This document discusses various aspects of intraoperative care including: 1) It outlines the WHO surgical safety checklist which includes prelist briefing, sign in, time out, sign out and post list debriefing. 2) The time out is performed before surgery starts and includes team introductions, confirming identity, operative site, procedure and antibiotics. 3) Sign out includes checking the procedure was recorded, instrument and swab counts, and specimen labelling. 4) Other topics covered include operating theatre environment, patient transfer and positioning, infection control, and scrubbing procedures.

1. Intraoperative Care
Hem Narayan Amatya
1st year resident
Lumbini Medical college
Total number of slides=29
1

2. Contents
• Preoperative Preparation
• WHO surgical safety Checklist
• Operating theatre environment
• Patient transfer and positioning
• Scrubbing up
• Prepping and draping the patient
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3. Preoperative Preparation
• Before theatre
• Communication between anesthetist and surgeon
• Special requirement discussion
• Arrange theatre list
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4. WHO surgical safety Checklist
• Prelist briefing
• Sign in
• Time out
• Sign out
• Post list debriefing
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5. 5

6. 6

7. 7

8. Time Out
• Performed immediately before the surgical procedure starts.
• Team introductions
• Verbal confirmation
• identity
• Operative site
• Procedure
• anticipated critical
• antibiotic prophylaxis
• Review of essential imaging
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9. Sign out
• Checking that the procedure has been recorded
• Instrument and swab counts
• Specimen labelling
• concerns for recovery recorded
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10. Antibiotics
• Within hour of incision
• Discontinued within 24hour of surgery
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11. Venous thromboembolism
• Risk assessment
• Optimum hydration
• Mechanical and pharmacological prophylaxis
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12. Operating theatre environment
Aim= prevention of airborne microorganism
• Filtered air introduced at ceiling
• Positive pressure relative to surrounding
• Limit personnel movement
• Laminar air flow-100 to 300 air changes per hour
• Optimal temperature and humidity
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13. Humidity and temperature
• Temperature of 20-24`C are acceptable
• Relative humidity of 50-60 percent
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14. Patient transfer and positioning
• Coordinated by the anesthetist, who protects airway devices.
• Sliding boards and low friction sliding sheets are helpful.
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15. Pressure areas which must be
given special consideration
• The skin over bony prominences
• Nerves in superficial courses
• No contact with any metal other than the diathermy plate
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16. Equipment's : Diathermy
In Monopolar
• Electrode plate site should be: clean and dry, free of hair
• Situated over well-perfused muscle mass
• Avoiding
• bony prominences,
• scar tissue
• areas distal to tourniquets
• implanted metal work
• Close to the operative site
• Checked at the end of surgery for injury
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17. Tourniquets
• Appropriate size
• As proximally as possible
• Apply padding lo site without creases
• Avoid slippage and prevent drainage
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18. Temperature control
• Heat loss rapidly from radiation
• Measures to limit the development intraoperative hypothermia
• Warming blankets
• Warmed intravenous and irrigation fluids
• Increasing the operating room ambient temperature
• Minimizing exposure of the patient
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19. Hair Removal
• Facilitate exposure
• Clipping preferred rather than shaving
• Wound infection rate is 1% if done immediately
• Rises to 5% if done 12 hours prior surgery
• Clipping and depilatory creams infection<1%
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20. Glycemic control
• Hyperglycemia- wound infection
• Unrecognized hypoglycemia-seizures and death
• Diabetic patients need more strict monitoring
• OHA are stopped on day of surgery.
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21. Infection control
• Asepsis and universal precautions:
• non-porous gloves,
• Eyewear
• mask
• apron for staff
• safe sharps handling techniques and adequate provision of sharps bins
• staff vaccination for hepatitis B
• staff with infected wounds or active dermatitis should not work in theatre
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22. Scrubbing up
• Hat, mask and eye protection
• Jewelry should be removed
• Scrubbing Nails and deep skin creases
• Hands and forearms are washed 3 times
• Arms are dried from distal to proximal using a sterile towel
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23. 23

24. 24

25. 25

26. Scrubbing
• Standard scrubbing solution:2 per cent chlorhexidine: effective for 4
hour
• 7.5 per cent povidone-iodine
• Alcohols (70% isopropranolol)
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27. Prepping and draping the patient
• Skin preparation should include the surgical site and wide area
around it
• Aims - create a protective zone around the operative
• Diathermy and suction equipment are attached to the drape
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28. Role of the assistant
• Review the anatomy and the operation before surgery
• Check that the patient is ready for theatre
• Should write important steps and information on board
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29. Reference
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• The 26th edition of Bailey & Love's Short Practice of Surgery
• Schwartz’s Principles of Surgery, 11e