Chapter 17
Care of Intraoperative Patients
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Members of the Surgical Team
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Surgeon and surgical assistant
Anesthesia providers:
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Anesthesiologist and CRNA
Holding area nurse
Circulating nurse
Scrub nurse
Surgical technologist
Specialty nurses
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Operating Room
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Minimally Invasive and Robotic
Surgery
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Environment of the Operating
Room
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Preparation of the surgical suite and team
safety
Layout
Health and hygiene of the surgical team
Surgical attire
Surgical scrub
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Surgical Asepsis
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Surgical Scrub, Gowning, and
Gloving
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Anesthesia
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Induced state of partial or total loss of
sensation, occurring with or without loss of
consciousness
Used to block nerve impulse transmission,
suppress reflexes, promote muscle
relaxation, and, in some cases, achieve a
controlled level of unconsciousness
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General Anesthesia
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Reversible loss of consciousness induced
by inhibiting neuronal impulses in several
areas of the central nervous system
Involves a single agent or a combination of
agents
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Four Stages of General
Anesthesia
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Stage 1—analgesia and sedation,
relaxation
Stage 2—excitement, delirium
Stage 3—operative anesthesia, surgical
anesthesia
Stage 4—danger
Emergence—recovery from anesthesia
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Administration of General
Anesthesia
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Inhalation
IV injection
Balanced anesthesia
Adjuncts to general anesthetic agents:
hypnotics, opioid analgesics,
neuromuscular blocking agents
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Balanced Anesthesia
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Combination of IV drugs and inhalation
agents used to obtain specific effects
Example: thiopental for induction, nitrous
oxide for amnesia, morphine for analgesia,
and pancuronium for muscle relaxation
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Complications from General
Anesthesia
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Malignant hyperthermia; possible
treatment with dantrolene
Overdose
Unrecognized hypoventilation
Complications of specific anesthetic
agents
Complications of intubation
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Local Anesthesia
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Briefly disrupts sensory nerve impulse
transmission from a specific body area or
region
Delivered topically and by local infiltration
Patient remains conscious and able to
follow instructions
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Regional Anesthesia
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Type of local anesthesia that blocks
multiple peripheral nerves in a specific
body region
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Field block
Nerve block
Spinal block
Epidural block
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Nerve Block Sites
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Spinal and Epidural Anesthesia
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Complications of Local or
Regional Anesthesia
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Anaphylaxis
Incorrect delivery technique
Systemic absorption
Overdose
Local complications
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Treatment of Complications
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Establish open airway.
Give oxygen.
Notify the surgeon.
Fast-acting barbiturate is usual treatment.
Epinephrine for unexplained bradycardia.
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Conscious Sedation
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IV delivery of sedative, hypnotic, and opioid
drugs to reduce the level of consciousness.
Patient maintains a patent airway and can
respond to verbal commands.
Amnesia action is short with rapid return to
ADLs.
Etomidate, diazepam, midazolam,
meperidine, fentanyl, alfentanil, and
morphine sulfate are the most commonly
used drugs.
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Collaborative Management
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Assessment
Medical record review
Allergies and previous reactions to
anesthesia or transfusions
Autologous blood transfusion
Laboratory and diagnostic test results
Medical history and physical examination
findings
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Surgical Positions
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Risk for Perioperative
Positioning Injury
Interventions include:
 Proper body position
 Risk for pressure ulcer formation
 Prevention of obstruction of circulation,
respiration, and nerve conduction
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Impaired Skin Integrity and
Impaired Tissue Integrity
Interventions include:
 Plastic adhesive drape
 Skin closures, sutures and staples,
nonabsorbable sutures
 Insertion of drains
 Application of dressing
 Transfer of patient from the operating room
table to a stretcher
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Common Skin Closures
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Potential for Hypoventilation
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Continuous monitoring of:
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Breathing
Circulation
Cardiac rhythms
Blood pressure and heart rate
Continuous presence of an anesthesia
provider
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