Development of care and anesthesia model for thoracotomy surgery patients at Chiangrai Prachanukroh hospital

Abstract

Background: Thoracic surgery is the major operation that risk for complications of the respiratory system, cardiovascular, resulting in hypovolemia or blood during and postoperative. By common severe complications in anesthesia of thoracic surgery patients including reintubation, pulmonary edema and cardiac arrest. Caring and anesthesia of the patients therefore require knowledge, competence, expertise and high expertise in practice.

Objective: To develop and study the effects of using a care model and anesthesia in thoracotomy surgery patients at Chiangrai Prachanukroh hospital consist of knowledge of patients, knowledge, opinion and satisfaction of nurses anesthetist, complications post anesthesia and integrity of recording anesthesiology medical record.

Methodology: The development research was studied between August 2019 to January 2020. There were two groups of samples, were 30 providers (nurse anesthetist) and 60 custumers (thoracic surgery patients). The study was divided into 2 phases; phase I developed a model of care and anesthesia in thoracic surgery patients (Thoracotomy); phase II was performed according to a care and anesthesia model in thoracotomy patients and evaluation. The data from focus group used content analysis and compared knowledge’s scores of patients and nurses anesthetist by t-test. Compared general data and results of two groups by t-test, exact probability test, rank sum test and multivariable regression.

Results: The care and anesthesia model developed in the thoracic surgery patients consisted of five parts; 1) risk assessment and patient preparation prior to anesthesia 2) care and surveillance during anesthesia and operation 3) care and surveillance post anesthesia and operation 4) guidelines for providing information on correct practice before and after anesthesia and operation and 5) guidelines for recording anesthesiology medical record. When compared before and after using the care model, it was found that the mean knowledge scores of the patients increased from 4.3±1.2 to 9.7±0.5 (p<0.001). The average knowledge scores of care and anesthesia in thoracic surgery patients of nurses anesthetist increased from 8.0±0.9 to 9.0±0.8 (p<0.001). Nurses anesthetists opined that the care and anesthesia model were beneficial to the patients, convenient, easy and practical, had satisfaction with the high to highest level. Used the care and anesthesia model decreased the risk of developed severe pain after operation 45.2% (95%CI -74.0, -16.7; p=0.002), desaturation 31.1% (95%CI -56.1, -6.1; p=0.015), reintubation 6.0% (95%CI -13.2, -1.2; p=0.100) and shivering 5.6% (95%CI -24.0, 12.7; p=0.545), it also improved the integrity of recording anesthesiology medical record to 69.2% (95%CI 50.2, 88.1; p<0.001).

Conclusion and Suggestion: Using a model of care and anesthesia in thoracic surgery patients help to increase the knowledge of the patients to behave properly. Increased knowledge of care and anesthesia for nurse anesthetists, reduced severe pain, desaturation, shivering and reintubation after anesthesia, and increased the integrity of recording anesthesiology medical record. The care and anesthesia model should be used in all thoracic surgery patients in order to continue to provide more quality care.