NIRVANA

ANAESTHESIA
1. INTRODUCTION Surgical treatment of disease requires gaining access to deeper tissues through the skin.
* The skin being a sensitive organ, is well provided with sensory nerves.
* Thus, it becomes important to interrupt the sensory pathways of skin, and deeper tissues (anaesthesia) if surgical access is to be provided.
* There are essentially two primary modes of rendering a patient insensitive to pain while undergoing surgical procedures:
- General anesthesia (central nervous system depression)
- Regional anesthesia (local anesthetic agents).

2. PRE-ANAESTHETIC EVALUATION
1 A thorough clinical examination of the patient is essential to establish the health status of the patient.
2. To detect the metabolic effects of the disease process for which he is undergoing the surgical procedure.
3. To detect any other existing disease in the patient, that he might be undetected so far.

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THE OVERHEAD LIGHT

WHAT IS NEW IN OPERATING LIGHT?
Lighting in the operating suite is achieved by the use of main overhead fluorescent lights, Halogen lamps are used within the overhead surgical lights.
Halogen lamps have a higher (measurement of the hue that a light emits) than incandescent light.

The halogen light emits a pale bluish cast that is less fatiguing to the eyes. Auxiliary Surgical spotlights placed at spots for maximum effect.
The operation light produces 100,000 lux strong homogenous light. Camera system is equipped with a color temperature of 4,300 K natural resolution. All camera functions can be operated from a distance by means of an optional remote control device. In some operating suites, closed-circuit television cameras are mounted within the framework of the surgical lights, so that the course of the operation can be viewed by students or auxiliary personnel outside the OT.

The mobile hospital light has a leak proof storage battery that is recharged during normal operation. In the power loss the lamp automatically switches to battery operation, enabling examinations or operations to continue for up to five hours.

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TABLE POSITIONS 4

More TABLE positions

HOW DO YOU GET THE LATERAL POSITION OF EXTENSION?
This position is used for operations on the kidney and chest, but may be modified slightly for operations on the hip.
For the former operations the patient is positioned over the kidney bridge which is raised to extend this region.
Alternatively, if an operation table which incorporates a `break back' is used, extension is achieved by positioning the patient over the division in the centre section before adjusting the angle of the table top.

HOW IS THE GALL-BLADDER AND LIVER POSITION ARRANGED?
This is another modified supine position which is used for operations on the gall-bladder or liver.
The patient is positioned over the back elevator which is raised to produce extension; and thereby push the gall-bladder towards the anterior abdominal wall.

HOW TO ARRANGE FOR LITHOTOMY POSITION? This is used for operations on the external genital organs, Perineum, and anal region. The buttocks project well over the edge of the table at the junction of the centre and foot section, which is lowered or removed. The legs are flexed at the hips and knees, and raised with the feet supported in webbing slings suspended from the lithotomy poles. A douching funnel may be fitted below the perineal area to collect blood.
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TABLE POSITIONS 3

TABLE supine 3 (modified supine) WHAT IS SUPINE HIP POSITION? This is used mainly for nailing a femoral neck fracture, Also suitable for osteotomy, slipped femoral epiphysis,etc. The patient is in a supine position, with his pelvis supported by a supplementary table top which is translucent to X-rays and incorporates a slot for introducing anterior position film cassettes under the pelvis fig 4. WHAT IS THE TRENDELENBURG POSITION (HEAD DOWN)? This position, a modification of supine, is used for intrapelvic operations. Fig 5. - The object being to allow the intestines to displace away from the pelvic cavity by gravity towards the upper abdomen. - They may also be packed off readily to leave easier access to the pelvic organs. Any questions be sent to drmmkapur@gmail.com All earlier posts are stored in archives for your access and review. Visitors that follow may post contributions to the site Service providers (Residents, Nurses) visit www.surgseminar.blogspot.com www.drmmkapur.blogspot.com Click on the image to see details.

TABLE POSITIONS 2

TABLE Positions supine (Modified)


WHAT IS BREAST AND AXILLA POSITION?
This is the position for operations on the breast and axilla.
It is a modified supine position,
-With both arms extended, and secured on arm tables.
-Or one arm secured by the side of the patient and the other on the affected side abducted and secured to arm table.
-or supported by a nurse.

WHAT IS NECK POSITION?
This position is used for operations on the neck, especially
Thyroidectomy,
and tracheotomy.
The patient is placed in the supine position with a pillow or sandbag under the shoulder blades, and
-with the neck well extended, a padded horse-shoe provides a good support for the head in such operations.

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TABLE POSITIONS

TABLE

Check list

Positions

Who Should Know?

*It is essential that all members of the theatre staff must master
The working of the operation table and its accessories which
*These must be easily available, and ready for immediate use.
*To insure this, passing on of information on the function status, of the table is a part of the introductory briefing of all new staff.
- The whole apparatus must be maintained in good working order
and checked before each operation list starts.
Careful and correct positioning of the patient is very important.
- It is essential to provide good access for surgery.
- And also to take into account patient safety.
- Anesthesia technique requirements.
- Providing space in all position for I.V. lines.
- The table top rubber mattress must provide insulation and
Prevent harm to the patient due to pressure, especially to
Nerves, and bony prominences.
Most of the following positions are demonstrated on a general
purpose operation table which incorporates the majority of the
features described already.

What are the Positions?

In Supine or Dorsal Recumbent Position
In this position the patient lies on his back and is used for MOST operations, including those on the
- Eye
- Ear
- Face
- Chest
- Abdomen
- Legs or Feet
- And with modifications is suitable for operations on the breast
arms or hands, where arms are extended on an arm table.

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POWERED EQUIPMENT

THE O.T. TABLE

The modern operation table is a powered or mechanical apparatus, capable of adjustment to give a variety of positions for a patient
Undergoing surgery.

1) Most tables are designed to provide suitable positions for a
wide range of general surgical operations.
2) It can be adapted for specialised procedures by the addition
of accessories (neurosurgery, orthopedics).

3) The Base unit positioned in the centre of the theatre on to which
Is fitted a removable top.
This facilitates the transport of the operated patient.
An operation table which offers power operation,
Interchangeability of table top for ease of patient transport is
Illustrated above

The table must have the following functions:
* Can be tilted downwards at the head and the foot ends.
* Can be tilted from side to side.
* Can be elevated or lowered as a whole to suit th surgeon.
* Can be broken at hip level for gynecologic operation (e.g.
vaginal hysterectomy), renal surgery, and certain orthopaedic
operations.
* Can have the head of the table removed to allow
for other attachments, eg. the application of a neurosurgical
frame.
• Foot end removed for Lithotomic position for anal surgery.

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