RLE 116-OPERATING ROOM NOTES

COMMON SURGICAL INSTRUMENTS

POOLE SUCTION
- suctioning large quantities of blood

TOWEL CLIP
- securing towels/ drapes
- -grasping tissue that will be NEEDLE HOLDER
removed - holding suture needles
- holding or reducing small bone CAUTERY PENCIL AND CAUTERY TIP
fragments - Cauterizing blood vessels and/or
cutting tissues.

SPONGE/ OVUM FORCEP

- grasping tissue
- holding sponges
“SPONGE STICK”- term used for a sponge
forceps holding a 4x8 OS in a triangular
fold.
ANOSCOPE WITH OBTURATOR ADSON W/O TEETH
- Retracting or viewing anal canal - Grasping tissues and applying
dressings

ADSON
W/
teeth
(Adson
tissue

forceps)
- grasping skin layer during wound
closure

THUMB FORCEP
- Grasping tissue/ applying dressing

TISSUE FORCEP
- Grasping tissue during skin closure

DEBAKEY
- Grasping fine tissues

ALLIS
- grasping organs or tissue during
removal
 BABCOCK MIXTER
- grasping delicate tissues (ex. - Clamping tissue or grasping ligature
Fallopian tubes, bowel, vas deferens) Around a curve. (ex. Pedicle/ blood vessel)

MAYO CURVED SCISSORS

- Cutting heavy tissue or muscle;
dissecting heavy tissue
METZENBAUM (METZ)
- Cutting or dissecting delicate tissues

KOCHERS/OCHSNER
- Grasping heavy tissue (fascia)

KELLY CURVE CLAMP(ROUNDNOSE)

- Clamping large blood vessels or
tissues

MOSQUITO CURVE CLAMP (SNAP)

- Clamping delicate tissues or blood
vessels
 SUTURE SCISSORS
- Cutting dressings, drains and sutures.

- Use blades #10, #11, #12, #15

BLADE HANDLE #4
- Use blades #20, #21,#22, #23

BLADE HANDLE #7
- Use blades #10, #11, #12, #15
-THINNER HANDLE FITS IN SMALLER
BLADE HANDLE #3
AREAS

#11 BLADE
- Makes “small” puncture incisions.
- A.k.a. “STAB KNIFE”

#15 BLADE
- Cutting in small areas and incising
delicate tissues
#21 BLADE
- Cutting heavy tissue or bone
 - Deep Wound Retraction
MALLEABLE/ RIBBON RETRACTOR
BALFOUR RETRACTOR - may be bent to desired shape
- A kind of self-retaining retractor - deep wound retraction
- For deep abdominal retraction

BLADDER RETRACTOR
- Part of a Balfour retractor that
separates the Urinary Bladder from
the uterus. 13 PRINCIPLES OF ASEPTIC TECHNIQUE IN THE OPERATING ROOM

RICHARDSON RETRACTOR 1.Only sterile items are used within the sterile field
- Retraction, exposing wound 2.Sterile persons are gowned and gloved; gowns are sterile from table to
chest level in front including sleeves to 2" above the elbow

3.Tables are sterile only at table level

4.Sterile persons touch only sterile items or areas. Unsterile persons touch
only unsterile items or areas

5.Unsterile persons avoid reaching over the sterile field. Sterile persons avoid
leaning over unsterile areas.

6.Edges of anything that encloses sterile content are considered unsterile

7.Unsterile persons avoid sterile areas

8.The sterile field is created as close as possible to the time of use

ARMY-NAVY RETRACTOR 9.Sterile areas are continuously kept in view

10.Sterile persons keep well within the sterile area

11.Sterile persons keep contact with sterile area to a minimum

12.Microorganisms must be kept to an irreducible minimum

13.Destruction of the integrity of microbial barriers results in contamination

QUADRANTS OF THE ABDOMEN

LAYERS OF THE ABDOMEN

THE SURGICAL SAFETY CHECKLIST

-checklist published by the World
Health Organization to ensure the
safety of patients undergoing surgery.
-its primary goal is to minimize
surgical errors in the operating room

THREE PHASES:
1. SIGN-IN
-done before the induction of
anesthesia
- confirms the identity of the patient,
pre-op medications, blood products etc.

Data needed to be gathered to the patient:

- Exposing Superficial Wound  Name, age, sex, civil status
DEAVER RETRACTOR
  Weight (basis of the amount of a. RA-SAB (REGIONAL ANESTHESIA-SUB
anesthesia to be given by the ARACHNOID BLOCK)/SPINAL
anesthesiologist) - Spinal anesthesia is a neuraxial
anesthesia technique in which anesthetic is placed
 Consent
directly in the intrathecal space (subarachnoid
 Last Meal/ Drink Taken by the patient
space).
(NPO)- patients who will be - Usually between L3-L4 (LUMBAR 3 AND
undergoing surgery must be NPO 6-8 LUMBAR 4)
HOURS before the scheduled - there should be a CLEAR AND FREE
operation. This also prevents the risk FLOWING CSF (Cerebrospinal Fluid) prior to
of the patient for aspiration. induction)
 Allergies (medications and food)
 Pre-operative Medications MEDICATION: BUPIVACAINE (SENSORCAINE
HEAVY)
 Available Blood Products (note if
blood products are crossmatched) Bupivacaine (0.75%): One of the most widely
 Present IVF used local anesthetics; onset of action is within
5 to 8 minutes, with a duration of anesthesia
 VITAL SIGNS (BP, HR, RR AND O2 SAT) that lasts from 90 to 150 minutes

2. TIME OUT
- BEFORE THE SURGICAL INCISION Needed materials/equipments:
 Team Member Introductions  Spinal Needle G25(orange top)
 Reconfirm Surgical Consent
 Review of Surgical, Nursing and
Anesthesia Plans

3. SIGN OUT
- BEFORE LEAVING THE OPERATING
ROOM

 Recording the Procedure  3cc syringe ( for xylocaine 2%)

 Counting the Instruments, sponges  1cc syringe (for epi and M0S04)
and needles  Hyponeedle G25 (orange)
 Labeling of Specimens  MEDS: xylocaine 2%
Sensorcaine Heavy

b. EPIDURAL ANESTHESIA
ANESTHESIA
Epidural anesthesia is a technique that may
Anesthesia is the use of medicines to prevent pain be used as a primary surgical anesthetic or as a
during surgery and other procedures. These
resource for postoperative pain management.
medicines are called anesthetics. They cause you to
have a loss of feeling or awareness. Epidural administration is a method of medication
administration n in which a medicine is injected into
I. Local anesthesia the epidural space around the spinal cord.
-numbs a small part of the body. You are
awake and alert during local anesthesia. MEDICATION: BUPIVACAINE(0.5%)-
(SENSORCAINE ISOBARIC)
Medication: LIDOCAINE 2% (XYLOCAINE 2%) Note: medications such as bupivacaine,
chloroprocaine and lidocaine are used as
combination during epidural anesthesia to decrease
II. Regional Anesthesia the required dose of anesthetic.
- is used for larger areas of the body such as
a leg, or everything below the waist/nipple line. You Materials needed:
may be awake during the procedure, or you may be (Same as SPINAL) plus with EPIDURAL CATHETER
given sedation.
 medical equipment needed:
Medications used in Conjunction with spinal and  Endotracheal Tube
epidural anesthesia:  10cc syringe ( to inflate ET tube balloon)
 Lubricating Jelly
 Epinephrine- helps prolong the effects of  Laryngoscope
anesthesia.  Oral Airway
-  Suction Catheter ( suctioning secretions)
 Morphine Sulfate (MOSO4) – indicated for the
relief of severe pain. It is used preoperatively Medication for GETA :
to sedate the patient and allay apprehension, SEVOFLURANE (SEVORANE)- gaseous anesthetic
facilitate anesthesia induction and reduce agent used in Conjunction of Oxygen
anesthetic dosage.
What are the risks of anesthesia?
MORPHINE PRECAUTIONS: Anesthesia is generally safe. But there can be risks,
- Watch out for pinpoint pupils, respiratory especially with general anesthesia, including:
depression ( RR<10cpm), increasing
somnolence, nausea and vomiting, pruritus,  Heart rhythm or breathing problems
urinary incontinence (output <30cc/hr) and  An allergic reaction to the anesthesia
any untoward signs and symptoms  Delirium after general anesthesia. Delirium
- makes people confused. They may be unclear
III. General anesthesia affects the whole body. It about what is happening to them. Some
makes you unconscious and unable to move. It is people over the age of 60 have delirium for
used during major surgeries, such as heart surgery, several days after surgery. It can also happen
brain surgery, back surgery, and organ transplants. to children when they first wake up from
anesthesia.
a. TIVA- Total Intravenous Anesthesia  Awareness when someone is under general
-is a technique of general anesthesia which anesthesia. This usually means that the
uses a combination of agents given exclusively by the person hears sounds. But sometimes they can
intravenous route without the use of inhalation agents. feel pain. This is rare.

Example medication used: Propofol (Diprivan)

b. GETA- General Endotracheal Anesthesia

- It is done to deliver oxygen or inhaled
anesthetics into the lungs. It is frequently used to help
control breathing during surgery.
-Endotracheal intubation is the insertion of a
soft rubber or plastic tube (endotracheal or E.T. tube)
through the nose or mouth into the windpipe
(trachea).