Introduction to Surgery Flashcards
What is SURGERY?
Is that branch of medicine, in which diseases are treated wholly or in part by manual or operative procedures
Attributes of a good surgeon
A surgeon must have::
- Eye of an eagle - good vision
- Heart of a lion - connotes courage
- Hand of a women - connotes dexterity
Hand of a women connotes?
dexterity
Heart of a lion connotes?
courage
Eye of an eagle
good vision
Competence in these areas, distinguishes the surgeon from the mere “operator”.
pre and post operative care
Categories of surgery
art & science
It is not an exact science because judgement & skills are involved.
surgery
Judgement consists of these two leading to rational decision
appraisal and opinion
TRUE or FALSE
It has been said that the ultimate product of responsible surgical judgement is the decision not to operate.
TRUE
the keys to a successful surgery
Good decisions & judgements
what to know in performing surgery
“know when not to cut, then when & where to cut, and when to stop cutting”
System of Rules by which the art of surgery is practiced
Asepsis
Anesthesia
Tissue manipulation
Suturing
These rules are probably the most crucial to an acceptable outcome.
asepsis
Otherwise known as complete asepsis
Integral Asepsis
Integral Asepsis also known as what?
complete asepsis
it refers to exclusion of all micro-organisms, this degree of asepsis is impossible (e.g. it is impossible to sterilize skin or the environment)
Integral Asepsis or Complete Asepsis
It implies that all practical steps are taken to achieve complete asepsis.
Relative Asepsis
In this context, micro-organisms can gain access to surgical wound without resulting an infection.
Relative Asepsis
Involves the relative exclusion of micro-organisms and careful handling of tissues to preserve an inherent defenses.
Surgical Asepsis
How to protect tissue defenses?
- Limit exposure.
- Minimize imposition of foreign materials (sutures, blood clots etc.).
- Preservation of circulation.
How much less than ideal aseptic tech. can be & still preclude infection depends on:
Species involved
Susceptibility of tissues to become inflamed
The type and number of micro-organisms present
Sources of Contamination:
Surgical Instruments
Environment
Personnel
Animal patient
2 types of 2 types:
Cold Sterilization process
Heat sterilization process
Type of Sterilization process with the use of chemical solutions
Cold Sterilization process
Type of Sterilization process with the use of dry heat (oven), autoclave (steam under pressure), moist heat (boiling)
Heat sterilization process
tool use for dry heat sterilization
oven
tool use to steam under pressure
autoclave
tool use for moist heat
boiling
Other factors that influence wound infection include:
Duration of surgery
Surgical technique
Impaired host resistance
Contamination of the wound
What is the most widely used and efficient method of sterilization?
Autoclave
Items w/c may be sterilized in the Autoclave
surgical instruments
drapes
gowns
swabs
most rubber articles
glassware
some plastic goods
Items which may be damaged in the autoclave:
- fibre-optic equipment
- lenses and plastics
- disposable items like catheters
The surgical team:
- Surgeon
- Assistant surgeon/Scrubbed nurse
- Anesthetist
- Circulating assistant
Duties/responsibilities of the Surgeon:
- Considered as the team captain.
- Take responsible in the pre-op, intra-op and post-op.
- Take responsible in the surgical judgment.
Duties of the Asst. Surgeon
~ Prepare the instrument trolley.
~ Assist in draping the patient.
~ Pass instruments, swabs, etc. to the surgeon.
~ Assist with surgery: retract tissue, cut sutures, etc.
~ Be responsible for all equipment, swabs, sutures, needles etc.
Duties of the Anesthetist
~ Responsible in the objective assessment of the surgical patient.
~ Administer the appropriate pre-anesthetic and anesthetic drugs. Has the authority on what anesthetic agents to use to a particular patient and type of operation.
~ Responsible in monitoring the vital signs, maintenance & level of surgical sleep.
Duties of the Circulating Assistant
~ Help prepare theatre, instruments & equipment for surgery.
~ Tie the surgical team into gowns.
~ Help position the patient on the table.
~ Preparation of the surgical site.
~ Connect apparatus (diathermy, suction, etc).
~ Open packs of sutures/instruments etc.
~ Count swabs, sutures etc. with the asst. surgeon.
~ Be in theatre at all times when surgery is in progress.
~ Assist the anesthetist.
~ Prepare post-operative dressings.
~ Help clear theatre at the end of surgery.
Preparation of the Surgical Team
~ Scrubbing-up
~ Putting on a Surgical gown
Back-tie
Side-tie
~ Putting on Surgical gloves
Closed gloving
Open gloving
Plunge method
Types of Putting on a Surgical gown
Back-tie
Side-tie
Types of Putting on Surgical gloves
Closed gloving
Open gloving
Plunge method
Surgical cases may be categorized as follows
~ Elective & Non-urgent
~ Necessary or Urgent
~ Emergency surgery
Surgical case for healthy & often young
Elective & Non-urgent
Surgical case for not immediately life threatening but require prompt attention
Surgical case for life threatening condition
Emergency surgery
Pre-operative preparation of the Patient
- Starvation
- Starvation Clipping
- Bathing
- Administration of Enema
- Preparation of the skin
- Preparation of the eyes & mucous
- Positioning the patient for surgery
- Draping the patient
food is usually withheld for 12 hrs prior to surgery.
Starvation
clipping the surgical site is necessary in most procedures (except intra-oral)
Clipping
ideally all patient should be bathed before surgery to decrease the risk of contamination but this is not always feasible.
Bathing
food is usually withheld for how many hrs prior to surgery?
12 hrs
for some surgery (e.g rectal/colonic, intestinal anastomosis)
Administration of Enema
are the 2 greatest sources of wound contamination as it is not possible to remove all bacteria from the skin. Common bacteria found in the skin (Staph. spp., Bacillus spp., and ocasionally Streptococcus spp.)
skin & coat
Common bacteria found in the skin
- Staph. spp.
- Bacillus spp., and ocasionally Streptococcus spp.
Potent scrub solutions
~ chlorhexidine
~ povidone iodine
Preparation of the eyes & mucous membranes – for surgery in this area this solution is commonly used to irrigate as antiseptic.
0.1-0.2% diluted povidone iodine
Draping the patient using the ff drapes
- Plain drapes
- Fenestrated drapes
- Adhesive barrier drapes
Immediate post-operative care:
Recovery from anesthesia:
1. The patient should not be left unattended until it is conscious and sitting-up.
2. The Endotracheal tube is usually removed just before the cough reflex returns.
3. Color of the mucous membrane, absence or presence of resp. noise and effort will be indicators of effective ventilation by the animal.
This should be done before the animal regains its consciousness. Take care not to apply too tightly.
Application of Dressings or Cast
A normal naked individual may disquamate:
___________ particles/minute
___________ are microbes
100T- 30 M
3T – 50 T
Scrubbing-up should take how many minutes
5-10 minutes
The hands are kept inside the sleeves while gloving takes place. This tech has the advantage that it minimises the chances of contaminating the gloves, since the outside of the gloves do not contact the skin.
Closed gloving
The hands are extended out of the sleeves while gowning. This technique has the disadvantage that the gloves are relatively easily contaminated by skin contact.
Open gloving
With this method the sterile glove is hald open by a scrubbed assistant and the hand inserted. There is a risk of contaminating both personnel involved. This technique is not commonly employed in vet. operating theatre.
Plunge method:
Commonly performed surgeries in dogs and cats
- SPAY/OVH
- CASTRATION
- lump removal
- digit amputation
- exploratory laparotomy
- orthopaedics
- enucleation
Spaying of bitches is recommended for the following reasons:
~ prevents unwanted pregnancy/puppies
~ no psuedo-pregnancy
~ avoids pyometra and other uterine diseases
~ reduced risk of mammary cancer
uterine infection
pyometra
Castration should be considered:
~ treatment to limit straying
~ treatment for unacceptable sexual behaviour
~ medical reasons e.g. prevent or remove testicular cancer, reduce risk of prostatic hyperplasia and peri-anal adenoma
~ to prevent perpetuation of genetic defects
Routine bitch spay type of incision
ventral midline incision, laparoscopy (keyhole surgery
Routine bitch spay premedicate with what drugs
Atropine SO4
ACP
opioid e.g. buprenorphine
Routine bitch spay induce with thee ff:
propofol
intubate
isoflurane/sevoflurane or IV gen.
Anesthetic e.g. Zoletil, Ketamine etc.
example of Anesthetic
Zoletil
Ketamine
Routine bitch spay total surgical time
20 - 90 minutes depending on patient
Routine bitch spay post operative analgesia (NSAIDs)
meperidine
Routine dog castration surgical time
2 - 10 minutes
Routine dog castration incision
Single midline prescrotal incision
