Introduction to Surgery Flashcards by Danica Mae Araza

What is SURGERY?

Is that branch of medicine, in which diseases are treated wholly or in part by manual or operative procedures

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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

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Hand of a women connotes?

dexterity

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Heart of a lion connotes?

courage

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Eye of an eagle

good vision

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Competence in these areas, distinguishes the surgeon from the mere “operator”.

pre and post operative care

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Categories of surgery

art & science

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It is not an exact science because judgement & skills are involved.

surgery

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Judgement consists of these two leading to rational decision

appraisal and opinion

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TRUE or FALSE

It has been said that the ultimate product of responsible surgical judgement is the decision not to operate.

TRUE

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the keys to a successful surgery

Good decisions & judgements

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what to know in performing surgery

“know when not to cut, then when & where to cut, and when to stop cutting”

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System of Rules by which the art of surgery is practiced

Asepsis
Anesthesia
Tissue manipulation
Suturing

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These rules are probably the most crucial to an acceptable outcome.

asepsis

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Otherwise known as complete asepsis

Integral Asepsis

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Integral Asepsis also known as what?

complete asepsis

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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

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It implies that all practical steps are taken to achieve complete asepsis.

Relative Asepsis

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In this context, micro-organisms can gain access to surgical wound without resulting an infection.

Relative Asepsis

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Involves the relative exclusion of micro-organisms and careful handling of tissues to preserve an inherent defenses.

Surgical Asepsis

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How to protect tissue defenses?

Limit exposure.
Minimize imposition of foreign materials (sutures, blood clots etc.).
Preservation of circulation.

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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

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Sources of Contamination:

Surgical Instruments
Environment
Personnel
Animal patient

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2 types of 2 types:

Cold Sterilization process
Heat sterilization process

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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:

1. fibre-optic equipment 2. lenses and plastics 3. disposable items like catheters

The surgical team:

1. Surgeon 2. Assistant surgeon/Scrubbed nurse 3. Anesthetist 4. Circulating assistant

Duties/responsibilities of the Surgeon:

1. Considered as the team captain. 2. Take responsible in the pre-op, intra-op and post-op. 3. 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

1. Starvation 2. Starvation Clipping 3. Bathing 4. Administration of Enema 5. Preparation of the skin 6. Preparation of the eyes & mucous 7. Positioning the patient for surgery 8. 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

1. Staph. spp. 2. 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

1. Plain drapes 2. Fenestrated drapes 3. 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

1. SPAY/OVH 2. CASTRATION 3. lump removal 4. digit amputation 5. exploratory laparotomy 6. orthopaedics 7. 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