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26 Ensure that all relevant information, for example X-rays, notes, blood results, accompany the patient to the operating theatre. To prevent delays which can increase the patient’s anxiety and to ensure that the anaesthetist and surgeon have all the information they require for safe treatment of the patient. E

27 The patient should be accompanied to the theatre by a ward nurse who remains present until the patient has been checked by the anaesthetic assistant/nurse and/or anaesthetized. To reduce patient anxiety and ensure a safe environment during induction. E

28 The ward nurse should give a full handover to the anaesthetic nurse or operating department practitioner on arrival in the anaesthetic room, using patient records and the preoperative checklist. To ensure the patient has the correct operation. To ensure continuity of care and to maintain the safety of the patient by exchanging all relevant information (AORN 2000, C).

Intraoperative care

Intraoperative care: anaesthesia

Definition

Intraoperative care is the physical and psychological care given to the patient in the anaesthetic room and operating theatre until transfer to the recovery room. In the anaesthetic room the patients are admitted and checked into the operating suite. When they are transferred into theatre they are already anaesthetized and are transferred onto the operating table.

Related theory

Safe administration of anaesthesia has been evolving since the early 1840s. During this time surgery was often seen as a final attempt to save life and very few operations were performed. This was because surgery was very painful and patients were conscious during the procedure and could hear everything that was being said and done. In order to support the patients, surgeons would attempt to administer alcohol, morphine and other sedatives but this would not work and most patients were restrained either with straps or held down. The surgeon had to be speedy and often the patients would either faint from pain or die from the bleeding. Then on 16th October 1846 William Morton publicly administered ether at Massachusetts General Hospital, Boston, followed shortly by James Robinson who administered the first ether anaesthetic in England on 19th December 1846. Thus began the developments in anaesthesia as in 1847, James Simpson, Professor of Obstetrics, introduced chloroform in Edinburgh. Although chloroform had severe side-effects such as sudden death and delayed liver damage, it still became popular because it worked well and was easier to use than ether. This was followed closely by the introduction of local anaesthetic in 1877 which led to infiltration anaesthesia, nerve blocks, spinal and epidural analgesia.

However, it was not until the turn of the 20th century that control of the airway using tubes in the trachea to help breathing and intravenous induction agents was introduced, enabling patients to fall asleep quickly and safely. Muscle relaxants emerged in the 1940s and today anaesthesia is very safe and there are very few deaths. Anaesthetists are highly trained and skilled physicians who provide a range of patient care such as obstetric analgesia and anaesthesia, resuscitation, pain management, major accident plan and emergency medicine in A and E.

Evidence-based approaches

Outcomes

To ensure that the patient understands what will happen in the operating theatres at all times in order to minimize anxiety.

To ensure that the patient has the correct surgery for which the consent form was signed.

To ensure patient safety at all times and minimize postoperative complications by:

(a) giving the required care for the unconscious patient

(b) ensuring injury is not sustained from hazards associated with the use of swabs, needles, instruments, diathermy and power tools

(c) minimizing postoperative problems associated with patient positioning, such as nerve or tissue damage

(d) maintaining asepsis during surgical procedures to reduce the risk of postoperative wound infection in accordance with hospital policies on infection control.

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