Bakgrund: Operationssjukvården kännetecknas av en högteknologisk arbetsmiljö där operationssjuksköterskan har ett stort ansvar för patienten. Fokus är att se och skydda hela patienten för att förebygga vårdlidande till följd av vårdskada. Genom att ha ett vakande öga på omgivningen kan olika riskfaktorer förebyggas. Det finns omfattande forskning som berör området, men det är sparsamt studerat utifrån operationssjuksköterskans erfarenheter och hur hen anser att olika faktorer pre- och intraoperativt kan påverka patientsäkerheten. Syfte: Syftet var att utifrån operationssjuksköterskans erfarenheter synliggöra  faktorer som påverkar patientsäkerheten pre- och intraoperativt. Metod: En systematisk litteraturstudie genomfördes i enlighet med Bettany-Saltikov och McSherry (2016). För att få en djupare tolkning och förståelse av valt problemområde användes en induktiv och kvalitativ ansats. I analysen ingick tolv stycken vetenskapliga artiklar som sammanställdes till ett resultat. Resultat: Resultatet visade att det fanns många faktorer som spelade en betydande roll för patientsäkerheten, både pre- och intraoperativt. Fyra huvudkategorier framkom i resultatet; arbetsmiljöns betydelse, teamets betydelse, planering och förberedelse och yrkesspecifik kompetens. Slutsats: Att arbeta som operationssjuksköterska innebar att ha fullt fokus på både patienten och omgivningen för att på så vis förebygga riskfaktorer. Det fanns flera faktorer som påverkade patientsäkerheten pre- och intraoperativt, både positiva och negativa. En faktor var att arbetsmiljön speglades av hög arbetsbelastning och stress vilket var ett stort bekymmer. En annan faktor visade att samarbetet inom operationsteamet påverkades av hur vi bemöter varandra. Genom att bemöta varandra med respekt främjades ett gott samarbete och därmed en säkrare vård. / Background: The surgical care is characterized by a hich-tech work environment where the operating theatre nurse has a great responsibility for the patient. The focus is on seeing and protecting the entire patient in order to prevent suffering of the patient as a result of adverse event. By keeping a watchful eye on the environment various risk factors can be prevented. There is a lot of research that concerns the area, but it is very sparingly studied on the basis of the operating theatre nurse experiences and how they consider that different factors pre- and intraoperatively affect patient safety. Purpose: The purpose was to make visible factors that affect patient safety pre- and intraoperatively, based on operating theatre nurse experiences. Method: A systematic literature review was conducted in accordance with Bettany-Saltikov and McSherry (2016). In order to get a deeper interpretation and understanding of the chosen problem area, an inductive and qualitative approach was used. The analysis included twelve scientific articles that were compiled into a result. Result: The result showed that there were many different factors that played a considerable role in patient safety, both pre- and intraoperatively. Four main categories emerged from the result; the importance of the working environment, the importance of the team, planning and preparation and professional-specific skills. Conclusion: Working as an operating theatre nurse meant having full focus on both the patient and the environment in order to prevent risk factors. There were several factors that affect patient safety pre- and intraoperatively, both positive and negative. One factor was that the working environment was characterised by high workload and stress, wich was a major concern. Another factor showed that the cooperation within the operation team was influenced by how we respond to each other. By responding to each other with respect, good cooperation and thus a safer care was promoted.

Trata-se de um estudo descritivo prospectivo, com abordagem quantitativa, sobre as complicações de estoma e de pele periestoma de estomizados intestinais em seguimento ambulatorial, que teve como objetivos caracterizar o perfil sociodemográfico e clínico desta clientela em um hospital universitário de ensino público; descrever a presença de fatores de risco descritos na literatura científica para esta clientela; e analisar a presença de complicações de estoma e de pele periestoma nesta clientela (CEP/EERP 383.771). Os critérios de inclusão da amostra foram pacientes maiores de 18 anos, independente da raça, classe social e sexo, com estomias intestinais e em seguimento ambulatorial no período da coleta de dados e o critério de exclusão foi paciente com instabilidade clínica. A amostra de conveniência foi composta por 56 estomizados. Utilizou-se instrumento de coleta de dados, contemplando dados sociodemográficos, clínicos e terapêuticos, assim como presença de complicações de estoma e pele periestoma e utilização de equipamentos coletores e adjuvantes. A coleta de dados ocorreu no período de setembro de 2013 a fevereiro de 2014. Foi criado um banco de dados no Excel, mediante dupla digitação, cuja análise estatística descritiva foi realizada pelo Programa SPSS, versão 17.0, com frequência absoluta, relativa e percentual. Os resultados evidenciaram distribuição equitativa em relação ao sexo, média de idade de 56,2 anos, predomínio das neoplasias colorretais 31 (55,4%), de normalidade do índice de massa corporal 47 (83,9%), presença de comorbidades 7 (12,5%), realização de quimioterapia adjuvante 15 (26,8%), cirurgias de grande porte 43 (76,8%) e demarcação pré-operatória 43 (76,8%) e 21 (37,5%) pacientes com complicações de estoma e pele periestoma. Do total de 43 (76,8%) demarcados, 14 (32,6%) apresentaram complicações, enquanto que nos 13 (23,2%) não demarcados, 7 (53,8%) tiveram complicações. Em relação aos equipamentos coletores e adjuvantes 51 (91%) utilizavam bolsa de duas peças, drenável 51 (91%), base flexível 31 (55,4%), cinto 40 (71,4%) e barreira protetora 1 (1,8%). Os fatores de risco para complicações de estoma e de pele periestoma como idade avançada, comorbidade, localização do estoma, não demarcação de estoma e não utilização de barreiras protetoras foi verificada na amostra. Conclui-se que no seguimento ambulatorial desta clientela, há necessidade de avaliação periódica e sistematizada em relação ao autocuidado, indicação dos equipamentos coletores e adjuvantes com adaptação às necessidades de cada paciente, além da identificação dos fatores de risco para prevenção destas complicações / This is a prospective descriptive study with a quantitative approach, on the complications of the stoma and peristomal skin of ostomy intestinal outpatients, we aimed to characterize the sociodemographic and clinical profile of the clientele in a university hospital in public education; describe the presence of risk factors described in the scientific literature for this clientele; and analyze the presence of complications of the stoma and peristomal skin in this clientele (CEP / EERP 383 771). The inclusion criteria for the sample were patients older than 18 years, regardless of race, social class and gender, with intestinal stomas and in outpatients in the period of data collection and the exclusion criteria were patients with clinical instability. The convenience sample consisted of 56 ostomates. Instrument was used for data collection, covering sociodemographic, clinical and therapeutic data, as well as the presence of complications of the stoma and peristomal skin and use of equipment and aids collectors. Data collection occurred from September 2013 to February 2014. A database in Excel, by double entry, whose descriptive statistical analysis was performed using SPSS, version 17.0, with absolute, relative and percentage frequency was created. The results showed equal distribution in relation to sex, average age of 56.2 years, prevalence of colorectal neoplasms 31 (55.4%), normal body mass index 47 (83.9%), presence of comorbidities 7 (12.5%) accomplishment of adjuvant chemotherapy 15 (26.8%), large surgeries 43 (76.8%) and preoperative demarcation 43 (76.8%) and 21 (37.5%) patients with complications of the stoma and peristomal skin. Of 43 (76.8%) demarcated, 14 (32.6%) had complications, whereas in 13 (23.2%) unmarked, 7 (53.8%) had complications. Regarding equipment collectors and adjuvants 51 (91%) used two-piece pouch, drainable 51 (91%), flexible base 31 (55.4%), belt 40 (71.4%) and protective barrier 1 (1, 8%). Risk factors for complications of the stoma and peristomal skin such as age, comorbidity, location of stoma, no demarcation of stoma and non-use of protective barriers was seen in the sample. It is concluded that, for the outpatients, there is need for regular and systematic review in relation to self-care, statement of collectors equipment and aids to adapt to the needs of each patient during follow-up of this clientele, in addition to the identification of risk factors for prevention of these complications

Submitted by Erika Demachki (erikademachki@gmail.com) on 2017-01-18T14:52:54Z No. of bitstreams: 2 Dissertação - Charlise Fortunato Pedroso - 2016.pdf: 1888405 bytes, checksum: 7e4406a4bbeeb6bce12caecdf06bb72b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-19T10:30:24Z (GMT) No. of bitstreams: 2 Dissertação - Charlise Fortunato Pedroso - 2016.pdf: 1888405 bytes, checksum: 7e4406a4bbeeb6bce12caecdf06bb72b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-01-19T10:30:24Z (GMT). No. of bitstreams: 2 Dissertação - Charlise Fortunato Pedroso - 2016.pdf: 1888405 bytes, checksum: 7e4406a4bbeeb6bce12caecdf06bb72b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-04-14 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Reports of pain in the preoperative period are frequent and may be influenced by socioeconomic, clinical, psychological and behavioral factors and by health conditions. However, little is known about this pain in the preoperative period of cesarean section, one of the surgeries performed more frequently in the global surgical setting. The aim of the study was to identify the prevalence, characteristics and factors associated with pain in the preoperative period immediately prior to cesarean section. This was a cross-sectional analysis of data from the baseline of research matrix, cohort study, open and prospective, the data of which were collected in the wards and apartments of a private hospital, contracted to the Health Unic System (SUS), of the city of Goiânia, Brazil. The recruitment of women (n = 1082) was made between February 2014 and July 2015. The study sample consisted of 877 women. The outcome variable investigated was the report of any pain reported by women in the immediate preoperative period. The pain characteristics include intensity, measured by means of numeric pain scale of 11 points (END) which allows the intensity measured by numbers representing the amount of pain felt (zero (0) = no pain; 1 , 2.3 and 4 = mild pain; 5:06 = moderate pain, 7.8 and 9 = severe pain, and ten (10) = worst possible pain), location; onset and duration of painful episodes. The associated variables were: symptoms of anxiety and depression, assessed through the Hospital Anxiety and Depression Scale (HADS), as well as sociodemographic, clinical and behavioral variables and health related conditions. For the statistical analysis, logistic regression was used to identify factors associated with preoperative pain. In the multivariate analysis, variables that presented p-values <0,10 were included. For all tests p-values <.05 were considered significant. The prevalence of preoperative pain was 27.5% (CI: 95%:24.6-30.5). The locations most mentioned by the women included the lower back (29.9%), pelvic/genital region (22.4%) and head (12.9%). The pain appeared with more prevalence in the final trimester of pregnancy (37.8%), being considered by the majority of the participants as a daily complaint (68.5%). The intensity was classified as strong in 44.8% of cases. Preoperative pain was associated with pregnancyrelated pain (OR: 3.50; 2.23-5.252) and symptoms of anxiety (OR: 1.61; 1.14-2.28; p=.006). The evaluation of pain in the preoperative period should include negative aspects, such as anxiety, in order to use therapies for its management proper. In the prenatal care, it is essential to evaluate the characteristics of pain that arises after the confirmation of the pregnancy, in order to implement strategies to avoid prolonged contact with this experience and consequent impairments in the postoperative period. Nurses are responsible for part of this mission, together with obstetric nurses, who can and should fulfill their role as promoters of health / Relatos de dor no período pré-operatório são frequentes e podem sofrer influência de fatores socioeconômicos, clínicos, psicológicos e de comportamentos e condições de saúde. No entanto, pouco se conhece sobre a dor referida no período pré-operatório de cesariana, uma das cirurgias realizadas com maior frequência no cenário cirúrgico mundial. O objetivo da pesquisa foi identificar a prevalência, as características e os fatores associados à dor referida no período pré-operatório imediato de cesariana. Trata-se de análise transversal de dados da linha de base da pesquisa matriz, tipo coorte, aberta e prospectiva, cujos dados foram colhidos nas enfermarias e apartamentos de um hospital privado, conveniado ao Sistema único de Saúde, no município de Goiânia, Goiás, Brasil. O recrutamento das mulheres (n=1082) foi feito entre fevereiro de 2014 e julho de 2015. A amostra deste recorte compôsse de 877 mulheres. A variável de desfecho investigada foi o relato de qualquer dor referida pelas mulheres no período pré-operatório imediato. As características da dor incluíram a intensidade, mensurada por meio da Escala Numérica de Dor de 11 pontos (END), a qual permite a medida da intensidade por meio de números que representam a quantidade de dor sentida (0 (zero)=nenhuma dor; 1,2,3 e 4=dor leve; 5 e 6=dor moderada; 7,8 e 9=dor forte; e 10 (dez)=pior dor possível), localização; início e duração dos episódios dolorosos. As variáveis de associação foram: sintomas de ansiedade e depressão, avaliados por meio da Escala Hospitalar de Ansiedade e Depressão (HADS), além de variáveis sociodemográficas, clínicas, comportamentos e condições relacionados à saúde. Para análise estatística, foi utilizada a regressão logística a fim de identificar os fatores associados à dor pré-operatória. Na análise multivariada, as variáveis que apresentaram valores de p<0,10, foram incluídas. Valores de p<0,05 foram considerados significativos para todos os testes. A prevalência de dor pré-operatória foi de 27,5% (IC:95%:24,6-30,5). Os locais mais referidos pelas mulheres incluíram a região lombar (29,9%), pélvica/genital (22,4%) e cabeça (12,9%). A dor apareceu com maior prevalência no último trimestre de gestação (37,8%), sendo considerada pela maioria das participantes como uma queixa diária (68,5%). A intensidade foi classificada como forte em 44,8% dos casos. Dor pré-operatória esteve associada com dor relacionada à gestação (OR:3,50; 2,23-5,252) e sintomatologia para ansiedade (OR:1,61;1,14-2,28; p=0,006). A avaliação da dor no período pré-operatório inclui comportamentos negativos como a ansiedade, com vistas à utilização de terapêuticas para o adequado manejo. No pré- natal é fundamental a avaliação da dor que surgiu após a constatação da gravidez e suas características, a fim de implementar estratégias que contribuam na redução de convívio com essa experiência e, consequentemente, com os prejuízos no pós-operatório. Ao enfermeiro cabe parte dessa missão, juntamente com as enfermeiras obstetrizes, que podem e devem ocupar seu papel de promotoras da saúde.

Höftkirurgi är ett vanligt ingrepp både som elektivt och akut. Sjuksköterskans arbete inkluderar preoperativ information vilken oftast ges muntligt. Studier visar att smärta ofta är ett problem postoperativt. Tidigare forskning har även kommit fram till att patienter önskar vara välinformerade om det postoperativa förloppet för att kunna vara delaktiga i sin egen vård. Syfte : Syftet var att utifrån aktuell forskning undersöka betydelsen av olika sätt att informera patienter preoperativt avseende smärta och smärtbehandling för patientens postoperativa smärtupplevelse vid höftkirurgi. Metod : En litteraturöversikt gjordes genom att söka artiklar på databaserna CINAHL och PubMed. En granskningsmall användes där valda artiklar kvalitetsgranskades och endast artiklar av minst medelhög kvalitet användes. Arbetet grundas på 17 artiklar som delades in i huvudkategorierna elektiv, akut, information och smärta. Resultat : Ett samband mellan preoperativ information och postoperativ smärta hittades i 13 artiklar. Sambandet visar att den givna informationen skapade förutsättningar för patienterna att hantera den postoperativa smärtan. Vid elektiv kirurgi fanns bättre förutsättningar för patientaktiverande preoperativa utbildningar. Preoperativa individuella strategier identifierades. Slutsats : Merparten av studierna syftar till att preoperativ information används för att kunna minska postoperativ smärta genom att öka patienternas delaktighet och copingförmåga. Då samband hittats hos de flesta av artiklarna i denna litteraturstudie stärker detta sannolikheten att det finns ett samband mellan sjuksköterskans preoperativa information och patientens postoperativa smärtupplevelse. / Hip surgery is a common operation, for both elective and acute approach. Nurses’ duties includes pain prevention and information to the patient. This with the patient always in focus. Studies have shown that it is most common to give the information verbally, and that patients want to know more preoperative about the postoperative phase to be more involved. Aim : The purpose of this literature review was to investigate the importance of nurses’ preoperative information for postoperative pain management. Methods : For the research the database CINAHL and PubMed was used. A review template was used, and only the articles with a medium high score has been used. This work is based on 17 articles which has been divided in main categories that was elective, acute, information and pain. Results : A relationship between preoperative information and postoperative pain was found in 13 of the articles. This connection indicate that the given information provided the patients to manage their postoperative pain. Patients undergoing elective surgery was better prepared and was given more patient activated education preoperative than acute surgery. Preoperative individual strategies was identified. Conclusion: Most of the studies showed that preoperative information is used to reduce postoperative pain by increasing patients’ participation and their ability to cope better. Since a connection was found between most of the articles in this work it increases the likelihood that there is a relationship between nurses’ preoperative information and patients’ postoperative pain experience.

SAMMANFATTNING Bakgrund De allt kortare vårdtiderna inom sjukvården ställer höga krav på patientinformationen som ges pre- och postoperativt. Forskning visar att patienternas informationsbehov inte alltid överensstämmer med mängden information som ges. Patienter upplever ofta att informationen som ges är otillräcklig och saknar relevans. God pre- och postoperativ information har många fördelar, då den leder till såväl ökad trygghet som bättre förutsättningar i det postoperativa förloppet.   Syfte Syftet med denna studie var att undersöka hur kirurgiska patienter vid en hudmottagning och en urokirurgisk vårdavdelning uppfattade den pre- och postoperativa information de fick i samband med kirurgi.   Design Studien var en enkätstudie med kvantitativ ansats och inkluderade 30 respondenter.   Resultat Resultatet visade att huvuddelen av patienterna uppgav att de hade läst den skriftliga informationen de fick. De hade också uppfattat att informationen var lättillgänglig. Majoriteten tyckte att den totala mängden information var tillräcklig. Vidare svarade majoriteten att de hade fått tillräcklig information om smärtlindring under vårdtiden. Hälften av respondenterna angav att de hade fått tillräcklig information om hur de kunde förebygga komplikationer. Ungefär hälften uppgav att de inte hade fått tillräcklig information om sårvård.   Slutsats Av resultatet drogs slutsatsen att patientinformationen som ges på de två enheterna verkar vara lättförståelig och tillräckligt omfattande, dock finns utrymme för förbättring, framförallt inom området komplikationer och sårvård. / ABSTRACT Background The shorter length of stay in hospitals place greater demands on the patient information that is given pre- and postoperative. Research shows that the amount of given information does not match with the patients’ informational needs. Patients often experience the given information as inconclusive and irrelevant. Good pre- and postoperative information has many benefits. It leads both to an increased sense of security and to better postoperative outcomes.   Purpose The purpose of the current study was to explore how surgical patients at a dermatology outpatient facility and an acute care urological surgery ward perceived the pre- and postoperative information in connection with the surgery.   Design The study was a quantitative survey and included 30 participants.   Findings The results showed that the majority of the patients stated that they had read the written pre- and postoperative information that they had received. They had also perceived the information as easily available. The majority of the patients reported that the total amount of the information was sufficient. Furthermore, the majority also replied that they had received sufficient information about relieving their pain during the hospital stay. Half of the subjects stated that they had received enough information about how to prevent complications. Half of the subjects claimed that they had not received enough information about wound care.   Conclusions Based on the results, it could be concluded that the patient information that was given at the two clinics appears to be easily understood and sufficiently extensive, though there is room for improvement, especially within the area of complications and wound care.

Syfte: Att undersöka hur patienter på ett universitetssjukhus uppfattar information gällande preoperativ dusch samt patientens genomförande av duschen på avdelningen. Introduktion: Vårdrelaterade infektioner är vanliga och kan leda till ökade kostnader, långvarig sjukhusvistelse och ökad lidande för patienter. Ett sätt att förhindra detta är att duscha med klorhexidin före operation. Det är sjuksköterskans ansvar att informera patienten om den preoperativa duschen, kontrollera att patienten uppfattat informationen och har möjlighet och resurser att följa den. Metod: En kvalitativ deskriptiv intervjustudie med semistrukturerade frågor. Materialet analyserades enligt Granheim och Lundmans beskrivning av innehållsanalys på manifest nivå. Urvalet utfördes genom bekvämlighetsurval. Deltagarna i studien var 12 patienter. Resultat: Deltagarna var övergripande nöjda med informationen om den preoperativa duschen. De kände att de hade fått tillräcklig information och att den var lättförståelig. Patienternas hade uppfattat informationen på olika sätt. Utförandet av duschen, uppfattning om särskilt viktiga delar på kroppen och vad patienterna upplevde som viktigt att tänka på efter duschen varierade. Slutsats: Information måste individanpassas och sjuksköterskan bör se till att patienten förstår informationen genom att be patienten återberätta informationen. / Aim: To investigate how patients in a university hospital in Sweden perceive the information about the preoperative shower and the patients execution of the shower in the hospital ward. Introduction: Healthcare-associated infections are common and can lead to increased costs, prolonged hospital stay and increased patient suffering. One way to prevent this is to shower with chlorhexidine before surgery. It’s the nurses’ responsibility to give the patient information about the preoperative shower and check that the patient knows about the shower procedure and is able to follow the instructions. Method: A qualitative descriptive interview study with semi-structured questions. The material was analyzed according to Granheim and Lundman's description of content analysis on a manifest level. The selection was carried out by convenience sample. Participants in the study were 12 patients. Results: Participants were overall satisfied with the information about the preoperative shower. They felt they had sufficient information and that it was easy to understand. Patients understood the information in different way. The performance of the shower, the knowledge of key areas of the body and what the patients experienced as important to consider after the shower varied. Conclusion: Information must be individually adapted and the nurse should ensure that the patient understands the information by asking to retell the information.

Syftet med denna litteraturstudie var att beskriva hur patienter upplever information inför gynekologiska ingrepp och undersökningar. Metoden som användes för att belysa syftet var beskrivande litteraturstudie. Data insamlades via två databaser, Medline och Cinahl. Andra sökstrategier var manuell sökning i valda källor. 15 vetenskapliga artiklar inkluderades i resultatet, dessa kvalitetsgranskades, analyserades och sammanställdes. Huvudresultat: Resultatet visade att vissa kvinnor saknade information om olika behandlingsalternativ, information om förberedelser samt information om postoperativa perioden. Många kvinnor tyckte dock att denna information varit bra. Många tyckte information angående indikationer för operation som bra, många ville inte ha för detaljerad information, vissa saknade information för att kunna ställa följdfrågor och kvinnor tyckte information om bl.a. kirurgisk teknik var bra. Kvinnorna var ofta nöjda med informationen och att lita till vårdpersonalen. Kvinnorna upplevde oftast den givna informationen som tillräcklig. Slutsats: Författarna anser att vidare forskning bör bedrivas inom området då det i studien framkommit att kvinnor många gånger saknar information kring sin undersökning samt ingrepp. Då upplevd informationsbrist kan göra att hela vårdupplevelsen blir lidande behövs vidare studier och då främst om hur informationen når patienten bäst då vi sett att information som finns hos personalen inte kommer patienten till nytta alla gånger. / The purpose of this study was to describe how patients perceive information prior gynecological surgery and examinations. Method: The method used to illuminate the purpose was descriptive literature. Data were collected via two databases, Medline and Cinahl. Other search strategies were manual search of selected sources. 15 numbers of articles were included in the result. Quality was reviewed, analyzed then summarized. Main results: Results showed that some women lacked information about treatment options, information about preparation and information about the postoperative period. Many felt that this information was good. Many thought that the information about indications for surgery were good, many women didn´t want the information to detailed, some lacked information to come up with additional questions and women thought that the information about such as surgical technique was good. Women were often satisfied with the information and with trusting the caregivers. Women usually experienced the given information to be adequate. Conlusion: The authors believe that further research should be conducted in the area where the study found that women often lack information about their investigation and intervention. This perceived lack of information can make the entire health care experience suffer, therefore further studies are needed, mainly on how to reach the patient with the information as we have seen that information given by the staff is not always received or recognized by the patient.

Background: In morbidly obese individuals (MO) cardiorespiratory comorbidities and body habitus challenge the perioperative management of anesthesia. To implement safe and reproducible routines for anesthesia and fluid therapy is the cornerstone in order to minimize anesthesia-related complications and to meet individual variability in rehydration needs. Methods: Paper I: Impact of rapid-weight-loss preparation prior to bariatric surgery was investigated. Prevalence of preoperative dehydration and cardiac function were assessed with transthoracic echocardiography (TTE). Paper II: The anesthetic technique for rapid sequence induction (RSI) in MO based on a combination of volatile and i.v. anesthetics was developed. Pre- and post-induction oxygenation, blood pressure levels and feasibility of the method was evaluated. Paper III: The preoperative ideal body weight based rehydration regime was evaluated by TTE. Paper IV: Need of rehydration during bariatric surgery was evaluated by comparing conventional monitoring to a more advanced approach (i.e. preoperative TTE and arterial pulse wave analysis). Results: Rapid-weight-loss preparation prior to bariatric surgery may expose MO to dehydration. TTE was shown to be a robust modality for preoperative screening of the level of venous return, assessment of filling pressures and biventricular function of the heart in MO. The combination of sevoflurane, propofol, alfentanil and suxamethonium was demonstrated to be a safe method for RSI regardless of BMI. The preoperative rehydration regime implemented by colloids 6 ml/kg IBW was an adequate treatment to obtain euvolemia. In addition, preoperative rehydration seems to increase hemodynamic stability during intravenous induction of anesthesia and even intraoperatively. Conclusion: This thesis describes a safe and comprehensive perioperative management of morbidly obese individuals scheduled for bariatric surgery. Hemodynamic and respiratory stability can be achieved by implementation of strict and proven methods of anesthesia and fluid therapy. Much focus should be placed on feasible monitoring and preoperative optimization in morbidly obese individuals for increased perioperative safety.

The aim of the present thesis was to advance the knowledge of diagnostic procedures for lateralizing visual memory deficits and to study the characteristics of perception in temporal lobe epilepsy (TLE). The first study examined the appropriateness of four routinely used learning and reproduction visuo-spatial memory tests as an identification method for right mesial temporal lobe dysfunctions. Various statistical methods illustrate the tests poor capacity to lateralize the functional deficit zone, even when epilepsy-related clinical and other cognitive factors were controlled. The second study is built upon the results of the first, aiming to validate a new test paradigm for lateralizing right hippocampal dysfunctions. Thus we assessed mesial TLE patients preoperatively with the Delayed Matching to Sample (DMS-48) task and postoperatively with two parallel versions that we had developed and standardized in healthy controls. Our analysis suggests that the DMS-48 and its parallel versions were able to lateralize the epileptic onset zone pre- and postsurgically. The third part consists of an expansion from visual memory to visual perception. A study of single case suggests that visual object recognition and visual imagery are sustained by cortical areas located in proximity to the temporo-occipital ventral pathway and that perception and imagery for space is subserved by mechanisms, which are close anatomically, and outside the ventral path. Furthermore, the results seem to indicate that nonlesional paroxysmal activity in the posterior temporal lobe can cause chronic dysfunctions of the visual system, which may be reversible with effective seizure control.

Objective: The purpose of this study was to examine social cognitive constructs as predictors of preoperative exercise (PE) in a sample of individuals waiting for total joint replacement (TJR) surgery using the framework of Bandura’s Social Cognitive Theory (SCT). Methods: Participants (N = 78) were individuals waiting for TJR at the two major urban centres on Vancouver Island, Canada who completed measures of the SCT (barrier self-efficacy, outcome expectancy, self regulation, task efficacy & sociocultural factors of pain, physical function and neighbourhood walking environment) framed for (PE). Results: Independent t-tests suggested no differences between type of surgery (hip versus knee), gender or age for PE (p<.05). Over half of the sample was considered inactive (55%) using a definition of physical activity as accumulating at least 30 minutes of exercise at a moderate or vigorous intensity at least 3 days per week in bouts of 10 minutes or more. Bivariate correlations relating to PE were significant (p<.05) between self regulation (SR) (.25), task efficacy for exercise (TEE) (.27) and pain (-.28). Hierarchical regression analysis revealed that SR (β=.17) and TEE (β=.20) explained 10% of the variance in PE behaviour, but were not significant predictors of PE independently. The addition of pain to the regression analysis added 4% of the explained variance, and remained the only significant predictor (p<.05) of Pe behaviour. Conclusions: SCT showed modest capability in predicting PE in this sample, suggesting further testing of theoretical models is warranted in this area. These findings highlight the influence of pain on exercise before TJR surgery, and support the importance of considering individual factors such as pain when designing targeted interventions to increase activity in this population.