OR design-anesthesia

1. -Dr Nisar Ahmed Arain
Assistant professor
Anesthesia/Critical care/ER
OPERATION THEATRE DESIGN

2. OPERATION THEATRE
-The design of operation theatre should
provide with “optimum facilities” and
minimum inconvenience in the
management of different areas.
The prime requirements in the design
of theatre are the “control of infections
and safe environment for the patient”

3. THE STRUCTURE OF OPERATION THEATRE
-1-The walls should be hard and easily washable
material e.g MARBLE
-2-Pipes and central Oxygen, Nitrous Oxide,
suction should be fitted to the walls.
-3-Adequate Air-conditioning should be provided
-4-In the absence of window adequate light should
be provided.
-5-Fire extinguisher should be adequate

4. ANESTHESIA ROOM
Preparation of an anesthetic room
-1-Attach an anesthetic breathing system with a
proper size face mask
-2-Confirm proper functioning of Mechanical
Ventilators
-3-Confirm availability and proper functioning
of central suction (or wall mounted suction)
-4-Confirm availability of
a-Intravenous solutions
b-Connecting tubes
c-Suction catheter

5. -1-Local Anesthesia (Lidocaine)
-2-Benzodiazapine (Diazepam)
-3-Catacholamines to treat
allergic reactions
-4-Opiod (Fentanyl, Sufentanyl)
PREPARING DRUGS FOR INDUCTION AND
TO USE THEM IN EMERGENCY CASES

6. STERILIZATION ROOM
A sterilization room should be built adjacent to the
operation theatre with a functional glass window.
Through this window instruments and equipment can be
passed freely between the operation room and ST room
without repeatedly opening the main doors
RECOVERY ROOM
--The main purpose of recovery room is to give post
-operative care and nursing care to the patient
--The resuscitation equipment must be available and
facilities for oxygen and suction should also be there
--Essential articles such as I /v infusion, fluids, I/V stand,
stethoscope, BP apparatus etc. Should be there

7. --Cylinders of oxygen and Nitrous oxide, additional
equipment infusion fluid bags, syringes, needles,
drugs, and operation related equipment are kept
in this room
STOREROOM
CHANGING ROOM
-A room is provided for theatre personal to change
into OT cloths, footwear, sterile caps and mask
also kept in this room
SCRUB ROOM
-The Surgeons, Nurses, and students scrub in this
room and this room opens into the OT
OPERATION TABLE
-A modern operation table has adjustments to enable
surgeon to give proper and safe position to the patient
-Some tables are designed for specific type of operation
but most are made as an all purposes

8. THEATRE TECHNIQUE
-1-Surgical scrub technique
-2-Gowning and Gloving
POSITION OF PATIENT USED FOR SURGERY
-Supine, Dorsal, Recumbent position – used for operation of Eye
ear, Face, chest, abdomen, Breast, legs, feet and hands
-Lateral position – is used for operations on Kidney, liver, & Hip
Lithotomy position is used for operations on external Genitalia
Vagina, and in anal infection
-Prone position – is used for posterior cerebellar and spine
operations
PREPARATION OF THEATRE EQUIPMENT AND SUPPLIES
Theatre Cleaning
Cleaning is a process which physically removes organic
matter but does not necessarily destroy micro-organism

9. DAILY ROUTINE CLEANING
-Operation heater is closed at least one hr
before operations are started.
-The floor is cleaned when ever it gets dirty.
-It is also cleaned at the end of the days work.
-Ideally the floor is cleaned with machine with
scrub and suction dries
CLEANING BETWEEN CASES
-Area which is contaminated or dirty have to be cleaned
-If blood spills on the floor it is covered by 1%
Hypochloride solution for 10 minutes, then it is moped
away
DAILY CLEANING AT THE END OF THE DAY
Routine cleaning is the same, but attention
should be paid to the wall

10. WEEKLY CLEANING
-The floor is washed & cleaned after removing all the equipment
and furniture from the theatre
CLEANING OR AFTER FINISHING INFECTED CASES
-Routine cleaning is carried out
-Fumigation should be done either with the Formalin vapour or
Hypochloride spray.
-In case the patient had an infection that can be transmitted
through the blood, then all linin and instruments are soaked in
1% Hypochloride solution before washing
DEEP CLEANING
-This is a six-monthly programmed cleaning of the clinical area of the
theatre departments which will be undertaken by a dedicated
“Deep clean team”
-This cleaning includes all the patient's areas, preparation room, ceilings,
and walls etc.
-Nonclinical areas such as storerooms and offices will receive a yearly clean
-The deep clean Programme will be drawn up in the consultation with
“cleaning managers”, Facilities staff, Infection control team and
theatre manager

11. PREPARATION OF EQUIPMENTS FOR STERILIZATION
-Instruments are prepared on a metal tray which is covered
by a large drape which is secured to the rim of the tray
CLEANING AND CARE OF INSTRUMENTS
-Instruments must be thoroughly washed either by hand or
by using a “sonic washer "This is paid (applied) to joint and
grooves of instruments
INSTRUMENTS AND DIFFERENT TYPE OF DISINFECTION
-The precise type of disinfection depends on the type of instruments.
medical devices, equipment and surgical materials are divided into
three general categories depending on the potential risk of infection
CRITICAL ITEM
-These are instruments or objects that are introduced directly into
the blood stream or into other normally sterile areas of the body
e.g cardiac catheter

12. SEMI CRITICAL ITEMS
-These instruments are introduced into body cavities and therefore
come into contact with intact mucous membranes, but do not
ordinarily penetrate body surfaces e.g endotracheal tube
NON-CRITICAL ITEMS
-These are items that do not ordinarily penetrate, but touch only intact
skin, such items includes crutches, bed board, blood pressure cuff
INSTRUMENT PREPARATION
-Clean all the instruments and material prior to sterilization
-Dirt, Blood and all contamination should be completely
removed as they comprise sterilization
-Always soak instrument in water and detergent immediately
is done to remove blood and human body fluids
-Rinse instruments thoroughly after washing to remove any
residue from the cleaning agents
-Dry instruments should be packed in towels loosely

13. METHODS OF STERILIZATION
HEAT STERILIZATION
MOIST HEAT METHOD
-An autoclave provides moist heat under pressure which achieves
temperature higher than that of the Boiling point of Water
-Autoclave is used to sterile most of the equipment in common
use like dressings, metal wire, and instruments
-Dressings should be wrapped in a paper or cloth
Glassware should be packed individually
-Rubber gloves wrapped in glove covers or paper
-Rubber catheter, suture, and treatment trays should be wrapped
in paper or muslin cloth
-Here the sterilization is done in Hot air oven at 1600-degree
centigrade for one hour. It is usually fitted with internal Fan
to provide an even distribution of heat
DRY HEAT

14. -REQUIREMENT OF HEAT STERILIZATION
Item, time, and minute
-Glassware 60 minutes
-Instruments 60 minutes
-Wooden articles 60 minutes
-Suture Needles 60 minutes
-Syringes 75 minutes
-Needles 120 minutes
STEAM AND FORMALDEHYDE
-Low temperature steam with formaldehyde autoclave can
be used to sterilize heat labile material such as Plastic and
anesthetics
SATURATED STEAM UNDER PRESSURE
-The Flash sterilizer is frequently used in the operation
theatre for urgently needed unwrapped instrument.
-The Temperature used is 270 degree for a period of
3 – 10 mi cycle

15. COLD STERILIZATION
METHODS OF STERILIZATION
GAMMA IRRADIATION
-Gamma rays ionizing radiation can be used commercially
for sterilization of a wide range of articles such as SUTURE
SYRINGES, SYRIGES NEEDLES, CATHETERS, and dressing
material
ETHYLENE OXIDE
-This is a colorless liquid with boiling point with
a 10.70 degree centigrade and it is highly
inflammable and explosive. It is specially used
for sterilizing anesthetic machine, sutures, and
dental equipment etc.
PASTEURIZATION
-It is a method of low temperature disinfection particularly
used for “endoscopic instruments”.
-The cleaned instrument is totally immersed in an electrically
heated water tank at 75-degree foe at least 10 minutes

16. BOILING
-Each instrument should be totally immersed in a container
of distilled water and boil for 5 minutes, at a temperature
of 90 to 100-degree Celsius
SUTURE
-A stitch or row of stitches holding together the edges
of a wound or surgical wound
PURPOSE OF SUTURE
-To hold a wound edges together in a good apposition until
such time that the natural healing process is sufficiently
well established to make the support from the suture
CHOICE OF SUTURE MATERIAL
Choice depends on
-Properties of suture material
-Absorption rate
-Size of suture
-Type of needle
-Handling characteristics of knotting
properties

17. NATURAL SUTURE MATERIAL
-It is Non-Absorbable
-Silk
-Linin
Stainless steel wire
SYNTHETIC SUTURE MATERIAL
ABSORBABLE
-Polyglycolic acid
-Polyglactin
-Polydiosone
NON-ABSORBABLE
-Polyamide (Nylon)
-Polyester (Dacron)

18. -NEEDLE POINT
FIVE POINTS OF NEEDLE POINTS ARE IN COMMON USE
-Conventional cutting needle
-Reverse cutting needle
-Blunt point needle
-Straight
-1/4 circle
-3/8 circle
-1/2 circle
-5/8 circle
-Half curve
-Half curve at both end
THERE ARE SEVERAL SHAPES OF SURGICAL NEEDLES, THESE INCLUDE