Questions exam Flashcards
List the periods of the history of surgery! What were the milestones!
The history of surgery is divided into 3 periods
I. From the primeval times until the middle of the 19th hundred
- Only removal of injured parts was used
II. From the discovery of narcosis (1846) until the 1960s
- Included not only removal of the injured parts, but also their reconstruction
- The milestone was the initiation and application of the principles of asepsis and antisepsis, discovery of blood groups and the development of intensive therapy
III. Lasted from the 1960s until today
- The development of instruments, natural science, researchers, as well as technical development
When was the Ether Day? Who did and what on this day?
On October 16. 1846 Dr. William T. G. Morton anesthetized a patient with ethyl ether for
the first time
When and by whom was the chlorinated lime hand-washing introduced? What were his findings?
Ignaz Semmelweis 1847
- To prevent puerperal fever
- Mortality of labor women from 30% to 1%
- “Corpuscles from dead body could enter into blood stream”
Who created the antiseptic theory?
Sir Joseph Lister
Who introduced the antiseptic theory?
Ignaz Semmelweis
Name 4 surgical instruments which refer to doctors involved in the development of surgery!
- Kocher clamp
- Lumnitzer clamp
- Hagar needle holder
- Péan clamp
- Lister bandage scissor
- Véres needle
What does the acronym NOTES mean?
Use of natural openings to perform surgical procedures
- NOTES: natural orifice transluminal endoscopic surgery
What are the synonyms for „ NOTES” technique!
- Endoscope
- Transgastric
- Transvaginal
- Transcolonic
- Transvesical
What is the definition of surgical intervention?
All such diagnostic or therapeutic interventions, in which we disrupt body integrity or reconstruct the continuity of the tissues
- Two types: bloody or bloodless
List some examples of bloodless and bloody procedures!
- Bloodless: reducing joint translocation or treating closed fracture
- Bloody: abdominal or thoracic surgery
What do the septic and aseptic operating theatres stand for?
There are two types of operating rooms; septic and aseptic ones
- In the septic operating room the infected parts of the body are operated (e.g. purulent wounds, gangrenes)
- In aseptic operating rooms the danger of bacterial infection does not usually exist (e.g. varicectomy)
There is no need to build the aseptic operating room in a separate area; the two different types can even share a common corridor
How shall the staff and the patient enter the operating room?
- Before entering into the operating room you should change your clothes in the locker room and wear the surgical cap and the face mask
- Following this, you can enter into the surgical territory
- The patients are brought into the operating room after passing through a separate locker room
Describe the structure of the operating room!
Se bok
List 8 equipments /instruments within the operating room!
Operating lamp, operating table, Sonnenburg’s table, supplementary instrument stand, kick bucket, suction apparatus, diathermy, microwave oven, portable X-ray, anesthesia machine, and other instruments required during anesthesia
Explain the rules of behaviour in the operating room!
1) Only those people whose presence is absolutely necessary should stay in the OR
2) Activity causing superfluous air flow (talking, laughter, or walking around) should be avoided
3) Entry into the OR is allowed only in operating room outfit and shoes worn exclusively in the OR
- This complete change to the clothes used in the OR should also apply for the patient placed in the holding area (i.e. locker room)
4) Leaving the OR in surgical outfit is forbidden
5) The doors of the OR must be closed
6) Movement into the OR out of the holding area (locker room) is allowed only in a cap and mask covering the hair, mouth, and nose
Describe the general rules of the aseptic operating room!
- Only sterile instruments can be used to perform a sterile operation
- Sterile personnel can handle only sterile equipment
- The sterile instrument will stay so if only the sterile person touch it
- Instruments which are located below the waist are not considered sterile
- If a sterile instrument comes in contact with an instrument of doubtful sterility, it will lose its sterility
- The edges of boxes and pots can not be considered sterile
- A surgical area can never be considered sterile
o However, the applications of aseptic rules of operations are mandatory
Explain the definition of asepsis!
Includes all the procedures, activities and behaviors designed to keep away the microorganisms from the patient’s body and the surgical wound
In other words, the purpose of asepsis is to prevent contamination (maintain sterility)
In a wider sense, asepsis means such an ideal state when the instruments, the skin, and the surgical territory do not contain microorganisms (prevention)
Explain the definition of antisepsis!
Includes all those procedures and techniques designed to eliminate contamination (bacterial, viral, fungal) present on objects and skin by means of sterilization and disinfection
Because skin surfaces and so the operating field and the surgeon’s hands cannot be considered sterile, in these cases we do not talk about superficial sterilization
- In a wider sense, antisepsis includes all those prophylactic procedures designed to ensure surgical asepsis (treatment)
How to prevent the evolution of postoperative wound infections before the surgery?
- Careful scrub and preparation of the operative site (cleansing and removal of hair) is necessary
- Wearing sterile clothes in the OR
- Knowledge and control of risk factors (e.g. normalization of the serum glucose level in case of diabetes mellitus)
- In septic and high-risk patients: perioperative antibiotic prophylaxis
How to prevent the evolution of postoperative wound infections during the surgery?
- Appropriate surgical techniques must be applied
- Change of gloves and rescrub is necessary
- Optimize body temperature of the patient
o Narcosis may worsen thermoregulation
o Hypothermia and general anesthesia both induce vasodilation, and thus the core temperature will decrease - The oxygen tension must be maintained
How to prevent the evolution of postoperative wound infections after the surgery?
- Wound infection generally evolves shortly (within 2 hours) after contamination
- Hand washing is mandatory and the use of sterile gloves is compulsory while handling wound dressings and changing bandages during postoperative care
What is the definition of sterilization!
- To sterilize means to kill all microorganisms and spores to create a germ-free environment
- Methods:
o Autoclave (steam with high pressure)
o Gas sterilization with ethylene-dioxide
o Cold sterilization with sprecide chemicals
o Gamma and electron radiation
o Plasma sterilization (low temperature hydrogen peroxide gas plasma – effect of free radicals)
What is the definition of disinfection!
- The aim is to decrease the number of or inactivate live microbes
- Methods:
o Low temperature steam
o Chemical disinfectants (phenol, chloride containing compounds, alcohols)
Explain the steps of the two-phase surgical hand scrub!
Se bok
What is the purpose of isolation? How do we do it?
- After skin preparation the operating area must be isolated from the non-disinfected skin surfaces, and body areas by application of sterile linen textile or sterile water proof paper drapes
- The main aim is to prevent contamination from the patients skin
- It is generally done with the help of 4 pieces
- The scrub nurse and the assistant use a special specially folded first, big sheet to isolate the patient’ legs
- The second, horizontal sheet is used to isolate the head, and is fixed to the guard
- Placement of the two sided sheets then follows
- The isolated area is always smaller than the scrubbed area
- 4 Backhaus towel clips will fix the isolating sheets
List the basic surgical instrument groups!
1) Cutting and dissecting instruments
2) Grasping instruments
3) Hemostatic instruments
4) Retracting instruments
5) Tissue unifying instruments and materials
6) Special instruments
What is the function of the dissecting instruments? List some of these dissecting instruments!
- Their function is to cut or dissect the tissue and remove the unnecessary tissues during surgery
- Scalpel
- Scissors
- Hemostats used for tissue preparation (Péan, mosquito, abd Péan)
- Dissector
- Diathermy knife
- Ultrasonic cutting device
- CUSA (cavitron ultrasonic surgical aspirator)
- LASER (light amplification by stimulated emission radiation)
- Amputating knifes, saws and raspatories
Explain the use of electric/diathermy knife! What kind of diathermy knifes do you know?
- Dissects tissue with the help of heat which is generated by electrical current
- During the dissection the heat can also coagulate the blood from vessels, giving it a strong advantage by cutting and hemostasis simultaneously
- They can be either mono- or bipolar
o Bipolar: the electric current is passing between two parts of the instrument
§ E.g. bipolar forceps
§ There is a need for smaller voltage and amperages making it possible to perform more precise work and smaller size of burned area
o Monopolar: the electric current is passing between the instrument and an indifferent electrode placed beneath the back or one of the limbs of the patient
§ More common in general surgery
§ E.g. electrocauter or electrocautery knife
Is it accepted to use electric knife on patients with pacemaker?
In patients with old pacemakers the electrical current may cause arrhythmias, and it must therefore be adjusted prior to surgery
What do you know about the ultrasonic cutting device?
- Ultrasonic cutting device (Ultracision) is using ultrasound to cut and coagulate the tissues
- It is working similarly to the diathermy but it does not cause thermic injury
- It makes possible to have more precise movements during surgery
Name the non-locking grasping instruments! Explain their functions!
Thumb forceps
- Smooth forceps ("anatomical")
- Toothed forceps ("surgical")
- Splinter forceps ("ophtalmic")
- Ring forceps (brain tissue forceps)
- Dental forceps
o They are used to hold tissue during cutting and suturing, grasping and retracting, and remove foreign bodies
o For holding of sponges, bandages, vessels and hollow organsList organ clamps!
- Klammer intestinal clamp
- Allis clamp (lung)
- Gallbladder forceps
- Babcock forceps (tube shaped structures)
List the hemostatic instruments! Explain their functions!
They act mechanically or thermally to stop bleeding at the site of incision or in the surgical territory
- Vascular clamps: Péan, mosquito, abdominal Péan, Kocher, Lumnitzer, Satinsky, bulldog
- Electrocautery knife
- Various ligation needles and directing probes: e.g. Deschamp ligation needle, and Payr probe)
- Argon beam coagulator
List the retracting instruments! Explain their functions!
Retractors are sued to hold tissues and organs aside during surgery in order to improve the exposure, visibility and accessibility
1) Hand-held retractors (by assistant)
- Skin hook, Rake, Roux, Langenback, visceral and abdominal wall retractors
2) Self-retaining retractors
- Weitlaner self-retaining retractor, Gosset self-retaining retractor
Explain the application area of metallic clips!
1) They are used to close a skin wound and any luminal structure, vessel, duct etc. (Michel clips)
2) Other uses
- Wound closure
- Hemostasis (can occlude lumen)
- Marker (can be seen on the X-ray- e.g. bed of a tumor)
What do you know about the CT and MRI examination of a patient carrying metalic clips?
- CT: the clip disturbs the picture only in the vicinity of it and so examination can be done
- MRI:
o The clips make it impossible to perform the examination because these metals can move in the magnetic field
o The clips can become wandering within the body
o Due to this it has become more common to use the non-magnetic clips like titanium, platinum and absorbable clip
What is the Steri-Strip? When to use it?
- Usually produced from fibrin, collagen or thrombin and induces the last phase of blood coagulation producing fine fibrin mesh
- Application
o Hemostasis in operations done on solid organs
o Close the place of air leakage in lung surgeries
o Wound closure - Disadvantage: can increase the degree of infection in infected wounds and lead to abscess formation
List special instruments!
- Volkmann curette
- Instruments used in bone surgery
- Round-ended probe
- Payr clamp
- Suction set
- X-raying set
- Implants, prosthesis
o The metallic screws and pins, joint prosthesis, hernial meshes, vascular grafts and silicon implants
Describe the conventional (close-eye, French-eyed) needles!
- Needs to be threaded
- The needle and two arms of the thread goes through the tissue
- Danger of untying
- Re-sterilization
Describe the atraumatic needles!
- Has less thickness going through tissue due to no arms of the thread, resulting in less tissue damage
- The thickness of the thread is slightly thicker than the hole made by the needle, making the tissue pack around the thread and avoiding leakage
- No threading time
- No re-sterilization
- No danger for corrosion and untying
- Be careful to not pull to hard, the thread may detach from the needle
What are the main groups of the circular needles?
Has 3 main groups; taper-point, taper-cutting and blunt taper
Explain the difference between conventional and reverse cutting needles!
- In the conventional needle the third edge is facing the internal part of the curving body (pyramide-trekant)
- In the reverse needle the third edge is facing the external part of the curving body (opp-ned trekant)
What are the main characteristics of the surgical suture materials?
The most important properties are:
o Physical: caliber, tensile strength, elasticity, capillarity, structure, water absorbent capacity, sterilizability
o Application properties: flexibility, capability to slip in tissue, knotting properties, knot security
o Biological properties: absorbent capacity
What are the advantages and disadvantages of natural and synthetic suture materials?
Natural materials:
+ Good knotting properties and are easy to handle
- Enzymatic absorption (inflam. reaction)
Synthetic materials:
+ Hydrolytic absorption (less inflam. reaction)
- Harder to handle
What does the term “thread memory” stand for?
Thread memory is the capacity of the suture thread to
return to its former, packaged shape
What are the advantages of monofilament threads?
- Smooth surface
- Smaller friction
- Smaller resistance
- Smaller tissue injury
- No spreading of bacteria
- No capillarity
- Not transporting the tumor cells
