Preliminary study of cytogenetic damage in personnel exposed to anesthetic gases. (1/9)

Occupational exposure to anesthetic gases is associated with various adverse health effects. Genetic material has been shown to be a sensitive target of numerous harmful agents. The aim of this study was to examine whether chromosomal damage could serve to indicate exposure to anesthetics. A group of 43 hospital workers of three professions (anesthesiologists, technicians and operating room nurses) and 26 control subjects were examined for chromosome aberrations, sister chromatid exchanges and micronucleus frequency. The exposed groups matched in duration of exposure to anesthetics, but not in age. An equal ratio between women and men was possible in all groups except nurses. Likewise, the ratio between smokers and non-smokers was also not comparable. An increase in chromosome damage was found in all exposed groups. While the increase in sister chromatid exchange frequency was not significant, chromosome aberrations and micronucleus frequency increased significantly, showing higher rates in women. The results suggest that the micronucleus test is the most sensitive indicator of changes caused by anesthetic gases. The observed difference between sexes with respect to exposure risk call for further, targeted investigations.  (+info)

Scattered radiation during fixation of hip fractures. Is distance alone enough protection? (2/9)

We measured the scattered radiation received by theatre staff, using high-sensitivity electronic personal dosimeters, during fixation of extracapsular fractures of the neck of the femur by dynamic hip screw. The dose received was correlated with that received by the patient, and the distance from the source of radiation. A scintillation detector and a water-filled model were used to define a map of the dose rate of scattered radiation in a standard operating theatre during surgery. Beyond two metres from the source of radiation, the scattered dose received was consistently low, while within the operating distance that received by staff was significant for both lateral and posteroanterior (PA) projections. The routine use of lead aprons outside the 2 m zone may be unnecessary. Within that zone it is recommended that lead aprons be worn and that thyroid shields are available for the surgeon and nursing assistants.  (+info)

Quantifying net staffing costs due to longer-than-average surgical case durations. (3/9)

BACKGROUND: Anesthesiology departments incur staffing costs that are not covered by revenue because the operating room (OR) time allocation and case scheduling are not done to maximize OR efficiency and because surgical durations are longer than average. The purpose of this article is to demonstrate a method to quantify net anesthesia staffing costs due to longer-than-average surgical durations and evaluate the factors that influence staffing costs. METHODS: Data collected from two anesthesiology departments in academic hospitals for 1 yr included date of surgery, time that patients entered the OR, time that patients exited the OR, surgical service, and the Current Procedural Terminology code for the primary surgical procedure. Anesthesia care performed outside the main surgical suite and services not billed with American Society of Anesthesiologists units were excluded. National average surgical durations were determined from the Current Procedural Terminology code from the Centers for Medicare and Medicaid Services' database. Actual surgical durations were then used to determine staffing solutions to maximize OR efficiency; national average surgical durations were then used to determine a second solution. The difference in staffing costs between these two staffing solutions represented the staffing costs attributable to longer surgical durations. Costs were converted to dollar amounts using compensation values reported in a national compensation survey. The differences in revenue were determined by applying conversion factors to the differences in surgical durations. The annual net cost attributable to longer surgical durations equaled the staffing costs minus the revenue produced by longer durations. Net staffing costs were estimated for two hospitals using median staffing compensation and median payer mix. Net staffing costs were then recalculated by varying the parameters (conversion factors, limits on differences between actual and average surgical duration, levels of compensation, surgical service size of OR allocation). RESULTS: Using the median compensation of staff and an average conversion factor, the net annual staffing costs attributable to longer surgical durations were $672,100 for the first hospital. However, if staff members were highly compensated and the payer mix was unfavorable, the net staffing costs were $1,688,000. Reducing the difference between actual and average duration resulted in lower staffing costs. Net staffing costs were less in a second hospital studied that had many low-volume surgical services. CONCLUSIONS: Longer-than-average surgical durations can increase net staffing costs for anesthesiology groups. The increase is dependent on factors such as staffing compensation and payer mix.  (+info)

Transmission of tuberculosis from patient to healthcare workers in the anaesthesia context. (4/9)

INTRODUCTION: Pulmonary tuberculosis (PTB) is prevalent in our population. We report an incident of healthcare workers (HCWs) suspected of being infected by a patient with undiagnosed active PTB in the operating theatre. CLINICAL PICTURE: A 60-year-old patient admitted for intestinal obstruction, underwent an emergency laparotomy. Preoperative chest X-ray (CXR) showed diffuse reticular-nodular shadowing and postoperative sputum was positive for acid-fast bacilli. TREATMENT: The patient was isolated and treated for active tuberculosis. The anaesthetist and her assistants in the operating theatre that day were referred to the infectious disease physician and some were started on tuberculosis prophylaxis. OUTCOME: The patient and the HCWs involved recovered. CONCLUSION: Thus, all PTB-susceptible patients with suggestive CXR should be treated as potentially infective. Adequate personnel protection should include highly efficient facemasks and shields. Risk of patient-to-patient transmission of tuberculosis through the anaesthetic circuit is low if effective bacterial/viral filters are used.  (+info)

Understanding of intra-operative tourniquets amongst orthopaedic surgeons and theatre staff--a questionnaire study. (5/9)

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Health effects associated with exposure to anaesthetic gases in Ontario hospital personnel. (6/9)

In a retrospective study (by questionnaire) of 8032 personnel exposed to anaesthetic gases in operating and recovery rooms in Ontario hospitals, and 2525 non-exposed hospital staff, the response was 78.8% for the exposed and 87.2% for the unexposed personnel during the period 1981-5. Logistic regression analysis, with age and smoking standardised, showed that women in the exposed group had significantly increased frequencies of spontaneous abortion and their children had significantly more congenital abnormalities (p less than 0.05). No chronic disease was significantly associated with the exposed group. These findings, together with similar ones from other studies, suggest that it is prudent to minimise exposure to waste anaesthetic gases.  (+info)

Building the evidence on simulation validity: comparison of anesthesiologists' communication patterns in real and simulated cases. (7/9)

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Simulation-based assessment to identify critical gaps in safe anesthesia resident performance. (8/9)

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