Hypersensitivity Reaction to Perioperative Drug Mistaken for Local Anesthetic Systemic Toxicity in a Patient under Brachial Plexus Block / 고신대학교의과대학학술지

Perioperative anaphylaxis, although rare, is a severe, life-threatening unexpected systemic hypersensitivity reaction. Simultaneous administration of various drugs during anesthesia, the difficulty of communicate with patients in sedation and anesthesia, and coverage of the patient with surgical drapes are considered to be factors that impede early recognition of anaphylactic reactions. It is very important to perform an intradermal skin test because antibiotics are the most common cause of perioperative anaphylaxis. We report a case of negative-intradermal skin test antibiotic anaphylaxis mistaken for local aesthetic systemic toxicity without increase of serum tryptase for confirmative diagnostic biomaker during surgery under brachial plexus block. It is not possible to exclude the danger of anaphylaxis completely, even if it is negative-intradermal skin test and normal tryptase level. Therefore, anesthesiologists should be closely monitored and treated early for antibiotics related hypersensitive reaction, like other medicines during anesthesia.

Hair Control during Scalp Surgery Using a Sterile Gel Technique

It is necessary to organize and arrange the hair before performing surgery on the scalp. The hair is preserved in most cases, and the remaining hair makes it difficult to apply and maintain the drape. Moreover, hair that has not been properly sterilized can be a risk factor for infection. Accordingly, the authors of the present study benchmarked a method of hair control within the operative field using a sterile gel. Prior to surgery, the hair around the lesion can be organized and rearranged to the desired shape by using a sterile medical gel as a hairstyling product. Subsequently, chlorhexidine-isopropyl alcohol can be used for aseptic skin preparation, followed by draping for surgery. By controlling the hair using this method, hair can be prevented from falling into the operative field, thereby reducing the risk of surgical site infection.

Airway obstruction by dissection of the inner layer of a reinforced endotracheal tube in a patient with Ludwig's angina: A case report

Intraoperative airway obstruction is perplexing to anesthesiologists because the patient may fall into danger rapidly. A 74-year-old woman underwent an emergency incision and drainage for a deep neck infection of dental origin. She was orally intubated with a 6. 0 mm internal diameter reinforced endotracheal tube by video laryngoscope using volatile induction and maintenance anesthesia (VIMA) with sevoflurane, fentanyl (100 µg), and succinylcholine (75 mg). During surgery, peak inspiratory pressure increased from 22 to 38 cmH₂O and plateau pressure increased from 20 to 28 cmH₂O. We maintained anesthesia because we were unable to access the airway, which was covered with surgical drapes, and tidal volume was delivered. At the end of surgery, we found a longitudinal fold inside the tube with a fiberoptic bronchoscope. The patient was reintubated with another tube and ventilation immediately improved. We recognized that the tube was obstructed due to dissection of the inner layer.

Postpartum blood loss: visual estimation versus objective quantification with a novel birthing drape

<p><b>INTRODUCTION</b>Immediate postpartum haemorrhage (PPH) is the most common cause of maternal mortality worldwide. Most recommendations focus on its prevention and management. Visual estimation of blood loss is widely used for the early detection of PPH, but the most appropriate method remains unclear. This study aimed to compare the efficacy of visual estimation and objective measurement using a sterile under-buttock drape, to determine the volume of postpartum blood loss.</p><p><b>METHODS</b>This study evaluated patients aged ≥ 18 years with low-risk term pregnancies, who delivered vaginally. Immediately after delivery, a birth attendant inserted the drape under the patient's buttocks. Postpartum blood loss was measured by visual estimation and then compared with objective measurement using the drape. All participants received standard intra- and postpartum care.</p><p><b>RESULTS</b>In total, 286 patients with term pregnancies were enrolled. There was a significant difference in postpartum blood loss between visual estimation and objective measurement using the under-buttock drape (178.6 ± 133.1 mL vs. 259.0 ± 174.9 mL; p < 0.0001). Regarding accuracy at 100 mL discrete categories of postpartum blood loss, visual estimation was found to be inaccurate, resulting in underestimation, with low correspondence (27.6%) and poor agreement (Cohen's kappa coefficient 0.07; p < 0.05), compared with objective measurement using the drape. Two-thirds of cases of immediate PPH (65.4%) were misdiagnosed using visual estimation.</p><p><b>CONCLUSION</b>Visual estimation is not optimal for measurement of postpartum blood loss in PPH. This method should be withdrawn from standard obstetric practice and replaced with objective measurement using the sterile under-buttock drape.</p>

Comparison of eye protection methods for corneal abrasion during general anesthesia

BACKGROUND: Corneal abrasion is one of the most common ophthalmic complications that occurs after general anesthesia. Although they can occur by direct contact with surgical drapes or masks, most occur as a result of the drying of the cornea exposed during general anesthesia due to a reduced amount of tear secretions, the loss of light reflex, or the loss of recognition of pain during the procedure. Thus, to prevent corneal abrasions during general anesthesia, proper eye protection is required. METHODS: Seventy-two patients (144 eyes) were divided into four groups as follows: 1) control group: careful manual eye closure; 2) adhesive tape group: a bandage attached over the eyelid; 3) ointment group: eye ointment placed into the eye followed by eye closure; and 4) ointment and tape group: eye ointment placed into the eye followed by a bandage attached over the eyelid, with the patient subjected to both methods for each eye. The National Eye Institute (NEI) scale, conjunctiva hyperemia scale, tear break-up time, and Schmer test were conducted before and after operation. RESULTS: No statistically significant difference was noted between groups regarding the NEI scale, conjunctiva hyperemia scale, tear break-up time, or Schirmer test. CONCLUSIONS: To prevent corneal abrasions in normal patients undergoing general anesthesia, eye taping, eye ointment application, or taping after eye ointment application will not significantly reduce the degree of corneal epithelial damage compared to manual eye closure.

Mapeamento do processo de reprocessamento de campos cirúrgicos de tecido de algodão / Mapping the process of reprocessing cotton drapes

Mapear o processo de reprocessamento de campos de tecido de algodão, duplos e simples, integrantes dos pacotes de LAP cirúrgico. Método: Estudo de caso exploratório, descritivo, conduzido no Serviço de Rouparia (SR) e no Centro de Material e Esterilização (CME) de um hospital de ensino. Acompanhou-se a condução de todo o processo por meio de observações não participantes no SR e no CME e, posteriormente, realizou-se reuniões com profissionais representantes do SR (camareiras) e do CME (auxiliares e técnicos de enfermagem), visando o detalhamento, complementação e validação das etapas e atividades observadas. Resultados: Foram mapeadas quatro etapas: processamento das roupas por lavanderia terceirizada, recepção das roupas no SR, montagem e esterilização dos pacotes de LAP e armazenamento dos pacotes de LAP no CME. Conclusão: O mapeamento possibilitou a visualização dos recursos consumidos nas etapas e atividades constituintes do processo, fornecendo informações que contribuirão para a alocação racional dos recursos envolvidos...

Direct Cost of Reprocessing Cotton-woven Surgical Drapes: a Case Study / Costo Directo del Reprocesamiento de Campos Quirúrgicos de Tela de Algodón: un Estudio de Caso / Custo direto do reprocessamento de campos cirúrgicos de tecido de algodão: um estudo de caso

OBJECTIVE Identify the direct cost of reprocessing double and single cotton-woven drapes of the surgical LAP package. METHOD A quantitative, exploratory and descriptive case study, performed at a teaching hospital. The direct cost of reprocessing cotton-woven surgical drapes was calculated by multiplying the time spent by professionals involved in reprocessing the unit with the direct cost of labor, adding to the cost of materials. The Brazilian currency (R$) originally used for the calculations was converted to US currency at the rate of US$0.42/R$. RESULTS The average total cost for surgical LAP package was US$9.72, with the predominance being in the cost of materials (US$8.70 or 89.65%). It is noteworthy that the average total cost of materials was mostly impacted by the cost of the cotton-woven drapes (US$7.99 or 91.90%). CONCLUSION The knowledge gained will subsidize discussions about replacing reusable cotton-woven surgical drapes for disposable ones, favoring arguments regarding the advantages and disadvantages of this possibility considering human resources, materials, as well as structural, environmental and financial resources. .

OBJETIVO Identificar el costo directo del reprocesamiento de campos de tela de algodón, dobles y sencillos, integrantes del paquete de LAP quirúrgico. MÉTODO Estudio de caso cuantitativo, exploratorio-descriptivo, llevado a cabo en un hospital de enseñanza. Se calculó el costo directo multiplicándose el tiempo empleado por los profesionales involucrados en el reprocesamiento por el costo unitario de la mano de obra directa, sumándose al costo de los materiales. La moneda brasileña (R$) utilizada originalmente para los cálculos se convirtió en moneda estadounidense a la tasa de US$ 0.42/R$. RESULTADOS El costo total medio, por paquete de LAP quirúrgico, fue US$ 9.72, con predominancia del costo con materiales (US$ 8.70), el 89.65%. Se destaca que el costo total medio de los materiales recibió fuerte impacto de los costos de los campos de tela de algodón (US$ 7.99), el 91.90%. CONCLUSIÓN El conocimiento obtenido subsidiará discusiones acerca del reemplazo de campos de tela reutilizables por campos desechables, favoreciendo argumentaciones relativas a las ventajas y desventajas de dicha posibilidad al considerarse los recursos humanos, materiales, estructurales, ambientales y financieros. .

OBJETIVO Identificar o custo direto do reprocessamento de campos de tecido de algodão, duplos e simples, integrantes do pacote de LAP cirúrgico. MÉTODO Estudo de caso quantitativo, exploratório-descritivo, realizado em um hospital de ensino. Calculou-se o custo direto multiplicando-se o tempo despendido por profissionais envolvidos no reprocessamento pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais. A moeda brasileira (R$) utilizada originalmente para os cálculos foi convertida para a moeda norte-americana pela taxa de US$ 0.42/R$. RESULTADOS O custo total médio, por pacote de LAP cirúrgico, foi de US$ 9.72, com predominância do custo com materiais (US$ 8.70) 89.65%. Destaca-se que o custo total médio dos materiais recebeu forte impacto dos custos dos campos de tecido de algodão (US$ 7.99) 91.90%. CONCLUSÃO O conhecimento obtido subsidiará discussões sobre a substituição de campos de tecido reutilizáveis por campos descartáveis, favorecendo argumentações relativas às vantagens e desvantagens dessa possibilidade considerando os recursos humanos, materiais, estruturais, ambientais e financeiros. .

Application of Hand Towel Drape over Dingman Mouth Gag

In cleft palate surgery, the environment is especially critical when suturing. Encum-bered, obstructive space in the environment can hinder a suture while using the Dingman mouth gag. We introduced a novel but simple draping technique. A simple hand towel is placed over the gag. A hole is cut out in the middle according to each patient's mouth. After making the hole, the hand towel is soaked in water and gently squeezed. Then the towel is properly placed over the Dingman mouth gag. Dripping water on the hand towel during the suture helps keep it in place. Using this draping technique, we cut 14 minutes of operation time compared to the average operation time of the past 2 years. There were several disadvantages in previous draping method. First, long suture material may easily get caught. Second, the operation field can easily be contaminated. Third, focusing on the operation becomes difficult due to the obstruction. This draping technique can compensate for the disadvantages of the previous Dingman mouth gag.

Custo do reprocessamento de campos cirúrgicos de tecido de algodão: um estudo de caso / Cost for reprocessing cotton surgical drapes: a case study

Introdução: Os campos de tecido de algodão constituem uma das barreiras contra a invasão de micro-organismos nos sítios cirúrgicos dos pacientes e para proteção dos profissionais de saúde contra a exposição a fluidos orgânicos. Utiliza-se para cada procedimento, no mínimo, um pacote padrão composto por seis campos cirúrgicos duplos de algodão, um campo cirúrgico simples de algodão e um campo duplo de algodão para embalagem, que são reprocessáveis, denominado LAP cirúrgico. Objetivo: Mapear as etapas e atividades referentes ao processo de reprocessamento de campos de tecido de algodão duplos e simples integrantes dos pacotes de LAP cirúrgico e identificar o custo direto do reprocessamento de campos de tecido de algodão duplos e simples integrantes dos pacotes de LAP cirúrgico. Método: Pesquisa quantitativa, exploratória, descritiva, do tipo estudo de caso único, realizada no Hospital Santa Lucinda (HSL), Hospital de Ensino da Pontifícia Universidade de São Paulo. Calculou-se o custo direto multiplicando-se o tempo despendido por profissionais envolvidos no reprocessamento do pacote de LAP cirúrgico (Camareiras, Auxiliares e Técnicos de Enfermagem) pelo custo unitário da mão de obra direta (MOD), somando-se ao custo dos materiais. Para a realização dos cálculos utilizou-se a moeda brasileira (R$). Resultados: Foram mapeadas e validadas quatro etapas relativas ao reprocessamento de campos de tecido de algodão: processamento das roupas por lavanderia terceirizada, recepção das roupas no Serviço de Rouparia, montagem e esterilização dos pacotes de LAP cirúrgico e armazenamento dos pacotes de LAP cirúrgico no Centro de Material e Esterilização. O custo direto do reprocessamento, por pacote de LAP cirúrgico, correspondeu a R$ 23,09, sendo o custo com materiais o mais representativo (R$ 20,70 - 92,50%).Os custos, unitário e total, dos campos de tecido de algodão (duplo, duplo para embalagem e simples) impactaram predominantemente no custo total final dos materiais (R$ 19,02 -91,90%) utilizados. A partir do agrupamento das cirurgias/procedimentos relativos às 14 especialidades atendidas no HSL, considerando três meses típicos, estimou-se o consumo médio mensal de 1139 pacotes de LAP cirúrgico, totalizando R$ 33.226,51. Conclusão: O conhecimento do custo direto do reprocessamento do pacote de LAP cirúrgico poderá auxiliar nas tomadas de decisões em relação aos recursos envolvidos evitando desperdícios ao contribuir com elementos que propiciem o gerenciamento de custos.

Introduction: Drapes made of cotton constitute one of the barriers against the invasion of microorganisms into the surgical sites of patients, while protecting health professionals against exposure to organic fluids. Per procedure, at least one standard package is needed, consisting of six double cotton surgical drapes, one simple cotton surgical drape and one double cotton drape for packaging, which may be reprocessed, named surgical LAP. Objective: Map the stages and activities regarding the process of reprocessing double and simple cotton drapes, composing the surgical LAP packages, and identify the direct cost for this reprocessing. Method: Quantitative, exploratory, descriptive, single-case study conducted at Hospital Santa Lucinda (HSL), a teaching hospital of the Pontifical Catholic University of São Paulo. The direct cost was calculated by multiplying the time spent by professionals involved in the reprocessing of surgical LAP packages (cleaners, nursing technicians and nursing aides) by the unitary cost of the direct workforce (DWF), added to the cost of the materials. The Brazilian currency (R$) was used in the calculations. Results: Four stages regarding the reprocessing of cotton drapes were mapped and validated: processing of clothes by an outsourced laundry, entry of the clothes into the Clothing Service, putting together and sterilizing surgical LAP packages and storing surgical LAP packages in the Material and Sterilization Center. The reprocessing direct cost, per surgical LAP package, corresponded to R$ 23.09, with the cost for materials being the most significant(R$ 20.70 - 92.50%).The costs, both unitary and total, for the cotton drapes (double, double for packaging and simple) had a predominant impact on the final total cost for the used materials(R$ 19.02 - 91.90%). Based on the grouping of surgeries/procedures regarding the 14 specialties available in the HSL, considering three typical months, a mean monthly consumption of 1139 surgical LAP packages was estimated, totaling R$ 33,226.51. Conclusion: Learning the direct cost for reprocessing surgical LAP packages may assist in making decisions regarding the resources involved in this process, thus avoiding waste by contributing with elements that enable the management of costs.

Introduction to method for determination of bio-burden on surgical drapes, gowns and clean air suits / 中国医疗器械杂志

Firstly, the essay introduces the definition of bio-burden, the significance of determination of bio-burden and the specific performance requirements. Then, the essay introduces the method selection and validation on the bio-burden determination of surgical drapes, gowns and clean air suits.

A Study for UV Protection Degree of Genital Protection Materials / 대한피부과학회지

BACKGROUND: Genital skin cancer is a potential side effect of phototherapy. Development of genital skin cancer lowers a patient's quality of life. However, there are no standards for genital protection during phototherapy. OBJECTIVE: This study was designed to find adequate materials for genital protection. METHODS: Eight common materials for genital protection were placed over an ultraviolet (UV) meter that was irradiated with UVA and narrowband UVB phototherapy units. The percentage of blocked UV was measured. RESULTS: White and black cotton underwear, white and black polyester underwear, and surgical drapes did not allow the transmission of UVA and narrowband UVB light. But a surgical mask allowed about 15% transmission of UV light. CONCLUSION: These results suggest that white and black cotton underwear, white and black polyester underwear and surgical drapes provide sufficient UV protection.

A verification study assessing the test method for resistance to dry microbial penetration about surgical gowns and surgical drapes / 中国医疗器械杂志

By testing the less critical product areas of two different materials, this paper verifies the test method described in ISO 22612.

Fires and Burn Caused by Alcohol-based Disinfectants and Electrocautery: A case report / 대한마취과학회지

Operating room fires, though rare, can involve substantial morbidity and mortality. Surgical fires require an ignition source, oxidizer, and fuel. Ignition sources generally include lasers and electrocautery, oxidizer are usually oxygen, nitrous oxide, and ambient air, whereas fuels are classically surgical drapes, materials, and prepping agents. We experienced a patient who, during skin incision, sustained burns resulting from a fire in the operating room. Shortly after application of disinfectants and placement of the surgical drapes, the surgeon used the electrosurgical unit on the incision. In this case, the use of an alcohol-based disinfectant was the major contributing factor to the surgical fire. To avoid recurrence, if alcohol is used for skin prepping, it should be allowed to dry completely before draping.

Wall-Suction Assisted Vacuum Sealing for Treatment of Infected Diabetic Foot Ulcer / 대한족부족관절학회지

PURPOSE: The infected diabetic foot patients were reviewed to analyze the result of new dressing methods using a wall-suction instruments. MATERIALS AND METHODS: Eighteen patients treated with wall-suction assisted vacuum dressing were included. After debridement under local anesthesia, a sponge pad, a drain, and a surgical drape were used to seal the wound. Negative pressure applied by the wall-suction at around 200 mmHg and dressing were repeated in every two to three days. The results of repeated wound cultures, growth of granulation tissues, and CRP level were closely observed on the regular basis. RESULTS: Rapid growth of granulation tissues was noticed around the wound in 16 cases. No organism was obtained in an average 5 days and wound coverage was possible in an average 18 days. The CRP level returned to normal in an average 4 weeks. Two patients with end stage renal disease, who were regularly hemodialised, underwent major amputation. CONCLUSION: New dressing method has the following advantages: a rapid wound improvement in the patients with infected diabetic foot, less expensive, less painful, impediment of bacterial contamination in the hospital room. However, further study will be needed for the end stage renal disease patients.