Obstructive Sleep Apnea
CPAP Reduces Post-op Apnea Risk
Is your PACU equipped with a continuous positive airway pressure machine and a few sleep apnea masks? It should be, say researchers at the Utah Valley Regional Medical Center in Provo, Utah, who found that you can reduce respiratory complications immediately after surgery if you identify patients with obstructive sleep apnea beforehand and fit them with a CPAP mask for their first few minutes in the recovery room.

"We found that these patients wake up in PACU more fully awake than those who don't receive CPAP," says respiratory therapist Karl Ludwig, RRT, who adds that CPAP decreases carbon dioxide and helps patients wake up, while those without CPAP are more prone to a carbon dioxide-enhanced narcosis. "Patients we put in CPAP aren't falling back into that deep sleep mode after they get their pain meds because they're more awake after surgery."

Obstructive sleep apnea is characterized by episodes of stopped breathing during sleep. Normally, low levels of oxygen and high levels of carbon dioxide in the blood arouse the sleeper with apnea. But an anesthetic or powerful pain medicine after surgery may interfere with the protective mechanism and prevent the person from waking up, resulting in respiratory arrest. Apnea patients are very sensitive to narcotics, which relax muscles, including those in the throat that the apnea has already predisposed to relaxing during sleep. The relaxation closes the throat and prevents the patient from getting oxygen into the system, sometimes resulting in brain damage and death.

For the study, Douglas Ross, MD, and Mr. Ludwig randomly assigned 200 patients identified by a questionnaire as likely sleep apnea sufferers to undergo either traditional recovery treatment or the use of a CPAP mask after surgery. They found that using the mask for 15 or 20 minutes dropped the risk of complications to the level of patients who didn't have sleep apnea. Discharge times for the patients who received CPAP were identical to those without sleep apnea, says Mr. Ludwig. Dr. Ross and Mr. Ludwig will present the findings of their research at the annual conference of the American Academy of Sleep Medicine in June.

- Dan O'Connor

Proper Attire
Should You Boot Crocs from the OR?
Crocs, the colorful and comfortable plastic clogs that many OR workers swear by, may pose a safety risk in your ORs: They are susceptible to static electricity buildup, which can cause OR equipment to shut down without warning, according to hospitals in Sweden and Norway that recently banned the shoes.

The dangers of static electricity in the OR are not new, says Jeffrey Gross, MD, professor of anesthesiology and pharmacology anesthesiology at the University of Connecticut School of Medicine in Farmington, Conn., but the technology that ORs now house is.

"The microchips that make up our modern equipment are quite sensitive to static discharges when out of their sockets," says the electricity safety expert. "Usually, the shielding of the equipment is sufficient to prevent static-induced damage. However, it certainly is possible to cause strange equipment malfunctions with static discharges. If these shoes do, in fact, predispose to buildup of static electricity more than 'ordinary' shoes, it might make sense not to wear them in the vicinity of sensitive equipment."

The shoes' maker says it knows of "no reason that Crocs would be any more susceptible to static electricity than shoes such as sneakers and other types of footwear worn by medical professionals" and that it will look into the problem.

- Stephanie Wasek

Outpatient Surgery Brings Industry
Leaders Together at New Orleans Gala
Bourbon Street was the backdrop as Outpatient Surgery Magazine welcomed more than 50 readers, vendors and industry leaders to a memorable dinner at last month's FASA conference in New Orleans.

Enjoying the night on the balcony at Jean Lafitte's Rendezvous are Vince Phillips, MD, and Kathleen Allman, RN, of Millennium Surgery Center in Bakersfield, Calif., Beverly Kirchner, RN, BSN, CNOR, CASC, the president and CEO of Genesee Associates, and ASCOA vice president of operations Ann Geier, RN, MSN, CNOR, CASC.

Source Medical director of marketing Marie Kennedy and AAAASF communications guru Jaime Trevino.

Scott Jackson from McKesson and the Rush Group's Shannon Marie Smith, CPA.

McKesson's Randy Ford (left) and B. Braun's Mike Connelly exchange marketing strategies.

Editorial board member Nancy Burden, MSML, RN, CPAN, CAPA, BayCare's director of ambulatory surgery (left), with Scott Horowitz of Kawasumi America and Sheila Carlson from 3M.

Are You on Top of Your Game?
Take This 6-Question Quiz to Find Out
Here are the audience participation questions from AORN's 2007 Perioperative QuizBowl.

Note: The obvious answer isn't always the correct one with these evidence-based questions and answers.

1 In a study by Hirn et al. (2004), which method was found to be most effective for decontaminating a cranial bone flap that falls on the floor?
a. Low-pressure pulse lavage with saline
b. Soaking in cefuroxime for 60 minutes

2 True or False? Based on a review by Stebral & Steelman (2006), double gloving has been found to reduce the incidence of surgical site infection.
a. True
b. False

3 In a study by Roth et al. (1996), which of the following was found to be a risk factor for eye injuries during non-ocular surgery?
a. Surgery on a Monday
b. Use of a laryngeal mask airway

4 In a study by King & Bridges (2006), interface pressure over the sacrum was higher when participants were lying on which of the following?
a. Standard operating bed mattress
b. Standard operating bed mattress with eggcrate foam overlay

5 According to 2002 HICPAC guidelines, is an alcohol rub reliable against clostridium?
a. Yes
b. No

6 Which antibiotic has a longer half-life, the factor upon which re-dosing should be based?
a. Cefazolin
b. Vancomycin

Answers:
1. a. Low-pressure pulse lavage with saline is most effective for decontaminating a cranial bone flap that falls on the floor.
2. b. False. Double gloving has been found to minimize the risk of exposure to blood and bodily fluids.
3. a. Surgery on a Monday is a risk factor for eye injuries during non-ocular surgery.
4. b. Standard operating bed mattress with eggcrate foam overlay.
5. b. No, an alcohol rub is not reliable against clostridium.
6. b. Vancomycin has a longer half-life than cefazolin (Cefazolin 1.5-2.5 hours; Vancomycin 5.0-10.0 hours).

Minimal Trespass for Cataract Patients
Are Oral Sedation and Topical Anesthesia Enough?
The combination of topical anesthesia and oral sedation appears to be a safe alternative to injection anesthesia for cataract surgery, even without the presence of an anesthetist, according to a study published in April's Canadian Journal of Ophthalmology. Guillermo Rocha, MD, GRMC, the study's lead author, performed surgery on 538 eyes of 373 patients at the Brandon Regional Health Centre in Brandon, Manitoba, between 2001 and 2003.

Oral sedation was achieved with 1mg lorazepam administered 45 minutes to 60 minutes before surgery; topical anesthesia was achieved with 0.5% tetracaine drops and application of 2% lidocaine hydrochloride jelly for five minutes. Patients who experienced significant discomfort during the procedure's early phases were injected with preservative-free 1% lidocaine hydrochloride.

Dr. Rocha reported no adverse events in 454 cases (84.4 percent), while 73 patients (15.6 percent) experienced mild adverse events, most notably complaints of mild pain. Moderate pain was reported by five patients and required the administration of 1% intracameral lidocaine. Five additional patients experienced serious adverse events involving hypertension or hypotension, which required anesthetist intervention.

According to the study, patients were screened for inclusion based on good general health, good dilation, moderate cataracts, cooperation with in-office tests and procedures and an understanding of cataract surgery. These factors, says Dr. Rocha, are important considerations and may have favorably impacted the patient's perceptions of pain and comfort with the topical anesthetic approach.

Dr. Rocha notes that the average cost per cataract case for intravenous sedation and block anesthesia is $324.42, compared to $6.77 for oral sedation and topical anesthesia. He concludes that the minimal approach is a safe and effective use of resources that could shave millions off annual cataract expenses by eliminating preoperative medical testing and anesthesia fees.

- Daniel Cook

Conscious During Surgery?
Suit: Man's Suicide Due to Anesthesia Awareness
The family of a 73-year-old West Virginia man who shot himself to death two weeks after he allegedly experienced anesthesia awareness during an exploratory laparotomy has filed a wrongful death suit against the anesthesiology group. This is believed to be the first case in the country to connect anesthesia awareness with suicide.

The family claims that an anesthesiologist and a CRNA from Raleigh Anesthesia Group gave Sherman Sizemore paralytic agents, then neglected to administer inhalational anesthesia for 16 minutes after the first incision at Raleigh General Hospital on Jan. 19, 2006. The plaintiffs believe Mr. Sizemore's bizarre behavior in the days after the procedure - including fears of being left alone or buried alive, an inability to sleep and complaints of breathing difficulties - stemmed from his consciousness, but inability to move or speak, during surgery and would ultimately result in his suicide on Feb. 2, 2006.

"One would be hard pressed to imagine a more disturbing scenario than having one's body cut open while totally awake and alert, but totally helpless to move, scream or alert others to the situation," says the complaint, filed last month in Raleigh County Circuit Court against Raleigh Anesthesia Group. The plaintiff's lawyer didn't return phone calls seeking comment.

"Raleigh Anesthesia Group denies the claims contained in the complaint," says defense lawyer William Foster of the Foster Law Firm in Charleston, W.Va. "The allegations contained in the Sizemore complaint are inconsistent with the facts known at this time. As such, Raleigh Anesthesia Group intends to defend against the claims. Privacy regulations prohibit us from referencing any specific information relative to Mr. Sizemore's medical treatment."

Sixteen minutes after the first incision into Mr. Sizemore's abdomen, the anesthesia providers discovered that they had failed to turn on the inhalational anesthesia, reads the complaint. They also administered to Mr. Sizemore a drug to induce amnesia of the event, it continues.

According to published reports, the issue came to light after Mr. Sizemore's death, when a doctor's condolences prompted nurses in Mr. Sizemore's family to take a closer look at the medical records. Raleigh Anesthesia Group no longer performs services at Raleigh General Hospital.

- Dan O'Connor

In the Know
Heavy hitters. The average physician will generate $1,496,432 in net revenue per year on behalf of his or her affiliated hospital, a survey conducted by physician search firm Merritt, Hawkins & Associates indicates. The average orthopedic surgeon generates $2,312,168 a year and an ophthalmologist $584,310.

How did you celebrate National Nurses Week? Millennium Surgery Center in Bakersfield, Calif., ran this ad (left) in Bakersfield Magazine and a local newspaper to show its appreciation for its staff during the week of May 6 to 12.

SterilMed and the Scope Exchange merge. The medical device repair and reprocessing firms have joined to create one of the top five U.S. repair companies, say company officials.

Quest Diagnostics to Acquire AmeriPath. Quest Diagnostics, the biggest U.S. provider of medical tests, has acquired diagnostic testing company AmeriPath for $2 billion. AmeriPath dermatopathologists interpret 2.4 million biopsies a year. The company has about 400 pathologists and 4,000 employees.

Staphylococcus aureus infection rates on the rise. There has been a significant increase in Staphylococcus aureus infection rates among patients in U.S. hospitals, resulting in longer hospitalizations and millions of dollars of excess healthcare costs, according to findings presented at the recent Society of Healthcare Epidemiology of America annual meeting. Researchers analyzed more than 45 million hospital discharge records and found that, from 1998 to 2003, the prevalence of S. aureus infections among all patients increased at rate of 7.1 percent annually. The problem grew even faster among surgical patients; the rate of S. aureus infection rose 7.9 percent each year for all surgical stays and 9.3 percent each year for orthopedic patients.

Acts of Charity
A Second Chance for Still-usable Medical Devices
Next time you throw away a sponge, gown, drape or glove that you opened for a case but didn't use, think of donating it to a hospital in a third-world country that can sorely use it. Recovered Medical Equipment for the Developing World, or Remedy, is a non-profit organization founded in 1991 that will help you how to collect your unneeded and unused supplies and donate them to charities that distribute them to third-world hospitals.

You can get a free teaching packet with a DVD and information on what can be used and recycled (sponges, gowns, drapes, gloves, sutures, drains and catheters) through the Web site (www.remedyinc.org). If your facility collects the products, Remedy will help connect you with a charity to pick it up and send it overseas.

You can also donate equipment. Remedy can post details about these donations on its site so charities can browse the listings and take what they need. "We always give aid wherever it's most needed," says Remedy's Jeanette Ruiz.

One participating organization is the University of Chicago's Pritzker School of Medicine, where a group of students formed Remedy UChicago, a charity that collects supplies for hospitals in the Dominican Republic. This program has collected thousands of dollars' worth of medicine and supplies, says Sahil Mehta, a student and president of Remedy UChicago.

"A lot of these supplies used to be discarded by the hospital, but now they just put them in a room and we pick them up," says Mr. Mehta.

- Nathan Hall

INSIDE THE Numbers
9 Number of states that are currently considering bills that would let physicians apologize when things go wrong without fear that their words will be used against them in court.

At least 27 other states have already passed similar laws, nearly all of them in the past four years, according to the American Medical Association.

$66 million Value of the 52 proposed healthcare projects Georgia's restrictive CON laws have denied in the last three years, including a $7.4 million multipurpose ambulatory surgery center and a $10 million, 50-bed hospital.

14 Number of states that have discontinued their CON programs since a federal mandate requiring state agencies to approve major health care capital projects was repealed in 1987.

40 Width, in inches, of waiting room chairs (compared to the standard 20) that more and more healthcare furniture makers are selling to accommodate heavier patients.

7 Number of surgery centers in Texas that didn't pass state department of health inspections last year. The department inspected 60 of the 355 centers in Texas. At that inspection rate, an ASC would only be inspected once every six years.

35 Percent of the 90,000 prostatectomies performed in the United States last year by Intuitive Surgical's robots, according to Oppenheimer.