda kejsarsnitt. I Sverige har antalet utförda kejsarsnitt ökat med elva procent de senaste fyra decennierna och kejsarsnittet har blivit ett fokus för kvinnans egen vilja och barnets rättigheter. Innebörden av ökningen är att samhället får fler patienter med pågående eller tidigare smärtupplevelser. Syftet med litteraturstudien var att beskriva den postoperativa smärtupplevelsen i samband med kejsarsnitt. Studien utfördes som en allmän litteraturstudie med analysmetoden innehållsanalys. Vetenskapliga artiklar erhölls genom strukturerade sökningar i tre olika databaser. Artiklarna granskades och bearbetades för att sedan sammanställas och struktureras till fem beskrivande teman: (1) Upplevda smärtförväntningar, (2) Smärtupplevelsens lokalisation & beskrivning, (3) Faktorer som förhöjer respektive sänker postoperativ smärtupplevelse, (4) Smärtupplevelsen i förhållande till kronisk smärta och (5) Helhetsintrycket av den postoperativa smärtupplevelsen. Studiens slutsats är att patienten upplever fysisk- och emotionell smärta som påverkar aktivitet och mammarollen. Smärtan upplevs både som nociceptiv och neuropatisk oavsett postoperativt skede och akut smärta är den bidragande faktor till uppkomsten av kronisk smärta. Sjuksköterskan bör vara stödjande, inneha god förståelse för patientens smärtupplevelse och ge patienten tillräckligt med information gällande ingreppet. Optimal smärtlindring är även av vikt för att ge en god vård. / Sweden and the rest of the countries in the world have experienced and still are experiencing an increase of the caesarean section numbers. In four decenniums the number of caesarean sections has risen eleven percent in Sweden and the caesarean section have become a focus for the woman’s own choice as well as the rights of the child. The effect of the increase is that the numbers of individuals with ongoing experience of pain or previous experience of pain, are becoming greater. The aim of the study was to describe the postoperative experience of pain in connection with the performance of a caesarean section. The study was executed with the method content analysis. Scientific articles were collected through searches in three databases. Through examination and processing the articles, findings were found and made into five themes: (1) Perceived pain expectations, (2) The experienced location and description of pain, (3) Factors that enhance and reduces postoperative pain perception, (4) The experience of pain in relation to chronic pain and (5) The overall impression of the postoperative pain experience. The conclusion is that the patient is experiencing both physical- and emotional pain which affects activity and the function of being a mother. The pain is experienced in both a nociceptive and a neuropathic way, regardless of the postoperative stage. Acute pain is the contributive factor to the emergence of chronic pain. The nurse ought to be supportive, to possess good understanding of the patient’s pain experience and give the patient enough of information about the procedure. Optimal pain relief is also important in the context of being able to give a good care to the patient.

Bakgrund: Nästan hälften av alla vuxna svenskar är överviktiga eller lider av fetma vilket tillsammans med dess följdsjukdomar kostar samhället flera miljarder kronor per år. Trots att behandlande överviktsoperationer (främst gastric bypass [GBP]) blir allt vanligare i Sverige, är patientens hälsotillstånd intra-, och postoperativt relativt outforskat vad gäller smärta, postoperativt illamående och kräkning [PONV], vårdtid samt det ökande lidandet detta medför.   Syfte och Metod: Syftet är att beskriva mängden analgetika och antiemetika som ges till patienter som genomgår GBP-operationer, från premedicinering till utskrivning på den postoperativa vårdavdelningen. Vidare undersöks om anestesisjuksköterskan positivt kan påverka den postoperativa vården med avseende på smärtlindring, PONV och vårdtid då detta kopplas till lidande. En kvantitativ deskriptiv retrospektiv journalgranskningsstudie gällande totalt 68 patienter genomfördes.   Resultat: Gavs lokalanestetika i operationssåret under operation minskade både behovet av analgetika postoperativt (p<0,05) och den postoperativa vårdtiden (p<0,05). Om antiemetika gavs intraoperativt minskade användningen av antiemetika postoperativt (p<0,001). Ju större dos antiemetika/kg/min som gavs intraoperativt desto kortare tid på den postoperativa vårdavdelningen (p<0,001). Detta gällde oavsett om patienten fått lokalanestetika (p<0,01) eller inte (p<0,05).   Slutsats: Anestesisjuksköterskan har stora möjligheter att på flera plan positivt påverka tiden direkt efter operation. Intraoperativ administrering av lokalanestetika och antiemetika har avgörande roller för den fortsatta vården hos patienter som genomgår GBP-operationer, både vad gäller smärta, PONV, vårdtid och det lidande som detta kan medföra. Antiemetika doseras till synes enligt rutin och inte i förhållande till vikt, men ger viktberoende effekter. Mer forskning inom området efterfrågas. / Objectives: Almost 50 % of Swedish adults are overweight or obese, which costs the society billions annually. Although surgical treatments of obesity (primarily gastric bypass [GBP]) are increasing in Sweden, the patient's perioperative health status are relatively unexplored in terms of pain, postoperative nausea and vomiting [PONV], length of postoperative observation ward [POW] stay and the increasing suffering this entails. The authors aim to describe the amount of perioperative analgesics and antiemetics that GBP patients receive, and investigate how the nurse anesthetist can affect the postoperative care. Method: A quantitative descriptive retrospective study with a total of 68 patients was conducted. Result: The need for postoperative analgesics (p<.05) and the length of stay in the POW (p<.05) were both reduced whenever local anesthetics were given during surgery. If antiemetics were given intraoperatively, the use of antiemetics postoperatively was reduced; (p<.001). A greater intraoperative dose antiemetic/kg/minute reduced the length of stay in the POW (p<.001) regardless whether the patients received local anesthetics (p<.01) or not (p<.05). Conclusion: The nurse anesthetist can positively impact the immediate time after surgery. Intraoperative administration of  antiemetics and local anesthetics have crucial roles for the continued care of the GBP patient in terms of suffering connected to pain, PONV and length of stay in the POW. Antiemetics are seemingly dosed based on a routine and not on the patient's weight. More research in this area are requested.

Many complications associated with heart surgery are due to the negative effects of extracorporeal circulation (ECC). Some of these complications may be attributed to ECC-induced activation of inflammation and coagulation pathways. The inflammatory reaction may be caused by the interaction of blood components with air and the artificial surfaces of the ECC, from substances produced due to ischaemia-reperfusion injury of the heart and lungs, and from increased release of endotoxin from ischemic intestines. Staphylococcus aureus (S. aureus) infections are the leading cause of respiratory, skin and soft tissue, and bloodstream infections. Nitric oxide (NO) is a gaseous signaling molecule involved in many physiological and pathological processes. The role of NO in infection and inflammation is complex. NO may contribute to morbidity by acting as a vasodilator, myocardial depressant, and cytotoxic mediator. On the other hand, NO may have a salutary role through microvascular, cytoprotective, immunoregulatory, and antimicrobial properties. A simulated extracorporeal circulation (SECC) model is a closed circuit, including a roller pump, an oxygenator, a venous reservoir and polyvinyl chloride (PVC) tubing, where human blood is circulated. The SECC model allows studies of the blood and its components, without any influence from other organ systems. The aim of this work was to investigate NO effects during SECC and in S. aureus infection. Study I. Human blood was circulated through SECC during 3 hours, and leukocyte granule release was studied. Results indicated that NO addition during SECC is pro-inflammatory by stimulating leukocyte activation and granule release, and has no effect on oxygen free radical production and interleukin release. Study II. Investigating the effect of NO on S. aureus growth in whole blood during 180 min SECC, results showed a 6.2 fold growth in the presence of NO. Results indicated that by stimulating the expression of inducible lactate dehydrogenase, specific to S. aureus, NO may improve S. aureus resistance to oxidative stress, giving the pathogen a survival advantage. Study III. In an in vitro system of SECC, we measured glyceryl trinitrate (GTN) induced changes in leukocyte activation in whole blood caused by S. aureus infestation, as well as the effect of GTN on S. aureus growth. Results indicated that GTN does not affect S. aureus growth during SECC and has no effect on SECC-induced leukocyte activation. Study IV. Whole blood concentrations of selected leukocyte adhesion molecules, complement system components and myeloperoxidase  were measured in an in vitro system of SECC. Results indicated that SECC induces the increased expression of some leukocyte markers and that GTN addition significantly reduces the expression of some leukocyte activation markers.

Delirium é um estado confusional agudo caracterizado por um distúrbio de consciência, alteração na cognição e curso flutuante ao longo do dia. É a complicação mais comum observada em idosos hospitalizados. É freqüente no pós-operatório de cirurgia cardíaca, e pode chegar a taxas tão altas quanto 73% em pacientes mais idosos. Pacientes com delirium apresentam maior risco de morte, demência e institucionalização, aumento do tempo de internação hospitalar e dos custos. Os objetivos deste estudo foram: 1) determinar a incidência do delirium no pós-operatório de cirurgia cardíaca em idosos; 2) identificar fatores predisponentes e precipitantes neste contexto; 3) avaliar a relação entre delirium e morbimortalidade por até 18 meses de seguimento. Este estudo foi observacional, prospectivo, tipo coorte, realizado no Hospital de Messejana no período de Setembro/2011 à Dezembro/2013. Foram estudados 173 pacientes com idade > 60 anos. Antes da cirurgia, os pacientes foram avaliados quanto à função cognitiva através do MEEM e TFV, e pelo CAM, para determinar a presença de delirium pré-operatório, motivo de exclusão do estudo. Foram registradas variáveis referentes aos dados demográficos, doenças prévias, medicações utilizadas, e calculado o risco de mortalidade cirúrgica para cada paciente através do EuroSCORE II. Resultados de exames pré-operatórios como ECG, ecodopplercardiograma, cateterismo cardíaco, Doppler de carótidas e exames laboratoriais também foram registrados. Durante a cirurgia, as variáveis avaliadas foram o tempo de CEC e clampeamento de aorta, duração da cirurgia e anestesia e uso de hemoderivados. Como variáveis pós-operatórias foram analisados o TIOT, tempo de permanência na UTI, presença de disfunção renal, hipoxemia. O delirium foi avaliado pelo CAM-ICU no pós-operatório. Para o desfecho composto foram registrados óbitos por todas as causas, infecções e IAM perioperatório identificados até a alta hospitalar ou 30 dias após a cirurgia. Os pacientes foram seguidos por um período de 12 a 18 meses e registrados eventos como óbitos, reinternações e demência, através de nova avaliação com MEEM e TFV. Após análise univariada foi realizada análise multivariada por regressão logística múltipla para identificar as variáveis independentes. A idade média dos pacientes foi 69,5 + 5,8. Cerca de 75,14% eram hipertensos e 39,88% eram diabéticos. A média do EuroSCORE II foi 4,06 + 3,86. Cerca de 30,06% eram analfabetos. A média do grau de escolaridade foi 3,05 + 3,08 anos. A incidência do delirium foi 34,1%. Em 70% dos casos, o delirium foi detectado nos dois primeiros dias após a cirurgia. Foram identificados o grau de escolaridade (OR = 0,81; IC 95% 0,71 - 0,92; p=0,002), HAS (OR = 2,73; IC 95% 1,16 - 6,40; p=0,021) e a presença de valvopatia mitral ( OR = 2,93; IC 95% 1,32 - 6,50; p=0,008) como fatores predisponentes independentes para delirium. Como fator precipitante independente foi identificado o tempo de internação na UTI com OR=1,18; IC 95% 1,07 - 1,30 e p=0,001. O delirium foi fator de risco independente para o desfecho composto com OR=2,35; IC 95% 1,20 - 4,58 e p=0,012, além do TIOT > 900 minutos (OR=2,50; IC 95% 1,30 - 4,80; p=0,006) após análise multivariada. Não houve relação entre delirium e óbito após alta hospitalar, demência ou taxa de reinternação durante o seguimento / Delirium is an acute and transient syndrome with features of inattention and global cognitive dysfunction over the time. Among elderly hospitalized patients is the most common complication. The postoperative cardiac surgery delirium occurs in 73% in older patients. Delirium patients, have prominent risk factors for dementia, institutionalization, death, hospital care and increased cost of healthcare. The aims of this study were: 1) to determine the incidence of postoperative cardiac delirium, focusing particularly on elderly individuals; 2) to identify the predisposing and precipitating factors of delirium; 3) evaluate the morbi-mortality associated with delirium in a follow up of eighteen months. A prospective observational cohort study (n=173) patients, aged >= 60 years, admitted at Heart and Lung Messejana\'s Hospital between September/2011 to December/2013. Before the surgery, the Mini-Mental Status Examination (MMSE) and Verbal Fluency Test (VFT) were administered to assess patient\'s cognitive functioning. The patients were screened for delirium using the Confusion Assessment Method (CAM). Patients were excluded preoperatively if they met criteria for delirium. Variables related to demographic data, previous diseases, medications were recorded and EuroSCORE II calculated the risk of surgical mortality for each patient. Results of preoperative tests, like ECG, echocardiography, cardiac catheterization, carotid Doppler ultrassound and laboratory tests were also recorded. During the surgery, variables were ECC (extracorporeal circulation) and aortic clamping time, duration of surgery and anesthesia, and blood products were also recorded. Postoperative variables analyzed were: the orotracheal intubation time (OIT), length of stay in the ICU, renal dysfunction and hypoxemia. The postoperative delirium was accessed by CAM-ICU. Mortality from any cause, infection and perioperative myocardial infarction, identified until hospital discharge or 30 days after surgery were predefined as the composite endpoint. During a follow up of 12 to 18 months, a new assessment using MMSE and VFT were held; events such as, deaths, readmissions and dementia were recorded. Multivariate analysis was performed by multiple logistic regressions to identify independent variables. Patients aged 69.5 ± 5.8. About 75.14% were hypertensive; 39.88% were diabetic. The mean EuroSCORE II was 4.06±3.86. About 30.06% were illiterate; an average 3.05 ± 3.08 years of school. In 70% of cases, delirium was detected at the first two days after surgery with an incidence of 34.1%. The degree of literacy (OR = 0,81; 95% CI 0,71 - 0,92; p=0,002), hypertension (OR = 2,73; 95% CI 1,16 - 6,40; p=0,021) and mitral valve disease (OR = 2,93; 95% CI 1,32 - 6,50; p=0,008) were independently associated with delirium. Longer ICU length of stay (OR=1,18; 95% CI 1,07 - 1,30; p=0,001) was also independently associated with delirium as a precipitation factor. Delirium was an independent risk factor for the composite outcome (OR = 2.35; 95% CI 1.20 - 4.58 and p = 0.012); OIT > 900 minutes (OR = 2.50; 95% CI 1.30 - 4.80; p = 0.006) after multivariate analysis. There was no relationship between delirium and mortality after hospital discharge, as well as, dementia or hospital readmission during follow up

abstract: Aortic aneurysms and dissections are life threatening conditions addressed by replacing damaged sections of the aorta. Blood circulation must be halted to facilitate repairs. Ischemia places the body, especially the brain, at risk of damage. Deep hypothermia circulatory arrest (DHCA) is employed to protect patients and provide time for surgeons to complete repairs on the basis that reducing body temperature suppresses the metabolic rate. Supplementary surgical techniques can be employed to reinforce the brain's protection and increase the duration circulation can be suspended. Even then, protection is not completely guaranteed though. A medical condition that can arise early in recovery is postoperative delirium, which is correlated with poor long term outcome. This study develops a methodology to intraoperatively monitor neurophysiology through electroencephalography (EEG) and anticipate postoperative delirium. The earliest opportunity to detect occurrences of complications through EEG is immediately following DHCA during warming. The first observable electrophysiological activity after being completely suppressed is a phenomenon known as burst suppression, which is related to the brain's metabolic state and recovery of nominal neurological function. A metric termed burst suppression duty cycle (BSDC) is developed to characterize the changing electrophysiological dynamics. Predictions of postoperative delirium incidences are made by identifying deviations in the way these dynamics evolve. Sixteen cases are examined in this study. Accurate predictions can be made, where on average 89.74% of cases are correctly classified when burst suppression concludes and 78.10% when burst suppression begins. The best case receiver operating characteristic curve has an area under its convex hull of 0.8988, whereas the worst case area under the hull is 0.7889. These results demonstrate the feasibility of monitoring BSDC to anticipate postoperative delirium during burst suppression. They also motivate a further analysis on identifying footprints of causal mechanisms of neural injury within BSDC. Being able to raise warning signs of postoperative delirium early provides an opportunity to intervene and potentially avert neurological complications. Doing so would improve the success rate and quality of life after surgery. / Dissertation/Thesis / Doctoral Dissertation Electrical Engineering 2020

Bakgrund: Postoperativ smärta är en subjektiv upplevelse och ett globalt, etiskt och samhällsekonomiskt problem. Alla patienter upplever smärta och smärtlindring på olika sätt och vårdpersonal anser samtidigt att postoperativ smärta är det största hindret för postoperativt välmående. Syfte: Syftet var att beskriva patienters upplevelser av smärta och smärtlindring i det postoperativa förloppet. Metod: Litteraturstudie med tio kvalitativa studier som identifierades via PubMed och CINAHL. Analysmetod: induktiv innehållsanalys där tre kategorier identifierades: Information, Bemötande och kommunikation samt Andra faktorer som påverkar smärta. Resultat: De flesta deltagare upplevde smärta i mer eller mindre hög utsträckning. Ett fåtal upplevde det postoperativa förloppet helt smärtfritt. Adekvat information inför och efter operation upplevdes som positivt i smärthanteringen, medan otillräcklig eller motsägelsefull information bidrog till osäkerhet och sämre hantering av smärta. Gott bemötande och god kommunikation av vårdpersonal upplevdes lindra lidandet medan dåligt bemötande och dålig kommunikation hindrade deltagarna från att be om smärtlindring. Det upplevdes som en brist att ej få tillräckligt mycket smärtlindring och att ej få smärtlindring i tid. Samtidigt kunde smärtlindring orsaka både trötthet och illamående. Delaktighet i den egna vården var individuell och upplevdes viktig för vissa och som en börda för andra. Deltagare som levt med kronisk ortopedisk smärta kunde uppleva den postoperativa smärtan som mindre svår än de föreställt sig och hade goda copingstrategier. Andra som levt med kronisk smärta upplevde den postoperativa smärtan som värre än väntad. Slutsats: Smärta i det postoperativa förloppet är en subjektiv och mångfacetterad förnimmelse som påverkar varje enskild individ på olika sätt. Hur smärtan upplevs kan både förstärkas och minskas genom ett flertal faktorer. Ej tillräckligt behandlad postoperativ smärta är idag en vanligt företeelse. Sjuksköterskan och sjukvården i stort har därför ett ansvar att kontinuerligt säkerställa kompetens om den, för individen unika företeelsen smärta, i det postoperativa förloppet och bidra till mer kunskap i ämnet genom fortsatt forskning för lindrat lidande i den postoperativa vården. / Background: Postoperative pain is a subjective experience that is a global, ethical and socio-economic problem. All patients’ experience pain and analgesia in different ways and pain is at the same time considered by health professionals to be the greatest obstacle for postoperative wellbeing. Purpose: The aim was to describe patients’ experience of pain and analgesia in postoperative care. Method: A literature study with ten qualitative studies via PubMed and CINAHL. Analysis method: inductive content analysis where three categories were identified: Information, personal treatment and communication and Other factors that affects pain. Result: Most participants experienced pain in a more or less high extent. A few experienced the time in postoperative care completely painless. Adequate information before and after surgery was experienced as positive in the pain management, whilst inadequate or contradictory information contributed to uncertainty and worse pain management. Good personal treatment and good communication with the nursing staff was experienced to relieve suffering, whilst bad personal treatment and bad communication inhibited the participants from asking for analgesia. Not getting enough pain relief and not getting pain relief in time was perceived as a flaw. At the same time, pain relief could cause both fatigue and nausea. Participation in the patients’ own self-care was individual and perceived as important so some and as a burden to others. Participants living with chronic orthopedic pain were able to experience the postoperative pain as less severe than they imagined and had good coping strategies for pain. Others who lived with chronic pain experienced the postoperative pain as worse than expected. Conclusion: Pain in the postoperative care pathway is a subjective and multifaceted experience that affects each individual in different ways. How the pain is experienced can be both enhanced and reduced by a number of factors. Inadequate post-operative pain is a common occurrence today. The nurse and the healthcare as a whole therefore have a responsibility to continuously ensure competence about pain, which is unique to the individual, the phenomenon of pain, in the postoperative care pathway and to contribute to more knowledge in the subject through further research for relieved suffering in postoperative care.

Introduction Previous study investigating Emergency Department (ED) visits rate and admission rates in bariatric patients’ post-surgery shows a 2-year admission rate of 26%. Aim The primary aim of this study was to assess the number of ED visits and admissions as well as examine if there is a correlation with comorbidities, education level, quality of life, and image method used. The secondary aim was to compare the ED and admission rate between the cohort and the general population. Methods This retrospective study included a total of 190 patients. They were followed for 2 years. All the patients were operated on during 2017 in Region Örebro. The cohort and data were obtained from the Scandinavian Obesity Surgery Registry and data concerning ED visit and admittance rate was collected by reviewing medical records. Results The ED visit rate was 116 (61%) and the admittance rate was 76 (40%). Poor mental health, low education level and smoking were correlated to a higher degree of admittance and ED visit rate. There were more imagining used in the group that visited the ED or got admitted. The most common diagnoses were symptoms related to the digestive system and abdomen. The study population had a higher degree of admittance and ED visit rate than the general population. Conclusions Rate of admittance seem to be correlated to factors related to socioeconomic status. More research is needed to investigate what intervention would help this subgroup most, so they don’t have to seek medical care to the same degree.

Bakgrund: Konfusion är ett akut förvirringstillstånd som är vanligt förekommande efter kirurgi där en desorientering av tid, rum, situation eller person sker vilket kan leda till längre vårdtider, ett ökat behov av rehabilitering samt en ökad dödlighet. Detta innebär dels ett lidande för patienten, men även en ökad belastning på vården med ökade kostnader på grund av den längre vårdtiden. Genom att förebygga postoperativ konfusion skulle de negativa konsekvenserna kunna förhindras och patientens lidande därmed minska. Syfte: Syftet med studien var att identifiera vilka icke-farmakologiska åtgärder som beskrivs i vetenskaplig litteratur för att förebygga postoperativ konfusion på somatiska vårdavdelningar.  Metod: En deskriptiv litteraturstudie som baserats på tio kvantitativa originalartiklar publicerade år 2015–2020. Databaserna som användes var PubMed och Cinahl. Artiklarnas kvalitet granskades och de sammanställda artiklarnas resultat analyserades och resultatet delades in teman och kategorier för ge en bättre överblick inom området.  Resultat: Som förebyggande åtgärder för postoperativ konfusion identifierades i det sammanvägda resultatet fem teman. Dessa var kunskap, orientering, miljö, basal omvårdnad och smärta. Inom temana identifierades även kategorier där kommunikation, utbildning av personal samt ett nära samarbete med närstående visades vara en viktig del i att förebygga postoperativ konfusion på somatiska vårdavdelningar.  Slutsats: Med icke-farmakologiska förebyggande åtgärder riktade mot kunskap, orientering, miljö, basal omvårdnad och smärta kunde fler fall av postoperativ konfusion förebyggas. Genom detta kunde därmed även patientens lidande och belastningen på vården minskas. / Background: Delirium is an acute state of confusion that is common post surgery where a disorientation of time, situation and person occurs which can lead to longer length of stay, an increased need for rehabilitation and an increased mortality. This leads to suffering for the patient but also an increased burden on healthcare. By preventing postoperative delirium the negative consequences could be avoided and the suffering of the patient thereby decrease. Aim: The aim of this study was to identify non-pharmacological measures that are described in scientific literature to prevent postoperative delirium in somatic wards.    Methods: A descriptive literature study based on ten quantitative peer reviewed articles published between 2015–2020. The databases that were used were Pubmed and Cinahl. The compiled results were evaluated and the compiled results were analyzed and then categorized into themes to give a better overview of the field.  Results: As preventive measures for postoperative delirium five themes were identified in the result. These were knowledge, orientation, environment, nursing care and pain. Within these themes categories were also identified and communication, staff education and a close cooperation with relatives were an important part in preventing postoperative delirium in somatic wards.   Conclusion: With non-pharmacological preventive measures aimed towards knowledge, orientation, environment, nursing care and pain more cases of postoperative delirium could be prevented. These preventive measures could thereby decrease the patients suffering and the burden on healthcare.

Die Prävalenz von Adipositas steigt seit Jahren global immer weiter an, so auch die Anzahl an Patienten, die konservativ oder durch bariatrische Chirurgie massiv an Gewicht verlieren. Da dieser extreme Gewichtsverlust mit starken Hautüberschüssen verbunden ist, die häufig mit großen funktionellen, hygienischen und mentalen Belastungen einhergehen, unterziehen sich immer mehr Patienten der körperformenden Chirurgie, insbesondere der rekonstruktiven Abdominoplastik, zur Wiederherstellung einer natürlichen äußeren Bauchdecke. Die vorliegende Studie analysiert retrospektiv die Komplikationen dieser Operation, die prä-, intra- und postoperativen Risikofaktoren sowie die persönliche Entwicklung der postoperativen Lebensqualität mittels eines validierten Fragebogens, um langfristig bessere Operationsergebnisse mit geringerer Komplikationsrate und höherer Patientenzufriedenheit erzielen zu können. Die Komplikationsanalyse der 101 Bauchdeckenstraffungen ergab eine hohe Anzahl von Lokalkomplikationen, insbesondere Seromen und Wundinfektionen. Die Möglichkeit, die Seromrate mit der Verwendung von intraoperativen Progressive Tension Sutures zu reduzieren, soll an dieser Stelle erwähnt sein. Die Gabe einer intravenösen präoperativen Single Shot Antibiose zur Infektionsprophylaxe mit gezielter Antibiotikatherapie bei akuter Infektion sollte beibehalten werden. Darüber hinaus sei bei Entstehung eines Hämatoms immer an die hohe Wahrscheinlichkeit der akuten Blutung und die eventuelle Notwendigkeit einer unmittelbaren Revisionsoperation gedacht. Als signifikante Einflussfaktoren für das Auftreten postoperativer Komplikationen erwiesen sich ein hoher präoperativer BMI, die Operationstechnik, die intraoperative Resektionsmenge, die Operationsdauer (SN- Zeit) sowie die Verwendung des epidermalen Vakuumverbandes auf die primär verschlossene Schnittwunde bei Hochrisikopatienten. Diese Beobachtungen sollen Anlass sein, über die Festlegung einer Obergrenze des präoperativen BMI auf 30 kg/m2 als ungefähre Zielwerte nachzudenken. Ein Grenzwert für die intraoperative Resektionsmenge empfinden wir als in der Praxis nicht umsetzbar. Es lässt sich außerdem schlussfolgern, dass die Vakuumtherapie in unserer Studie zwar keine Vorteile gegenüber dem herkömmlichen Wundverschluss in der Gesamtkomplikationsrate zeigte, jedoch in Zusammenschau mit der Literatur durchaus als vorteilhaft hinsichtlich der Komplikationsprävention und optimierter Wundheilung anzusehen ist. Bei der Wahl der Operationstechnik sprechen wir hinsichtlich der signifikant niedrigeren Komplikationsrate und der besseren Entwicklung von postoperativer Lebensqualität und Zufriedenheit eine klare Empfehlung für die Lipoabdominoplastik aus. Der zirkuläre Bodylift sollte durch komplikationsärmere OP- Methoden oder ein zweizeitiges Vorgehen in Kombination mit Liposuktion abgelöst werden. Beim Auftreten postoperativer Komplikationen war überdies die stationäre Aufenthaltsdauer signifikant verlängert. Sowohl Patienten mit sehr hohem Grad auf der Pitsburgh Rating Scale, als auch Patienten, die postoperativ ihr Gewicht halten oder weiter reduzieren konnten, wiesen eine signifikant bessere Entwicklung der postoperativen Lebensqualität und Zufriedenheit nach Abdominoplastik auf. Frauen, Ältere, Patienten mit Resektionsmengen von ungefähr 3000g und Patienten mit V.A.C.®- Wundverschluss zeigten sich tendenziell zufriedener und schätzten ihre Lebensqualität im Patientenfragebogen etwas höher ein. Die PRS, als Klassifikationssystem für präoperative Hautüberhänge, etablierte sich zudem als gute Grundlage für die Wahl des Operationsverfahrens und Abschätzung von Resektionsmenge und SN- Zeit. Insgesamt demonstrierte die Analyse des validierten Patientenfragebogens eine hohe Patientenzufriedenheit. 83% der befragten Patienten sahen durch die Abdominoplastik eine Verbesserung ihrer Lebensqualität, 86% würden die Operation wieder machen lassen oder einem Freund weiterempfehlen.