Surgical Procedures and Roles

Surgical Settings

• Advances in surgical technology and evidence-based practices have expanded surgical settings beyond traditional inpatient hospitals to include outpatient surgical centers.
• Inpatient surgical settings cater to invasive and lengthy procedures needing over 24 hours of monitoring and recovery.
• Cardiac surgeries exemplify inpatient procedures, often requiring ICU care and continuous monitoring.
• Ambulatory or outpatient surgery, also known as "same-day surgery," involves less invasive procedures with under 24 hours of monitored recovery.
• Outpatient surgery candidates usually have no comorbidities and require no additional recovery care beyond postanesthesia.
• Successful at-home recovery from outpatient surgery requires patient receptiveness to teaching and a 24-hour caregiver.
• Outpatient surgical examples range from ENT and oral surgeries to more complex procedures like mastectomies.
• Ambulatory surgery centers adhere to inpatient safety and clinical guidelines, including anesthesiologists and sterile environments.
• Freestanding outpatient surgery is increasingly popular.
• Outpatient surgery nurse prioritize patient education due to shorter recovery, often teaching preoperatively when patients are alert.

Surgical Categories

• Surgery is divided into six subcategories.
• Diagnostic surgeries, such as biopsies, determine disorder sources.
• Curative surgeries repair or remove disorder causes.
• Restorative surgeries, like hip replacements, reconstruct mechanical parts of the body.
• Palliative procedures aim for comfort and symptom relief.
• Cosmetic surgeries restore or improve appearance.
• Transplant surgeries replace organs to improve or sustain life.
• Surgical procedures are further categorized as elective, urgent, or emergency.
• Elective surgery is patient-chosen for well-being, often scheduled at the patient's convenience and performed outpatient.
• Urgent surgery is necessary but can be scheduled, including procedures like hysterectomies and joint replacements.
• Emergency surgery happens is unscheduled and immediately to save a patient's life or limb.
• Minor procedures, like oral surgeries, hold less surgical risk and require minimal postanesthesia recovery under local anesthesia.
• Major procedures are complex, performed under general anesthesia with possible overnight ICU stays.
• Simple procedures involve a small, defined area and radical procedures involve the affected area and surrounding tissue.

Surgical Team Members

• Surgical teams include surgeons, anesthesia providers, perioperative RNs, and unlicensed assistive personnel.
• Effective communication, respect, and teamwork are essential in the OR.
• Team members are categorized as sterile, those who scrub and gown to work in the sterile field, or nonsterile, functioning outside the sterile field.

Sterile Team Members

• Maintaining asepsis is the responsibility of the sterile team members.
• Surgical assistants are practitioners who aid surgeons, including physician assistants (PAs), surgical first assistants (SFAs), nurse practitioners (NPs), and RN first assistants (RNFAs).
• SFAs are certified surgical technologists that help with exposing the site, hemostasis, and other technical functions.
• Scrub nurses, surgical technologists, and OR technicians are responsible for setting up instruments, maintaining the sterile field, and assisting the surgical team.

Nonsterile Team Members

• Anesthesia providers maintain patient physiological status, possibly anesthesiologists or certified registered nurse anesthetists (CRNAs).
• Circulating RNs assist the team and maintain a safe, comfortable environment.
• Unlicensed assistive personnel transport patients, position them, and deliver specimens under RN supervision.
• OR directors/coordinators/managers oversee business aspects, budgets, staffing, and efficient OR operation.

Priority Assessments and Procedures

• Several key assessments and procedures ensure a safe operative experience.
• The preoperative assessment, by perioperative nurses, aims to determine the patients knowledge, confirm informed consent, assess patient anxiety, and obtain relevant patient information such as medication, allergies and health history.
• The surgical pause or time-out verifies the patient, procedure, surgeon, position, equipment, and imaging studies before starting.
• The surgical scrub and the donning of surgical attire is another key step in ensuring asepsis.

Anesthesia

• Anesthesia goals include amnesia, analgesia, reflexes, relaxation, and physiological manipulation.
• Before surgery, patients undergo a physical exam by the anesthesia team, which uses the ASA guidelines to assess and assign perioperative risk to administer anesthesia.
• Anesthesia types are general, regional, local, and monitored anesthesia care (MAC).
• General anesthesia induces a reversible unconscious state, achieved through inhalation, IV agents, and muscle relaxants.
• Volatile agents used include isoflurane, sevoflurane, desflurane, and nitrous oxide, with potency measured by minimum alveolar concentration.
• Barbiturates, benzodiazepines, opioids, propofol, and ketamine make up the current IV anesthetics.
• Barbiturates are central nervous system depressants are excellent anesthetics.
• Benzodiazepines increase receptor availability for the inhibitory neurotransmitter.
• Opioids bind to G-protein receptors and provide excellent analgesia.
• Propofol is a hypnotic known as "milk of anesthesia" that wears off quickly.
• Ketamine is a dissociative anesthetic used with amnestics for sedation.
• Dexmedetomidine (Precedex) is an anxiolytic, analgesic, and sedative.
• Muscle relaxants depolarizing or nondepolarizing agents.
• Succinylcholine is a depolarizing agent that produce paralysis.
• Nondepolarizing agents causes progressive paralysis.
• Complications of general anesthesia include hypoxia, respiratory and cardiovascular dysfunction, and hypotension.
• Malignant Hyperthermia (MH) is a hypermetabolic state triggered by volatile gas anesthetics and/or succinylcholine.
• Regional anesthesia uses local anesthetics to block nerves or nerve fibers via spinal, epidural, caudal, or nerve blocks.

Regional Anesthesia

• Regional anesthesia is a local anesthetic used to block or anesthetize a nerve or nerve fibers.
• Types of regional anesthesia or blocks include spinal, epidural, caudal, and nerve blocks.
• Spinal medication is injected into the spinal canal, and it's important to keep patients head flat to avoid headaches.
• Epidural medication is injected with a catheter, and headache is avoided here because the intrathecal space not entered.
• A nerve block is when a nerve in an extremity is anesthetizing to allow surgery in a specific area.
• Untoward effects of spinal anesthesia includes rapid decrease in blood pressure, spinal headaches, and respiratory paralysis, and seizures.

Local Anesthetics

• Local anesthetics use conduction blockade of nerve impulses.
• Lidocaine has a short-term duration and rapid onset.
• Bupivacaine has excellent postoperative analgesia and a long duration.
• Epinephrine may be mixed in for vasoconstrictive effects to help control bleeding and prolong the action of medications.
• Cocaine is used in nasal surgery for its vasoconstrictive properties and hypertension and tachycardia are key side effects.

Monitored Anesthesia Care

• Monitored anesthesia care (MAC) is anesthesia without unconsciousness.
• Goals include maintaining consciousness, enhancing cooperation, a degree of amnesia, and having minimal variation in vital signs.
• MAC couples sedation/analgesia with local anesthetics, such as diazepam, midazolam, and narcotics.

Airway Management

• Airway management ensures adequate oxygenation during surgery.
• Airway complications include laryngospasm, bronchial intubation, and tracheal and esophageal perforation.

Positioning in the Operating Room

• Patient positioning aims for optimal anatomical exposure and patient safety via devices to ensure safe alignment.
• Patient positioning is collaborative and uses standard positions, which include supine, prone, lateral, and lithotomy.
• The supine position used for procedures on the anterior surface of the body and ensures the patients arms must not be positioned lower than the spinal column.
• The Trendelenburg position is head-down tilt of 35 to 45 degrees and it used to move the abdominal viscera away from the pelvic area
• Reverse Trendelenburg position is where the head of the patients is higher than their feet.
• The Fowler's position is also called the sitting position, where the patient is in a supine position.
• The prone or ventral decubitus position is where is placed facedown.
• Jackknife or Kraske position is a modification of the prone position.
• The lateral decubitus position is used primarily thoracic, renal, and orthopedic procedures.
• The lithotomy position is for urological, and rectal procedures.

Positioning Devices

• Positioning devices are specific to procedure, surgeon, procedure and patient variables.
• Preoperative assessment is crucial to mitigate for any possible individual risk factors.
• Geriatric, pediatric and obese and demineralizing patients are high-risk for complications.
• Improper positioning can contribute to pressure injuries.
• High-risk situations include excessive pressure on body parts, vascular surgery, and prolonged procedures.

This quiz covers the classification, roles, and safety aspects of surgical procedures. It explores surgical risk assessment, extent of procedures, anesthesia options, and the importance of effective communication among surgical teams. Additionally, it touches upon gynecological surgeries.