Perioperative Phase

Overview of the Perioperative Phase

• The perioperative phase is divided into three distinct periods:

  • Preoperative Phase: Before surgery, includes patient assessment and preparation.

  • Intraoperative Phase: During surgery, from entry into the operating room (OR) until the patient leaves for recovery.

  • Postoperative Phase: After surgery, upon entering the recovery room until discharge from post-op care.

Preoperative Phase

• Scheduled Surgeries:

  • Unlike emergency surgeries, scheduled surgeries allow for comprehensive pre-admission processes.

  • Essential to gather information about the patient's health history, including comorbidities (e.g., Chronic Obstructive Pulmonary Disease - COPD, any respiratory disorders).

• Patient Assessment:

  • Gather information about previous medical conditions and medications currently being taken by the patient.

  • Conduct a full physical assessment, including listening to lung sounds and checking vital signs.

  • Order necessary laboratory tests and diagnostic tests as per the patient's needs, including potential consultations with specialists (e.g., cardiology clearance for patients with heart conditions).

• Informed Consent:

  • Mandatory for any surgical procedure; the patient must sign a consent form to affirm understanding and agreement to the procedure.

  • It is critical that the patient is mentally capable of giving consent.

• Medication Management:

  • Patients are often instructed to stop certain medications prior to surgery to minimize risks (e.g., blood thinners or anti-platelet medications).

  • Instructions typically include stopping aspirin and anti-platelets at least two weeks before the surgery, with timelines dependent on the specific medication.

• Preparation Checklist:

  • Patients must change into a hospital gown.

  • Skin sanitation may involve antiseptic wipes (e.g., CHG wipes) to reduce infection risk.

  • Initial postoperative education should begin during this phase to promote patient understanding before they become disoriented post-surgery.

• Deep Vein Thrombosis (DVT) Prevention:

  • Importance of moving the legs during surgery to promote blood flow and prevent clots, which can result from stasis in immobile patients.

Intraoperative Phase

• Roles and Responsibilities:

  • Scrub Nurse: Remains sterile and assists the surgeon; requires in-depth knowledge of tools and equipment to ensure the surgery proceeds smoothly.

  • Instrument Count: Post-surgery, all instruments must be accounted for before the patient leaves the OR. This prevents items from being inadvertently left inside the patient, which can lead to serious complications.

Types of Anesthesia

General Anesthesia

• Characteristics:

  • Causes complete unconsciousness; patients cannot breathe independently and are unaware of surroundings.

  • Intubation required for respiratory support during surgery.

  • The patient does not experience pain or memory of the procedure.

• Management of Complications:

  • If complications arise (e.g., muscle stiffness), administration of dantrolene (a muscle relaxer) is essential along with oxygen supplementation.

Regional Anesthesia

• Definition: Targets specific regions rather than the whole body, allowing the patient to remain conscious but pain-free in those areas.

  • Nerve Block: Commonly utilized for outpatient procedures (e.g., orthopedic surgeries).

  • Administered via ultrasound-guided injection to block sensation in specific areas (e.g., knee joint).

  • Spinal Anesthesia: Used during procedures like cesarean sections; administered in the subarachnoid space.

  • Leaves the patient unable to sense pain or move from the injection site downwards.

Epidural Anesthesia

• Function: Administers anesthetics to the epidural space; patients remain conscious with the ability to move but with diminished pain sensation.

  • Often used during childbirth for relief while maintaining some motor function.

Moderate/Conscious Sedation

• Characteristics:

  • Patients are awake but often groggy and may not remember much of the procedure.

  • Typically used in minor diagnostic procedures (e.g., cardiac catheterization).

  • Notable for being a less invasive option than general anesthesia, especially for patients with respiratory concerns.

Postoperative Phase

• Education and Interventions:

  • Begin pain management strategies immediately to facilitate compliance with interventions like using an incentive spirometer.

  • Teach patients about respiratory exercises, deep breathing, and the importance of hydration.

  • Monitor for signs of complications, including shock or other adverse reactions following surgery.