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Nicely done
Nicely done Received my August Journal yesterday and again it is superb. We have been doing ENT laser surgery and are now getting into the other specialties, so all of the articles are very applicable to us. The whole issue is very nicely laid out and done. Barbara J Gruendemann, RN Centinela Hospital Inglewood, Calif
Ambulatory surgery column welcome I was very glad to receive my most recent Journal and see the new column on same day surgery. It is a welcome addition to a fine publication. I have enjoyed reading the Journal since I started to work in the OR several years ago. I helped open the outpatient surgery unit in my hospital, and I look forward to the same quality, current information on ambulatory surgery to keep me in step with national standards. My hospital is currently doing about 150 outpatient surgeries per month, from tuba1 ligations to cataract extractions with lens implants. Again, thank you for helping me and others in this expanding OR role. Carol Massi, RN Palm Springs, Calif
The other side of spinal surgery After reading the two articles on the use of segmental spinal instrumentation in the July
668
Journal, I would like to add a few comments. Segmental spinal instrumentation (SSI) has gained acceptance in the surgical treatment of scoliosis. But, although SSI has several advantages over the Harrington system (for instance, fixation at multiple levels and no need for postoperative casting), it presents several problems that the OR nurse should be aware of. Surgicalprocedures that use the SSI system tend to have increased operative time as well as increased blood loss. More serious, however, is the increased risk of damage to the spinal cord. Because a laminotomy must be done at every level of fixation and a wire loop must be passed under the lamina, there is increased potential for neurological complications. Even with the spinal cord monitoringsystem now available,many spinal surgeons hesitate to use the SSI on patients with idiopathic scoliosis who have no neurological deficits prior to surgery. They prefer using the SSI on patients with neuromuscular diseases and paralytic curves or on patients who cannot tolerate postoperative casting (for instance, patients who are severely retarded). Another disadvantage to the SSI is its inability to correct pelvic obliquity as well as the Harrington system. In many patients, such as those with myelomeningoceles, it is important to obtain a level pelvis in addition to correcting the spinal deformity. Other problems may occur with the SSI system if the patient's bone is too soft or osteoporotic. Wires that are twisted too tight can cut through the lamina. The increased number of glove punctures from sharp wire ends that can occur during the operative procedure are another problem-they make intraoperative antibiotics a must.
AORN Journal, October 1983, Vol38, No 4
Ambulatory surgery column welcome I was very glad to receive my most recent Journal and see the new column on same day surgery. It is a welcome addition to a fine publication. I have enjoyed reading the Journal since I started to work in the OR several years ago. I helped open the outpatient surgery unit in my hospital, and I look forward to the same quality, current information on ambulatory surgery to keep me in step with national standards. My hospital is currently doing about 150 outpatient surgeries per month, from tuba1 ligations to cataract extractions with lens implants. Again, thank you for helping me and others in this expanding OR role. Carol Massi, RN Palm Springs, Calif
The other side of spinal surgery After reading the two articles on the use of segmental spinal instrumentation in the July
668
Journal, I would like to add a few comments. Segmental spinal instrumentation (SSI) has gained acceptance in the surgical treatment of scoliosis. But, although SSI has several advantages over the Harrington system (for instance, fixation at multiple levels and no need for postoperative casting), it presents several problems that the OR nurse should be aware of. Surgicalprocedures that use the SSI system tend to have increased operative time as well as increased blood loss. More serious, however, is the increased risk of damage to the spinal cord. Because a laminotomy must be done at every level of fixation and a wire loop must be passed under the lamina, there is increased potential for neurological complications. Even with the spinal cord monitoringsystem now available,many spinal surgeons hesitate to use the SSI on patients with idiopathic scoliosis who have no neurological deficits prior to surgery. They prefer using the SSI on patients with neuromuscular diseases and paralytic curves or on patients who cannot tolerate postoperative casting (for instance, patients who are severely retarded). Another disadvantage to the SSI is its inability to correct pelvic obliquity as well as the Harrington system. In many patients, such as those with myelomeningoceles, it is important to obtain a level pelvis in addition to correcting the spinal deformity. Other problems may occur with the SSI system if the patient's bone is too soft or osteoporotic. Wires that are twisted too tight can cut through the lamina. The increased number of glove punctures from sharp wire ends that can occur during the operative procedure are another problem-they make intraoperative antibiotics a must.
AORN Journal, October 1983, Vol38, No 4