Electrosurgery

Question 1

What is electrocautery?

Answer 1

Direct application of heat to the tissue via a hot-tipped electrode generated by a direct current. No current flowing through the patient means that the cautery occurs via heat

Question 2

What is the difference between monopolar vs bipolar electrosurgery devices?

Answer 2

This is a misnomer that does not apply to electrosurgery and should not be used

Question 3

What is the difference between monoterminal and biterminal electrosurgery devices?

Answer 3

This is what most mean when they say mono/bipolar

Monoterminal: No grounding electrode, electrons from patient dispense to table, floor, walls, and air

Biterminal: Presence of grounding electrodes (grounding pad vs biterminal forceps)

Question 4

What are examples of monoterminal electrosurgery devices?

Answer 4

Electrodesiccation and electrofulguration

• These do not have a grounding pad

Question 5

What are the relative current and voltage requirements of electrodesiccation and electrofulguration compared to other electrosurgical techniques?

Answer 5

Because there is no dispersive electrode to dissipate accumulated current, higher voltages are needed to reach the desired level of tissue destruction.

Question 6

What is the difference between electrofulguration and electrodesiccation?

Answer 6

Electrodesiccation the probe is in contact w/ the tissue and the electrofulguration is done just above the tissue w/ arches of current

Question 7

What are the two types of biterminal electrosurgery?

Answer 7

Electrocoagulation and electrosection

Question 8

What are the voltage/current properties of biterminal electrosurgery?

Answer 8

Current travels from body to the dispersive electrode (grounding pad on the other tip of the forceps)

• Since the dispersive terminal allows a way for the current to return to the device it permits an increased amperage and reduced voltage

Question 9

What is the difference electrically between electosection and electrocoagulation?

Answer 9

Both are alternating current, low voltage, high amperage biterminal

• Electrocautery is moderately dampened however (electrosection is undampened)

Question 10

What is dampening of the waveform w/ electrosurgery?

Answer 10

• Can be discontinuous or continuous
• The amplitude of the wave diminished over time
• The more dampened the waveform the more quickly the amplitude drops to zero
• The greater the dampening the more coagulation/destruction of tissue and less cutting occurs

Question 11

What are some advantages of heat cautery (electrocautery)?

Answer 11

Safe in pts w/ an implantable ICD or pacemaker (or other implanted electrical device)

It is also portable, safe, and works in a wet field

Question 12

What is the mechanism of electrodesiccation?

Answer 12

Probe is placed in contact with the tissue and the low-amperage, the high-voltage system slowly heats the tissue which results in water loss which dehydrates the superficial tissues

No significant protein denaturation

Question 13

What is the mechanism of electrofulguration?

Answer 13

No direct contact of the probe

Causes surface carbonization occurs

Causes a more superficial tissue damage since the underlying tissue is insulated

Question 14

What is the mechanism of electrocoagulation?

Answer 14

Direct contact with the probe leads to slow cellular heating, then intracellular fluid evaporation, coagulum formation and resultant protein denaturation

Question 15

Where should the grounding pad be placed on a pt for electrosurgery?

Answer 15

Should be on a highly vascularized surface in proximity to the operative site

Avoid placing any implantable monitoring devices between the active and dispersive electrodes

Question 16

What are more sensitive to electric currents/complications from electrosurgery, ICD’s or pacemakers?

Answer 16

ICD’s because they are designed to sense electric currents

Question 17

What types of electrosurgery can be used w/ pacemaker/ICD?

Answer 17

Electrocautery (always safe) or biterminal forceps

Question 18

What cautions can be used if the biterminal forceps or electrocautery are not available?

Answer 18

Direct current away from an implantable device

• Do not position implantable devices between active and dispersive electrodes
• Use short bursts of energy <5 seconds and spaced >5 seconds
• Use the lowest effective power setting
• Avoid electrosection (highest risk)
• Do not use within 5 cm of an implantable device
• Have crash cart/ACLS trained staff ready

Question 19

What is electrosurgery?

Answer 19

High-frequency alternating current prevents the depolarization of muscles and nerves. The unheated electrode produces alternating current and uses the high resistance of human tissues to halt the flow and convert electrical energy to thermal energy (ultimately head induced cautery)