RhoGam

an immunoglobin, is administered to Rh-negative women who are pregnant to prevent sensitization of the maternal immune system when pregnant with an Rh-positive fetus.

Routine pharmacological supplies used in orthopedics

antibiotics, hemostatic agents, and steroids.

Antibiotics (Orthopedic)

used intravenously and mixed with irrigation solutions. Polymixin, bacitracin, and cephalosporin antibiotics are mixed with irrigation solutions or injected into the bags of solution used during irrigation and/or pulsed lavage of the surgical wound.

Hemostatic Agent (Orthopedic)

absorbable gelatin sponge (Gelfoam), microfibrillary collagen (Avitene), thrombin (Thrombinar), and bone wax

Steroids (Orthopedic)

used for their anti-inflammatory action. Dexamethasone (Decadron), a short-acting corticosteroid; dexamethasone long-acting (Decadron LA); or betamethasone (Celestone), a long-acting corticosteroid, may be administered to reduce inflammation in a joint area caused by trauma, given therapeutically to treat the inflammation, or administered perioperatively to aid in reducing tissue inflammation resulting from the surgical intervention.

Cardiovascular Surgery

Heparinized saline solution for intravascular irrigation is commonly used during cardiac and peripheral vascular procedures.

Medications used during vascular procedures

contrast media for arteriography, topical papaverine HCl (Papaverine) for dilating blood vessels when working with small-diameter vessels, lidocaine HCl for local anesthesia, and oxidized cellulose (Oxicel, Surgicel) for hemostasis.

Drugs used during Neurosurgery

antibiotics in warm saline for irrigation, heparinized saline solution for intravascular irrigation, contrast media for cerebral arteriography, topical papaverine HCl (Papaverine) for dilating blood vessels during procedures involving cerebral vasculature, lidocaine HCl injection or absorbable gelatin sponge soaked in thrombin for hemostasis, and the use of polifeprosan 20 with carmustine implants (Gliadel Wafers) for topical placement onto the post-resection tumor bed for the treatment of glioblastoma multiforme.

Myydriatics

cause the iris to contract, resulting in dilation of the pupil referred to as mydriasis. primarily paralyze the iris sphincter, without affecting the lens’ ability to focus light rays on the retina. The commonly used agent is phenylephrine HCl (Neo-Syne.hrine).

Cycloplegics

paralyze the ciliary muscles, resulting in both pupil dilation and the inability of the ciliary process to focus the lens of the eye. In surgery, these agents are used to optimize exposure and removal of a cataract lens. Commonly used include tropicamide (Mydriacyl), cyclopentolate (Cyclogyl), and atropine sulfate (Atropisol)

Mitotic agents

act on the iris, resulting in iris relaxation and, therefore, pupil constriction. include pilocarpine HCl (Pilocar, Isopto Carpine) and carbachol (Miostat). They may be administered by instillation into the anterior chamber of the eye. These drugs also facilitate the drainage of aqueous humor through the trabecular meshwork of the canal of Schlemm, thus decreasing intraocular pressure (IOP), making them useful for the treatment of increased IOP due to glaucoma.used intraoperatively when pupil constriction is necessary, as in laser iridectomy or following placement of an intraocular lens (IOL) implant

Retrobulbar anesthesia

Behind the eyeball or pons

may be necessary for some procedures to block both sensory and motor nerve function. is accomplished by injecting the area around the optic nerve with a combination of lidocaine HCl and bupivacaine, both without epinephrine. Hyaluronidase (Wydase) is added to aid in distribution of local anesthetic agent(s), or epinephrine may be added to the solution to decrease bleeding during procedures of the eyelid

Viscoelastic/viscosurgical agents

used to expand the anterior chamber and revent injury to the corneal endothelium and surrounding tissues during cataract extraction. These agents can also be used as a replacement for vitreous humor. Chondroitin sulfate-sodium hyaluronate (Viscoat) and sodium hyaluronate (Healon, Amvisc) are commonly used

Balanced Salt Solution (BSS)

a sterile, physioloogically balanced irrigating fluid, is the solution most frequently employed. The surgical technologist will use a droptainer bottle of 15 or 30 mL, with an olive-tipped cannula, for irrigating the exposed cornea during the procedure. enhanced with bicarbonate, dextrose, and glutathione, is used for intraocular irrigation during extracapsular lens extraction, vitrectomy, and anterior segment procedures.

Factors affecting Hemostasis

Preexisting hemostatic defects and acquired hemostatic disorders affect the ability of the patient’s body to form blood clots naturally

Preexisting Hemostatic Defects

Clotting factor deficiencies—hemophilia, von Willebrand disease

Acquired Hemostatic Disorders

Liver disease

Anticoagulant therapy—heparin sodium, warfarin sodium (Coumadin)

Antiplatelet therapy—clopidogrel (Plavix), ticlopidine (Ticlid), acetylsalicylic acid (aspirin)

Aplastic anemia

Acoholic-induced liver failure

Control of blood during surgery

50% of post-operative bleeding is due to poor hemostasis during surgery.

Bone Wax

is a sterile mixture of beeswax applied to the cut edges of bone as a mechanical barrier to seal off oozing blood.is used in thoracic surgery when the sternum is split, in neurosurgical procedures when a craniotomy is performed, and for orthopedic and otorhinolaryngologic (ENT) procedures.

Absorbable Gelatin Sponge

is composed of collagen, a structural protein found in connective tissues. It is available in either powder form or a foam pad (Gelfoam, Gelfilm) that comes in a variety of sizes that can be cut. may be left in the wound postoperatively, because it will be absorbed by the body in approximately 30 days.

Microfibrillar Collagen

is a powder available in preloaded applicators or via a powered dispenser.

A dry 4 × 4 sponge is used to apply pressure over the microfibrillar collagen to ensure it adheres to the wound surface. The collagen is soluble, and as hemostasis occurs, it is absorbed and eliminated from the body.

Oxidized Cellulose

These products are applied directly to the bleeding surface and held in place until bleeding stops.

Silver Nitrate

*DO NOT TOUCH TIP*

is often used to control cervical or nasal bleeding. It is applied either in stick form as a caustic pencil or in solutions of 0.01% to 10%

Epinephrine

is a potent vasoconstrictor and is often combined with local anesthetic agents or with Gelfoam to aid in local hemostasis. It is absorbed rapidly by the body but provides good localized hemostasis.

Thrombin

of bovine origin is used as a topical hemostatic (never injected). is available in liquid or powder and may be poured, sprayed, or applied directly onto a bleeding site. kits can include a spray bottle for applying or delivered using a 4 × 4 or Gelfoam sponge. A Gelfoam pad, collagen sponge, or cottonoid sponge may be soaked in thrombin. Thrombin should be discarded if not used within several hours, because it loses potency. 4 hours

Blood Componets

The most common type of homologous blood replacement therapy used in the operating room is the administration of packed red blood cells (PRBCs).

Packed Red Blood Cells

Red blood cell (RBCs) from 1 unit of whole blood after most of plasma is removed

To restore oxygen-carrying capacity

Fresh Frozen Plasma

The fluid component of blood containing clotting factors removed from 1 unit of whole blood

Restores clotting factors; usually 1 unit of FFP is given for every 4 units of PRBCs

Hypnosis

results from an altered state of consciousness related to the patient’s perception of the surgical environment and the surgical procedure

Anesthesia

Freedom from pain is the major focus of anesthesia practice.

Amnesia

provide a lack of recall of perioperative events and permit the use of safer, less toxic anesthetic agents and techniques while providing a calm and cooperative surgical patient.

Muscle Relaxation

Neuromuscular blocking agents, used in combination with inhalation agents, are capable of producing profound muscle relaxation, facilitating endotracheal intubation and the development of new surgical interventions and techniques.

Optimal Patient Positioning

Advances in surgical procedures demand advantageous access to the surgical site. General anesthesia, patient physiological monitoring, and control of essential life processes must function in harmony to provide for an optimal patient outcome.must allow for surgical site access while maintaining physiological homeostasis

Continued Homeostasis of vital functions

it is said that general anesthesia is intentionally capable of inducing a state close to death and requires maintenance of the patient at this level for the duration of the surgical procedure

Two ways anesthetic agents are administered?

Inhalation (gas)

injectable agents

What does General Anesthesia focus on

altering the patient’s level of consciousness, thereby minimizing pain and awareness of the surgical environment

an alteration in patients’ perception of their environment through alterations in their level of consciousness.

What does Regional Anesthesia focus on

involves the prevention of sensory nerve impulse transmission in a specific location of the body, allowing the patient to remain conscious but not “feel” the pain of the procedure.

American Society of Anesthesiologist

uses a physical status classification system for assessing patient anesthetic risk, as indicated

Class 3 ASA Physical Status Classification

A patient with severe systemic disturbance or disease: angina, post-myocardial infarction (MI), poorly controlled hypertension, symptomatic respiratory disease, massive obesity

Agent Inhalation

involves the delivery of gases across the lung’s alveolar membrane where the agent enters the vascular system and is transported to the brain, where it is able to cross the blood–brain barrier, affecting CNS function.

Agent injection

during general anesthesia involves the intravenous administration of medications directly into the bloodstream.

Agent instillation

involves the administration of medication into an area such as the rectum, where the agent is absorbed via the mucous membranes and transported to the CNS by the circulatory system.

Induction Phase

involves altering the patient’s level of consciousness from the conscious state to the unconscious state. may be carried out in two ways: the use of an IV induction agent or the inhalation of gaseous vapors. The patient’s hearing is the last sense to be suppressed and may even become more acute during this phase of anesthesia; therefore, environmental noise should be kept to an absolute minimum. The surgical technologist should stop setting up the back table and Mayo stand to avoid making noise until the patient fully unconscious.

Maintenance phase

The surgical intervention takes place during this phase of anesthesia. Anesthesia administration is most dynamic during this period. The anesthesia care provider monitors the patient closely for changes in oxygen saturation, blood loss, muscle relaxation status, and cardiac status. Surgical manipulation may quickly change any of these parameters, and it is the responsibility of the anesthesia care provider to adjust anesthetic levels accordingly.

Emergence Phase

occurs as the surgical intervention is being completed. The goal of is to have the patient as awake as possible at the end of the surgical intervention.

Recovery phase

that period of time during which the patient returns to the optimum level of consciousness and well-being.

Advantages for General Anesthesia

• The patient is usually unaware of the activities and noises associated with the operative intervention.
• Once an adequate airway has been secured, the depth and rate of respiration can be controlled and the pulmonary tree is usually protected from aspirationaspirationDrawing in or out by suction aspiration Drawing in or out by suction .
• Medication dosages can be easily titrated to control the depth of anesthesia.
• Muscle relaxation for intubation and exposure of the surgical site is easily achieved.

Risks involved with Anesthesia

aspiration is greatest during the induction and emergence phases of general anesthesia. Induction agents and neuromuscular blockade both permit relaxation of the cardioesophageal sphincter, allowing gastric contents to enter the esophagus.

NPO

is from the Latin non per os or nil per os, meaning “nothing by mouth”. If this is not possible, the application of cricoid pressure can reduce the risk of aspiration. Suction apparatus should be available at all times.

Sellick's maneuver

the application of cricoid pressure, is performed to reduce the risk of aspiration .This maneuver is designed to prevent the stomach contents released into the esophagus from entering the laryngopharynx, thereby reducing the risk of aspiration into the respiratory tract.

Laryngospasm and bronchospasm

are reactions demonstrated by the lightly anesthetized patient. A slight trigger of the “gag” reflex results in a spasm or rigidity of the upper respiratory tract, resulting in an inability of the patient and/or anesthesia care provider to move air and waste gases in and out of the lungs.

Malignant Hyperthermia

is a potentially fatal hypermetabolic state of muscle activity resulting from a defect in calcium transportation within the muscle fibers of skeletal muscles. crisis is characterized by increased production of carbon dioxide, tachycardia, muscle rigidity, and, finally, a significant, rapid increase in core body temperature. a genetically transmitted disease, more commonly seen in males than in females. can be triggered by the use of succinylcholine, curare, and halogenated inhalation agents. The first sign is unexplained tachycardia followed by tachypnea and an increased level of carbon dioxide. A nontriggering anesthetic agent may be given. Dantrolene sodium (Dantrium) is the pharmacological agent administered specifically for the direct treatment

Pseudocholinesterase Deficiency

is a genetically transmitted trait that decreases the amount of acetylcholinesterase available in the neuromuscular junction to break down acetylcholine during muscle stimulation.

Allergic Reaction

is the result of histamine release in response to exposure to an allergen, a triggering protein. The patient’s history should include any prior allergic reactions, and those substances should be avoided if possible.

Shock

is an abnormal physiological state indicated by the presence of reduced cardiac output, tachycardia, hypotension, and diminished urinary output.

Cardiac Dysrhythmias

involve abnormal heart rate or rhythm, evidenced by electrocardiogram monitoring. Life-threatening dysrhythmias include ventricular tachycardia and ventricular fibrillation. The treatment for cardiac dysrhythmia includes the IV administration of lidocaine HCl. Additionally, defibrillation and pacemaker insertion may be necessary.

Cardiac Arrest

involves the cessation of heart pumping action and blood circulation. This, in turn, prevents the delivery of oxygen and glucose to cells for metabolism and the removal of wastes, resulting in metabolic and respiratory acidosis. The initial treatment for cardiac arrest is CPR, followed by advanced cardiac life support (ACLS).