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Intraoperative Phase

The intraoperative phase begins when the patient enters the OR and ends when the patient is transferred to the postanesthesia care unit (PACU)

This phase consists of all activities that occur during the surgery, such as positioning the patient on the operating table, administering anesthesia, performing surgical asepsis and sterile technique, monitoring vital signs and other parameters, assisting with surgical procedures, counting instruments and sponges, documenting events and transferring the patient to the PACU.

Intraoperative teams

  1. Surgeon

  2. Surgical assistant 

  3. Anesthesiologist 

  4. Scrub Nurse 

  5. Circulating Nurse 

  6. Certified surgical technologist

Positioning on the operating table is done to provide optimal exposure of the surgical site, prevent injury or pressure ulcers, maintain alignment and circulation, and ensure comfort and safety.

The position depends on the type of surgery, the surgeon’s preference, the anesthesia method and the patient’s condition.

Some common positions are supine (lying on back), prone (lying on stomach), lithotomy (lying on back with legs in stirrups), Trendelenburg (lying on back with head lower than feet), reverse Trendelenburg (lying on back with head higher than feet), lateral (lying on side) and Fowler’s (sitting up with head elevated)

The nurse should use padding, straps, bolsters and pillows to support and protect the patient’s body parts.

Anesthesia  Anesthesia is administered to induce a state of controlled unconsciousness, analgesia, amnesia and muscle relaxation during surgery.

It can be general, regional or local.

General anesthesia affects the whole body and requires endotracheal intubation or laryngeal mask airway (LMA) to maintain airway patency and mechanical ventilation to support breathing.

Regional anesthesia affects a large area of the body and involves injecting an anesthetic agent into or around a nerve plexus or spinal cord.

It can be spinal, epidural, caudal or nerve block.

Local anesthesia affects a small area of the body and involves applying or injecting an anesthetic agent into the skin or mucous membrane.

It can be topical, infiltration, intravenous regional or tumescent.

The nurse should monitor the patient’s level of consciousness, vital signs, oxygen saturation, end-tidal carbon dioxide, electrocardiogram, urine output and temperature during anesthesia.

Surgical asepsis and sterile technique Surgical asepsis and sterile technique are used to prevent infection and contamination of the surgical site and instruments.

They involve creating and maintaining a sterile field, wearing sterile gloves, gown, mask, cap and eyewear, using sterile equipment and supplies, handling sterile items with care, avoiding contact with nonsterile items, discarding any contaminated or questionable items and monitoring for breaks in sterility.

Intraoperative monitoring Vital signs and other parameters are monitored continuously or at regular intervals during surgery to assess the patient’s status and response to anesthesia and surgery.

They include blood pressure, pulse, respiratory rate, oxygen saturation, end-tidal carbon dioxide, electrocardiogram, urine output and temperature.

The nurse should compare the values with the baseline and normal ranges, report any abnormal or significant changes to the anesthesiologist or surgeon and intervene as needed.

Questions on Intraoperative Phase

Correct Answer is C

Explanation

<p>This is incorrect because the supine position does not enhance circulation and oxygenation to the brain. The supine position may actually decrease the functional residual capacity (FRC) of the lungs, which is the amount of air remaining in the lungs after a normal expiration. This can lead to reduced oxygenation and ventilation of the blood. Additionally, the supine position may cause venous congestion in the head and neck, which can impair cerebral perfusion and increase intracranial pressure. To enhance circulation and oxygenation to the brain, other positions such as reverse Trendelenburg or sitting may be used.</p>

Correct Answer is ["C"]

Explanation

<p>Maintaining surgical asepsis and sterile technique is a function of both the scrub nurse and the circulating nurse. The scrub nurse maintains a sterile field by wearing sterile attire, handling sterile instruments and supplies, and preventing contamination. The circulating nurse maintains asepsis by monitoring the sterile field, checking for breaks in technique, and obtaining additional items as needed.</p>

Correct Answer is A

Explanation

<p>This is not a correct definition of any type of anesthesia, but rather a description of natural sleep. General anesthesia is different from sleep because it involves a complete loss of awareness and responsiveness to any stimuli, whereas sleep involves periodic changes in brain activity and responsiveness to certain stimuli such as sounds or light. General anesthesia also requires artificial maintenance of vital functions such as breathing and blood pressure, whereas sleep does not.</p>

Correct Answer is D

Explanation

<p>This is correct because the Trendelenburg position helps to increase the space and visibility in the upper abdomen or chest by displacing the abdominal organs downward. This may facilitate surgical procedures such as cholecystectomy, hiatal hernia repair, or thoracic surgery.</p>

Correct Answer is D

Explanation

<p>Applying sterile drapes and handing instruments to the surgeon are both tasks that the CST performs. According to WebMD, these are part of the intraoperative duties of the CST, along with keeping the operating room sterile, assisting in retracting tissues, and suctioning and sponging. Therefore, choice D is correct and covers two of the main tasks that the CST performs.</p>

<p>Removing any metal jewelry from the patient is a correct action to prevent burns to the patient during electrocautery, but it is not sufficient by itself. Metal jewelry can cause electrical arcing or heating, leading to skin burns or fire hazards. However, removing metal jewelry alone does not en

<p>Discarding any unused items before the final count does not facilitate counting or prevent foreign body retention. It may actually increase the risk of losing track of the items used during the procedure or leaving some items inside the patient. Therefore, this is not a correct answer.</p>

<p>This is incorrect because an eyed needle with a blunt point is used for suturing tissues that are easy to separate, such as liver, kidney, or spleen A blunt point needle has a round body that ends in a blunt tip, which pushes aside the tissue fibers rather than cutting them An eyed needle has an

<p>This is incorrect because removing the dressing after 24 hours and leaving the wound open to air may not be advisable for some wounds, especially those that are deep, large, or at risk of infection. The wound may need to be covered with an appropriate dressing for a longer period of time to prote

<p>Flushing the drain tubing with saline solution every 4 hours is not recommended and may introduce infection or clog the tubing. The tubing should be kept clear by squeezing or &quot;milking&rdquo;. it occasionally to prevent clots from forming. : Instructions for Surgical Drain Care - Cleveland C
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