Preparation of surgical team,pack and patient

Mudasir BashirRoll no.-4856

Division of vety surgery and radiology-I.V.R.I

Preparation of surgical team• Each surgical team consists of 3-4 members.I. Surgeon—

captain of surgical team and performs surgical operation.

uses hand signals and talks slowly for necessary requests.

possess qualities of an ideal surgeon—thoghtful,kind,forgiving,understanding,quite,controlled,foresighted and gentle.

II Assistant surgeon– assists surgeon during operation. prepares and drapes surgical field of operation. keeps operative field free of visual

obstructions,particularly blood and clots. should remember to blot tissues instead of wiping

them. avoids accumulation of instruments,soiled

sponges,remnants of sutiures,abdominal packs. keeps in mind detail helping the surgeon.

• Anesthetist/helper— prepares and administers

preanaesthetics.keeps proper anaesthetic record.

records respiration,pulse,its quality and strength and temp.

keeps animal in recovery room after surgery.

preparations of surgical team involves:- Scrub suits:worn in the surgery area to limit amt .of dirt,debris and bacteria that surgical staff carry into operating room.

• Shouldnot shrink ,easily laundered.• Available in cotton,polyester blends or

disposable nonwoven material.• Usually consists of shirt and pant.

• Not worn to examine patients or change bandages if additional surgery is to be done.

• Head cover:-worn to reduce shedding of hair and bacteria{e.g;strept.viridens,e.coli,s.aureus} into incision.

• All people in operating room wear head cover.• Present in caps,hoods and bouffants.

• Shoe covers:-worn to exclude-• Bacteria on street shoes.• Reduce possibility of contaminating the

operating room.• To protect shoes from blood and hospital

bacteria.• Available in both reusable and disposable.• Use declining-no evidence of declining

surgical wound infection.

• Face masks:-recommended for anyone entering surgical room during surgery.

• Covers nose and mouth and are secured behind top of head and neck for minimal venting.

• Prevent surgical wound from saliva droplets and micro-organisms by radiating through sideways of mask.

• Surgical hand scrub:-surgeons hands usually more contaminated than do the hands of other medical personnel-more exposure to scrub soln.and contaminated wound.

• Brushes may or may not be used-no reduction in contamination.

• Done by 2 methods-I. Timed anatomic scrub-all surfaces scrubbed

for specific time.5minute scrub is safe and effective.

I. Counted brush strokes method:-each surface 0f arm and hands receive specific number of brush strokes.

Usually 10-25 times is being done.• Gowns:-provide barrier between operating

teams skin and patient.• Packaged individually and folded so that

internal back region is outermost.• Gloves:-worn by the operating team to protect

patient from micro-organisms present on operating teams skin.

• Powders are placed inside the gloves to make them easy to wear.

• Remember:-• Ensure that nails are socially clean,short and

without nail polish.• Ensure that hands are kept heigher than

elbow.• Rings watches should be removed.• Use of gloves does not replace hand washing.• Keep safe distance away from obstacles of the

gown.• Never touch anything which is non sterile.• Check there is no hole in gloves.

Preparation of patient• Dietary restrictions:-• Done to prepare animals GIT for surgery.• To prevent postoperative emesis causing undue stress

on incision and tracheobronchial aspiration of stomach contents

• Food intake is generally restricted for 12hrs in small animals and 24-48hrs in large animals.

• If inadequate fasting time,emesis may be induced.• EXCRETIONS:-Shortly before anaesthesia animal

should be allowed to defaecate and urinate-empty bladder is often required for abdominal surgeries.

• Preparation of patient is divided into:-I. Premedication:-done to:-Reduce amt of general anesthetic needed and

increase margin of safety.Calm the patient-anaesthesia can be

administered without fright or struggling.Reduce salivary secretions and of mucus

glands of respiratory tract.Reduce gastric and intestinal motility-prevent

vomiting while animal is under anaesthesia.

Block vagovagal reflex-prevent cardiac slowing or arrest.

Reduce pain,struggling and crying during the recovery period.

• drugs used as preanaesthetics are:-• Anticholinergics.• Tranquilizers.• Opiate and non-opiate analgesics.• Tranquilizer-narcotic combination.ETC.

• After applying pre-anaesthetics,general anesthetic is given to the animal.

• General anaesthetics are generally given either through i.v route or by inhalation.

• After attaining complete anaesthesia animal is intubated.

• In ruminants general anesthesia is not preferred—prolonged lateral recumbency leads to accumulation of gases—respiratory distress.

• In cat and horse never do surgery of eye or close to eye on local anesthetics—heart block.

• Antibiotics should be applied before surgery.• In horse tetanus toxoid should be given prior

to surgery[21days in elective surgery and before surgery in emergency surgery].

• Application of fluids.• Anesthesia given should be balanced that is—

hypnotic,muscle relaxant,andanalgesia.• Dosage of anesthetic is based on following

factors—• Metabolic activity of animal.• Existing disease condition.

• Pharmacological effect of drug.• Factors on which anesthetic is given:-• Age of animal.• Relative size of animal.• Body fat.• Sex.• Breeds.• temperament of animal.• Prolonged fasting.• Recent feeding.

• Activity of animal.• Duration of surgery.• Nature of operation.• Site of surgery.

• Surgical site preparation:-the skin and hair of animals are reservoir for bacteria{staph.micrococcus,acinetobacter,corynebacterium,strept,etc}.

• Hair removal:-razors,depilatories and clippers have been used.

• Razors-• Adv.:-leave minimal stubble.• Disadv.:-multiple laceration.• Skin erosion.• 10fold increase in surgical wound infection.

• Depilatories:-• Adv:-a traumatic.• Disadv:-donot work on coarse animals skin.• Expensive.• Frequent skin reactions esp.cats.• Clipping:-recommended method.• Adv:-less skin trauma.• Fewer surgical wound infection.• minimum of 15cm on each edge of proposed

incision is clipped.• For orthopedic procedures on limb-entire limb is

clipped.

• Skin preparation:-initial site preparation is performed outside the operating room with the animal positioned for easy access to the proper surgical site.

• If limb is being prepared, it is suspended from ceiling or an i.v stand to have complete access.

• The clipped area is scrubbed by applying gentle pressure in circular motion beginning at proposed incision site and moving centrifugally.

• After scrub apply antiseptic soln.-70% ethyl alcohol,tinctures of chlorhexidine and iodine.

• Positioning of patients:-• To ensure easy and complete access to surgical

site to facilitate manipulation.• Patient is then secured with

ropes,sandbags,adhesive tape,etc.to minimize movement during surgery.

• Surgical site is wiped with antiseptic to complete the preparation.

• Draping the patient:-• Isolates the surgical site from contaminated

areas and provides sterile working area.• First of four drapes is opened,applied along

one edge .similarly other three are kept on other edges.

• Second drape layer consists of large single shroud with a central opening.

• These art kept hold by using towel clamps.

• Skin draping:-• Purpose-prevent bacteria present in hair

follicles to contaminate the surgical wound.• Minimizes contamination of surgeons gloves.• PLASTIC DRAPES COMPARED TO CLOTH

DRAPES CAUSE SIGNIFICANT REDUCTION IN POSTOPERATIVE COUNTS OF ENDOGENOUS BACTERIA.

PREPARATION OF SURGICAL PACK• General surgical pack consists of following

instruments---• Mayo's scissors—blunt end,straight—1.• Mayo's scissors—blunt end, curved—1.• B.p.handle no.3 and no.4---------1 each.• Assorted blades for above handles—1 packet.• Mouse tooth tissue forcep----1.• Allis tissue forceps-----2• Cross bar towel clamp---4

• Mosquito hemostats'-------4.• Artery foreceps,curved and straight—2 each.• Mathews needle holder---1.• Groove director---1.• Suture needles assorted(traumatic and a

traumatic)-straight and curved---6.• Surgical gloves—2 pairs.• Surgical gown,mask,cap—2 each.• Surgical shroud(75×105cm) with 17×2cm slit

in centre----1.

• Surgical shroud without slit----1.• Surgical towels 20×30cm-------2.• Gauze sponges.• Surgical pack wrapper(90×120cm)—1.• General surgical pack should be prepared as

follows:-• Surgical pack wrapper should be spread over

diamond-wise on the table—one corner towards left and other towards right,one towards near side,fourth to far side.

• Items assembled on pack wrapper in such a way that when pack is opened the articles may be removed in the order in which they are to be used.

• All the instruments, surgical gowns,shrouds,gloves and towels should be cleaned dried before preparing a pack.

• Surgical shroud should be folded by accordion-folding at 9-10cm intervals so that folds are At rt.angle to the window.

• Pack should be sterilized. generally -121°c×15psi×15min.