Sterility of Miniature C-arm Fluoroscopy in Hand and Upper Extremity Surgery

Previous studies have demonstrated that sterile equipment is frequently contaminated intraoperatively, yet the incidence of miniature c-arm (MCA) contamination in hand and upper extremity surgery is unclear. To examine this incidence, a prospective study of MCA sterility in hand and upper extremity cases was performed in a hospital main operating room (MOR) (n = 13) or an ambulatory surgery center operating room (AOR) (n = 16) at a single tertiary care center. Case length, MCA usage parameters, and sterility of the MCA through the case were examined. We found that MOR surgical times trended toward significance (p = 0.055) and that MOR MCAs had significantly more contamination prior to draping than AOR MCAs (p < 0.001). In MORs and AORs, 46.2 and 37.5% of MCAs respectively were contaminated intraoperatively. In MORs and AORs, 85.7 and 80% of noncontaminated cases, respectively, used the above hand-table technique, while 50 and 83.3% of contaminated MOR and AOR cases, respectively, used a below hand-table technique. Similar CPT codes were noted in both settings. Thus, a high-rate of MCA intraoperative contamination occurs in both settings. MCA placement below the hand-table may impact intraoperative contamination, even to distant MCA areas. Regular sterilization of equipment and awareness of these possible risk factors could lower bacterial burden.

Management of Staffing and Case Scheduling for Anesthesia Outside of the Operating Room

What does a manager need to think about when scheduling cases requiring anesthesia outside the operating room (OOOR)? This chapter aims to answer that question by discussing some key strategic points that can facilitate a more efficient workday. The concepts of block scheduling and utilization apply in the OOOR setting as they do in the operating room, but there are added challenges given the increased physical distance to the main operating room suite. These challenges will be identified and recommendations will be provided on how to evaluate and improve OOOR efficiency. With more procedures being done OOOR, it is important for anesthesia groups to be mindful of these challenges and position themselves appropriately.

Anesthesia Outside the Operating Room

Anesthesia Outside of the Operating Room 2nd edition covers all aspects of providing anesthesia in settings outside of the main operating room, with a special focus on techniques, procedures and safety considerations. It discusses anesthetic concerns by procedure location, and includes selected latest guidelines from the American Society of Anesthesiologists (ASA) and other professional societies. Topics include patient monitoring techniques, pre-procedure evaluation and post-procedure care, and procedural sedation performed by non-anesthesia providers. The authors address problems of anesthesia that have unique answers in settings outside the operating room, such as patient transport and cardiac arrest, and discuss technological progress and considerations for the future. The text also covers surgical procedures and anesthetic considerations by procedure location, such as radiology, infertility clinics, field and military environments, and pediatric settings.