intro to surgery Flashcards
analgesics
pain relief
antiseptic
slows or stops growth of microorganisms on external surfaces of the body, helps prevent infection
Anaesthetics
produce complete or partial loss of feeling
(local or general or regional)
Halsted’s principles
1) strict asepsis
2) gentle tissue handling
3) preservation of blood supply
4) adequate hemostasis
5) elimination of dead space
6) minimize tissue tension
7) accurate tissue closure
8) debridement of dead tissue
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strict asepsis
defined as the absence of pathogenic microbes in living tissue
accomplished by
- aseptic prep of the patients skin
- sterilization of instruments, gloves, gowns, drapes etc
- prep of the surgery team for aseptic surgery
- careful draping of the patient
aseptic technique
defined as practice which prevents cross contamination in surgery
prep of the patients skin
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1) chlorohexidine surgical scrub; cleanser and antibacterial
2) alcohol; antiseptic kills bacteria on skin
3) alcohol/ chlorohexidine solution; final prep
sterilization of instruments
- steam under pressure (autoclaving)
- dry heat
- gas sterilization
- radiation
- chemical sterilization
surgical scrub; 2 commonly used surgical scrub agents
chlorhexidine and povidine-iodine (betadine)
chlorhexidine; wider bacteriocidal effect, longer persistent residual action
surgical hand scrub aim
to remove as many micro-organisms as possible from hands, nails and arms by mechanical washing and antiseptic contact time (5-8 mins)
draping the patient order
1st between patient and surgeon
2nd and 3rd head and tail
4th far side
gentle tissue handling
handling live tissue as gently as possible during surgery
rough handling or crushing of tissues will lead to
swelling, inflammation and post-operative pain and discomfort for the animal
correct use of instruments
- helps minimize trauma
- blunt dissection
- appropriate forceps type
moistened laporotomy sponges
to maintain tissue hydration
methods for gentle tissue handling
assistant fingers
doyen bowel clamps
stay sutures in hollow organs
preservation of blood supply
preserve blood supply where possible to help w healing, done by careful dissection
for preservation of blood supply must be aware
of surgical anatomy and ensure ligated vessels are not supplying viable tissue
adequate hemostasis, hemostasis vital because….
- uncontrolled hemorrhage life threatening
- blood ideal medium for bacterial contamination
- blood clots stop the co-aptation of wound edges
- fluid and dead space in the wound area interferes w healing
- blood obscures the surgical field
how is hemostasis achieved by
- ligation
- electrocautery
- Haemostatic forceps
- pressure
elimination of dead space
- dead space allows the accumulation of fluid and air to disrupt the close approx of tissues and delay its healing
elimination of dead space leads to decrease risk of
seroma or hematoma formation
how to prevent dead space
- good tissue apposition
- pressure bandage
- use of sutures to close dead space
- active and passive drains
minimize tissue tension: excessive tension is
unnecessary and sometimes detrimental
how much tension to use
- can’t be too tight; crushing and pressure necrosis could result
- loose enough to allow for postop swelling
- but not too loose; could cause leakage or dehiscence
accurate tissue closure; purpose of wound closure is to
bring the edges together to allow for healing
careful approx of tissues is achieved by
appropriate suturing techniques
tissue that cannot be salvaged must be
removed to allow wound healing to take place
debridement of dead tissue; necrotic tissue is
dead or devitalized
layer debridement
- debride progressively from surface of wound to deeper tissues
- allows conservation of healthy tissue
en bloc debridement
- complete excision of wound leaving healthy tissue
- wound closure can occur
gastric dilation and volvulus
GDV; emergency surgery, twisted stomach
