RLE 116-OPERATING ROOM NOTES

COMMON SURGICAL INSTRUMENTS

NEEDLE HOLDER
- holding suture needles

TOWEL CLIP
- securing towels/ drapes
- -grasping tissue that will be
removed
- holding or reducing small bone
fragments

CAUTERY PENCIL AND CAUTERY TIP

- Cauterizing blood vessels and/or
cutting tissues.

SPONGE/ OVUM FORCEP

- grasping tissue
- holding sponges
“SPONGE STICK”- term used for a sponge ANOSCOPE WITH OBTURATOR
forceps holding a 4x8 OS in a triangular - Retracting or viewing anal canal
fold.

ADSON W/O TEETH

- Grasping tissues and applying
POOLE SUCTION dressings
- suctioning large quantities of blood
ADSON W/ teeth (Adson tissue forceps)
- grasping skin layer during wound ALLIS
closure - grasping organs or tissue during
removal

THUMB FORCEP BABCOCK

- Grasping tissue/ applying dressing - grasping delicate tissues (ex.
Fallopian tubes, bowel, vas deferens)

TISSUE FORCEP
- Grasping tissue during skin closure KOCHERS/OCHSNER
- Grasping heavy tissue (fascia)

DEBAKEY KELLY CURVE CLAMP(ROUNDNOSE)

- Grasping fine tissues - Clamping large blood vessels or
tissues
MOSQUITO CURVE CLAMP (SNAP) SUTURE SCISSORS
- Clamping delicate tissues or blood - Cutting dressings, drains and sutures.
vessels

MIXTER BLADE HANDLE #3

- Clamping tissue or grasping ligature - Use blades #10, #11, #12, #15
Around a curve. (ex. Pedicle/ blood vessel)

MAYO CURVED SCISSORS BLADE HANDLE #4

- Cutting heavy tissue or muscle; - Use blades #20, #21,#22, #23
dissecting heavy tissue

METZENBAUM (METZ) BLADE HANDLE #7

- Cutting or dissecting delicate tissues - Use blades #10, #11, #12, #15
-THINNER HANDLE FITS IN SMALLER
AREAS
#11 BLADE
RICHARDSON RETRACTOR
- Makes “small” puncture incisions. - Retraction, exposing wound
- A.k.a. “STAB KNIFE”

#15 BLADE
- Cutting in small areas and incising ARMY-NAVY RETRACTOR
delicate tissues - Exposing Superficial Wound

#21 BLADE DEAVER RETRACTOR

- Cutting heavy tissue or bone - Deep Wound Retraction

BALFOUR RETRACTOR MALLEABLE/ RIBBON RETRACTOR

- A kind of self-retaining retractor - may be bent to desired shape
- For deep abdominal retraction - deep wound 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

1.Only sterile items are used within the sterile field THE SURGICAL SAFETY CHECKLIST
2.Sterile persons are gowned and gloved; gowns are sterile from table to -checklist published by the World
chest level in front including sleeves to 2" above the elbow Health Organization to ensure the
3.Tables are sterile only at table level safety of patients undergoing surgery.
4.Sterile persons touch only sterile items or areas. Unsterile persons touch -its primary goal is to minimize
only unsterile items or areas
surgical errors in the operating room
5.Unsterile persons avoid reaching over the sterile field. Sterile persons avoid
leaning over unsterile areas.
THREE PHASES:
6.Edges of anything that encloses sterile content are considered unsterile
1. SIGN-IN
7.Unsterile persons avoid sterile areas
-done before the induction of
8.The sterile field is created as close as possible to the time of use anesthesia
9.Sterile areas are continuously kept in view - confirms the identity of the patient,
10.Sterile persons keep well within the sterile area pre-op medications, blood products etc.
11.Sterile persons keep contact with sterile area to a minimum

12.Microorganisms must be kept to an irreducible minimum

Data needed to be gathered to the patient:
• Name, age, sex, civil status
13.Destruction of the integrity of microbial barriers results in contamination
• Weight (basis of the amount of
QUADRANTS OF THE ABDOMEN anesthesia to be given by the
anesthesiologist)
• Consent
• Last Meal/ Drink Taken by the patient
(NPO)- patients who will be
undergoing surgery must be NPO 6-8
HOURS before the scheduled
operation. This also prevents the risk
of the patient for aspiration.
• Allergies (medications and food)
• Pre-operative Medications
• Available Blood Products (note if
blood products are crossmatched)
• Present IVF
• VITAL SIGNS (BP, HR, RR AND O2 SAT)

LAYERS OF THE ABDOMEN 2. TIME OUT

- BEFORE THE SURGICAL INCISION
• Team Member Introductions
• Reconfirm Surgical Consent
• Review of Surgical, Nursing and
Anesthesia Plans

3. SIGN OUT
- BEFORE LEAVING THE OPERATING
ROOM

• Recording the Procedure

• Counting the Instruments, sponges
and needles
• Labeling of Specimens
ANESTHESIA
b. EPIDURAL ANESTHESIA
Anesthesia is the use of medicines to prevent pain
during surgery and other procedures. These Epidural anesthesia is a technique that may
medicines are called anesthetics. They cause you to
have a loss of feeling or awareness. be used as a primary surgical anesthetic or as a
resource for postoperative pain management.
I. Local anesthesia Epidural administration is a method of medication
-numbs a small part of the body. You are administration n in which a medicine is injected into
awake and alert during local anesthesia. the epidural space around the spinal cord.

Medication: LIDOCAINE 2% (XYLOCAINE 2%) MEDICATION: BUPIVACAINE(0.5%)-

(SENSORCAINE ISOBARIC)
Note: medications such as bupivacaine,
II. Regional Anesthesia chloroprocaine and lidocaine are used as
- is used for larger areas of the body such as combination during epidural anesthesia to decrease
a leg, or everything below the waist/nipple line. You the required dose of anesthetic.
may be awake during the procedure, or you may be
given sedation. Materials needed:
(Same as SPINAL) plus with EPIDURAL CATHETER
a. RA-SAB (REGIONAL ANESTHESIA-SUB
ARACHNOID BLOCK)/SPINAL
- Spinal anesthesia is a neuraxial
anesthesia technique in which anesthetic is placed
directly in the intrathecal space (subarachnoid
space).
- Usually between L3-L4 (LUMBAR 3 AND
LUMBAR 4)
- there should be a CLEAR AND FREE
FLOWING CSF (Cerebrospinal Fluid) prior to
induction)
Medications used in Conjunction with spinal and
MEDICATION: BUPIVACAINE (SENSORCAINE epidural anesthesia:
HEAVY)
• Epinephrine- helps prolong the effects of
Bupivacaine (0.75%): One of the most widely
used local anesthetics; onset of action is within anesthesia.
5 to 8 minutes, with a duration of anesthesia -
that lasts from 90 to 150 minutes • Morphine Sulfate (MOSO4) – indicated for the
relief of severe pain. It is used preoperatively
to sedate the patient and allay apprehension,
Needed materials/equipments: facilitate anesthesia induction and reduce
anesthetic dosage.
• Spinal Needle G25(orange top)
MORPHINE PRECAUTIONS:
- Watch out for pinpoint pupils, respiratory
depression ( RR<10cpm), increasing
somnolence, nausea and vomiting, pruritus,
urinary incontinence (output <30cc/hr) and
any untoward signs and symptoms
-
III. General anesthesia affects the whole body. It
makes you unconscious and unable to move. It is
• 3cc syringe ( for xylocaine 2%)
used during major surgeries, such as heart surgery,
• 1cc syringe (for epi and M0S04) brain surgery, back surgery, and organ transplants.

• Hyponeedle G25 (orange)

a. TIVA- Total Intravenous Anesthesia
• MEDS: xylocaine 2% -is a technique of general anesthesia which
uses a combination of agents given exclusively by the
Sensorcaine Heavy
intravenous route without the use of inhalation agents.

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).

medical equipment needed:

• Endotracheal Tube
• 10cc syringe ( to inflate ET tube balloon)
• Lubricating Jelly
• Laryngoscope
• Oral Airway
• Suction Catheter ( suctioning secretions)

Medication for GETA :

SEVOFLURANE (SEVORANE)- gaseous anesthetic
agent used in Conjunction of Oxygen

What are the risks of anesthesia?

Anesthesia is generally safe. But there can be risks,
especially with general anesthesia, including:

• Heart rhythm or breathing problems

• An allergic reaction to the anesthesia
• Delirium after general anesthesia. Delirium
makes people confused. They may be unclear
about what is happening to them. Some
people over the age of 60 have delirium for
several days after surgery. It can also happen
to children when they first wake up from
anesthesia.
• Awareness when someone is under general
anesthesia. This usually means that the
person hears sounds. But sometimes they can
feel pain. This is rare.