Intraoperative Nursing

By:
Bryan Mae H. Degorio, BSN, RN
dbryanmae@yahoo.com
Intraoperative Phase
- is the time when the person is
transferred to the operating room
-anesthesia is administered and the
person undergoes the scheduled
surgical procedure.
-the emphasis is on the asepsis,
homeostasis and safe administration of
anesthesia
The Surgical Team
2. Surgeon
-is the head of the surgical team and
makes the major decision
- Surgeons have medical degrees,
specialized surgical training of up to
seven years, and in most cases have
passed national board certification
exams.
2. Scrub Nurse
-participates directly during the
procedure, setting up the operating
room and making certain that the
environment for surgery is sterile.
-during the surgery, she maintains an
accurate count of sponges, sharps ad
instruments on the sterile field and
count the same materials together with
the circulating nurse.
3. Anesthesiologist/ Nurse Anesthetist
- anesthesiologists are physicians with
at least four years of advanced training in
anesthesia.
- anesthetists are qualified health care
professionals who administer
anesthesia.
- their functions include:
a. maintain the person airway
b. ensure that the person has an
adequate oxygen and
carbon dioxide exchange
 c. infuse blood, medications and
fluids as necessary
d. alert the surgeon immediately
for signs of complication
4. Circulating Nurse
- act as the manager of the operating
room
- the functions include:
a. check that all equipments are
working properly before the
surgery
 b. prepares and autoclave
instrument for surgery
c. alert team members of any
break in the sterile technique
d. contacts the x-ray and
pathologic departments if
requested by the
surgeon
e. do skin preparation
f. document the specific activity
throughout the
operation
 g. verify consent and coordinate
with the team

Aseptic Technique

• Sterilize all supplies used for sterile

procedures. When in doubt, consider an
object unsterile.
2. When putting on sterile gloves, do not
touch the outside of bare hands. When
wearing sterile gloves, only touch sterile
articles. If a glove is punctured, remove
the damaged glove, wash hands, and put
on a new glove as promptly as patient
safety permits.
3. The outer wrappings and edges of packs
that contain sterile items are not sterile.
They should be opened or handled by the
person who is not wearing sterile gloves.
Open sterile packages with the edges of
the wrapper directed away from your
body to avoid touching your uniform or
reaching over a sterile field. Touch only
the outside of a sterile wrapper. Once a
sterile pack has been opened, use it; if it
is not used, rewrap and resterilize it.
4. Avoid sneezing, coughing or talking
directly over a sterile field or object.
5. Do not reach across or above a sterile
field or wound.
6. Avoid spilling solutions on a sterile setup.
7. A sterile field should be away from drafts,
fans, and windows.
8. Store sterile packages in dry areas.
Frequently wash hands using correct
technique.
9. Be constantly aware of need for clean
surroundings.  
10. Hold sterile objects and gloved hands
above waist level or level to the sterile
field. Since it can not be sterilized, any
object that touches it is considered
contaminated. Have a special receptacle
or waxed paper or plastic bag to receive
contaminated materials.
Surgical Environment:
- a surgical suite is designed to
promote safe therapeutic environment
for the patient.
3. Traffic control
- The in and out of the operating room
is kept to minimum
-3 zones:
 a. unrestricted area
-provide entrance to and exit from
the operating room
-people may wear street clothes.
-it includes the holding area,
lounges, dressing room and
offices.
b. semirestricted area
-provide access to the restricted
zone and peripheral support
areas within the
surgical suite
 - scrub attire is required with caps
c. restricted area
-includes the individual OR’s,
scrub areas, sub sterile room,
and clean core areas.
-in this area, scrub attire, hair
covering and masks must be
worn
2. Operating Room Attire
a. masks
b. headgear
- should cover completely the hair,
neckline and beard
c. gown
d. gloves
Sedation and Anesthesia:
4 Levels
3. Minimal sedation
-is a drug induced state during which
the patient can respond normally to
verbal command
-cognitive functioning and coordination
maybe impaired but ventilatory and
cardiovascular functioning is not
impaired
2. Moderate sedation
-is a form of anesthesia that maybe
produced intravenously.
-there is a depressed level of
consciousness that does not impaired
the patient’s ability to maintain a
patent airway and to
respond appropriately to
physical stimulation and verbal
command
 -midazolam and diazepam are the
frequently used for
intravenous sedation
- the nurse must monitor the client for
dysrhythmias, respiratory and
central nervous system depression
- the nurse must be trained to detect
dysrhythmia, administering
oxygen and performing
rescuscitation.
3. Deep sedation
-is a drug induced state that client
cannot be easily aroused but can
respond purposely after repeated
stimulation.
-usually achieved when anesthetic
agent is inhaled or adm.
intravenously
-the commonly use are the volatile
liquids and gas anesthetics
Volatile liquids:
2. Halothane
3. Methoxyflurane
4. Enflurane
5. Isoflurane
6. Sevoflurane
7. Desflurane
Gases
1. Nitrous oxide
4. Anesthesia
- is the state of narcosis, analgesia and
relaxation and reflex loss
- the client is not arousable even to
painful stimuli
Stages of Anesthesia
Stage Start-Point End-Point Physical Nsg.
Reaction Intervention
s
I Onset Anesthetic Loss of Drowsy or Close
administratio consciousness dizzy, operating
n possible room doors,
visual or keep room
auditory quiet, stand
hallucination by to assist
the client

II Loss of Loss of eyelid Increase in Remain

Excitem consciousness reflexes autonomic quiet at
ent activity and client’s side
irregular assist
breathing, anesthesia
client may as needed
struggle
III surgical Loss of Loss of most Client is Begin
anesthesia eyelid reflexes and unconscious preparation
reflexes depression , muscles when the
of vital signs are relaxed, client is
no blink or breathing
gaga reflex well with
stable vital
signs

IV Danger Functions Respiratory Client is not If arrest

excessively and breathing, occurs,
depressed circulatory heartbeat respond
failure may or may immediately
not be to assist in
present establishing
airways and
other
procedures
Methods of Anesthesia Administration
2. General Anesthesia
-blocks the pain stimulus at the
cerebral cortex and induced
depression of the CNS that is
reversed by either a
metabolic change and
elimination from the body and by
pharmacologic agent.
-it is best indicated for surgery in the
upper turso, head, neck, back
and for prolong surgical
procedure.
-Administration of General Anesthesia
a. Intravenous anesthesia
-when administered intravenously, the
client experience
unconscious 30 seconds
after the administration.
b. Inhalation anesthesia
-a mixture of volatile liquids or gas and
oxygen is used.
 -there is ease in administration and
elimination.
-these are usually use to maintain the
stage 3 of the anesthesia
following induction which can be
administered through a mask
or endotracheal tube
2. Regional Anesthesia
-Regional anesthesia means numbing
only the portion of the body
which will be operated on. Usually
an injection of local anesthetic is
given in the area of nerves that
provide feeling to that part of the
 -Types of Regional Anesthesia
2. Spinal Anesthesia
-A spinal anesthetic is often used for
lower abdominal, pelvic, rectal, or
lower extremity surgery. This type of
anesthetic involves injecting a single
dose of the anesthetic agent
directly into the fluid
(SUBARACHNOID SPACE) surrounding the
spinal cord in the lower back, causing
numbness in the lower body
 -autonomic fiber is affected first and
are the last to recover, (1) touch, (2)
pain, (3) motor, (4) pressure, (5)
proprioceptive fiber
2. Epidural Anesthesia
-This anesthetic is similar to a spinal
anesthetic and also is commonly used
for surgery of the lower limbs and
during labor and childbirth. This type of
anesthesia involves continually infusing
medication through a thin catheter
that has been placed into the epidural
space of the spinal column in the lower
back, causing numbness in the lower
body. 
 -if the level of block is too high it may
lead to depression or paralysis
3. Caudal Block
-is produced by injection of local
anesthetic into caudal or sacral
canal
-commonly use for obstetric clients
4. Topical Anesthesia
-anesthetic agent maybe applied
directly on the area to be desensitized.
- it can be a solution, ointment, a gel a
cream or a powder.
 - this short acting anesthetic agent can
block the peripheral nerve
endings
5. Local Infiltration Anesthesia
-involves the injection of anesthetic
agent into the skin or
subcutaneous tissue of the area
to be anesthetized.
- aspirate before injecting
6. Field Block Anesthesia
-involves the injection of anesthetic
agent to the area proximal to the
planned incision site.
- this block forms the barrier between
the incision and the NS
7. Peripheral Nerve Block
- a nerve block anesthetizes individual
nerve or nerve plexus rather
than all the local nerves.
 - Nerve block can be obtained in a
finger, entire upper arm or
chest or abdomen
Complications and Discomforts of Spinal
Anesthesia
3. Hypotension
-due to paralysis of the vasomotor
nerves shortly after the induction
of anesthesia.
 - Nsg interventions
a. Administer O2
b. Vasoactive drug
c. Trendelenburg position
2. Nausea and Vomiting
- occurs mainly from abdominal surgery
because of the traction place in
various structure within the
abdomen
 - Interventions:
a. ephedrene, antiemetic
b. oxygen and fluid
3. Headache
- cerebrospinal fluid that is lost through
dural hole or leakage of fluid
due to use of large spinal needle
or poor hydration
 - Nursing Interventions:
a. Apply tight abdominal binder
b. fluids and analgesic
c. inject client blood to plug the hole
(10cc)
d. flat on bed after the surgery
4. Respiratory Paralysis
-occurs when the drug reaches upper
thoracic and cervical spinal level
 -Intervention:
a. artificial respiration
5. Neurological Complication
- maybe due to:
a. unsterile needle, syringes or
anesthetic agent
b. per-existing disease of CNS
c. transient response to
anesthetics
d. position during surgery
-Interventions:
a. supportive care for transient forms
b. antibiotic and steroid therapy
c. rehbilitation for permanent paralysis