This chapter explores temperature regulation and how it can be managed perioperatively. First, it addresses the components and mechanisms that control and regulate temperature in humans. Second, it explores the abnormalities that may occur due to pathologies, surgery, and anaesthesia. Lastly, it addresses how perioperative practitioners can regulate temperature effectively using a range of methods.

This chapter explores some of the new roles that have been introduced into perioperative care over the last couple of decades. These are the surgical first assistant, surgical care practitioner, and anaesthetic associate. It highlights the history, educational pathways, role boundaries, scope of practice, and the professional and legal implications of each of the extended or advanced roles.

General anaesthesia is the reversible loss of consciousness induced by pharmacological agents. Surgeries were previously often limited to superficial procedures and amputations due to significant patient discomfort. This chapter provides an overview of the conduct of general anaesthesia, and its various phases: induction, maintenance, and emergence. Core concepts such as depth of anaesthesia and perioperative care will also be reviewed. Anaesthetic adjuncts, drugs, and equipment will also be discussed due to their crucial role in ensuring patient safety during general anaesthesia.

The conduct of a general anaesthetic is more than just the administration of a drug to induce anaesthesia – a wide variety of agents are available, and they can be used pre-, intra-, and postoperatively. They will also be used for different purposes in different situations. This chapter discusses many of the common drugs used during a general anaesthetic, with a brief description of the effects, mechanism of action, and different routes of administration.

Regional anaesthesia is the use of local anaesthetic drugs to block sensations of pain from a large area of the body. It is used to allow surgery to proceed either without general anaesthesia or combined with general anaesthesia to provide superior pain relief than can be achieved with analgesic drugs alone. It is broadly divided into two categories. Neuraxial blocks involve injection of local anaesthetic close to the spinal cord, such as in the subarachnoid (intrathecal) space (known as a spinal) or in the epidural space (known as an epidural). Peripheral nerve blocks involve injection of local anaesthetic near peripheral nerves or plexuses. This can be performed either using landmark technique, a nerve stimulator, or with ultrasound guidance depending on the chosen block. Common equipment and techniques used to perform regional anaesthesia are discussed in this chapter, as well as advantages, potential risks, and the patient preparation and monitoring that is required.

This chapter discusses the management of obstetric patients undergoing anaesthesia and surgery. First, it outlines the distinct challenges of emergency obstetric anaesthesia and surgery. Second, it discusses pregnancy related changes to anatomy and physiology, common obstetric procedures, and drugs specific to the obstetric speciality. Finally, it highlights the advancements in care and medical technology and draws upon some of the moral and legal dilemmas faced by multidisciplinary teams in the obstetric setting.

Safe and effective health care underpinned by a sound evidence base is considered the gold standard of quality and compassionate care. Evidence-based practice remains a broad term that is frequently used but not always understood. This chapter explores what evidence-based practice is, why it matters, and the barriers that can hinder its implementation in practice. It is vital that operating department practice is informed, supported, and guided by evidence-based practice.

In acknowledging that ethics should be regarded as the cornerstone of healthcare practice and the significance of professional regulation for healthcare practitioners providing patient care, it is vital to develop an understanding of how and why this is the case. This chapter has been written to support all perioperative practitioners in developing this knowledge in the context of the operating theatre. The chapter includes discussion of some of the key moral theories and frameworks that may be used to guide reflective, ethical decision making before moving on to consider the role of professional codes and regulation in prescribing and enforcing standards of professional conduct and directing ethical decision making.

This chapter explains the fundamentals of basic patient monitoring for patients undergoing general anaesthesia. Monitoring provides information and feedback of a patient’s physiological state in response to any therapeutic interventions or stimuli during anaesthesia and surgery. It is vital that perioperative practitioners understand the underlying principles of basic patient monitoring. This includes understanding how and what is being measured, how the monitoring is assembled, and how to problem solve to ensure optimal functionality and accuracy.

This chapter explains the challenges involved with bariatric surgery and how they can be navigated to optimise patient care. Due to the increasing global rates of obesity, increasing numbers of bariatric patients are presenting for surgery. Obesity is associated with several physiological and psychological effects, and it is essential that these are considered in order to plan and deliver safe, effective, patient-centred perioperative care.

Surgery represents a physiologic challenge to even healthy patients - and many patients enter surgery with risk-intensifying co-morbidities. As a result, medical emergencies can occur during any surgery. Recognition and early management of these crises is crucial. Thus, this chapter seeks to provide an overview of serious medical emergencies that may arise in the preoperative period, ranging from anaphylaxis to diabetic ketoacidosis. To provide context for investigations and treatment, a brief outline of the relevant pathophysiology and/or epidemiology accompanies each problem. Building upon that foundation, this chapter describes the rudiments of recognising the emergencies and managing them appropriately. It is not the goal of the chapter to address the included issues comprehensively but to impart basic, essential knowledge of medical emergencies that will help the reader to participate in the provision of safe care in the operative setting.

This chapter explore human factors, also known as ergonomics, which is an established scientific discipline that has become integral in healthcare in recent years. The catalyst for this in the UK was the Clinical Human Factors Group led by Martin Bromiley. Martin’s wife Elaine died following errors made during a routine operation when the theatre team failed to respond appropriately to an unanticipated anaesthetic emergency in part because of a variety of human factors. There is still confusion around the term ‘human factors’. This is partly because human factors cannot be explored in isolation but need to be understood in the context of human activity, error, and the culture around error.

Healthcare-associated infections and more specifically surgical site infections, represent one of the biggest challenges facing practitioners in the perioperative environment. This chapter addresses the key points related to the causes of infection, and how they can be prevented. Infections are caused by pathogenic organisms, consequently, it is important to understand how they enter the body. The chain of infection model describes a series of links that outlines how infections can spread and provides a foundation to understand how they can be prevented. It is essential that perioperative practitioners understand how to break the chain of infection as well as the consequences of not doing so.

Patients with various ailments present to hospital with pain. This chapter defines pain and explores the assessment and the fundamental pathophysiology behind this common symptom. Pain can be managed using various pharmacological and non-pharmacological methods including interventional techniques. This chapter also explains the principles of management of acute pain in chronic pain patients on long term opioids and the problem of chronic post-surgical pain.

Intravenous fluids are solutions containing various quantities of water, electrolytes, salts, and sugar. They are used to maintain haemostasis when the enteral route is insufficient to meet physiological demand. Fluid therapy maintains hydration, oxygen delivery, and thus organ function. Poor perioperative fluid control is associated with impaired physiological function, resulting in patient harm and increasing healthcare costs. Perioperative fluid management is based upon three distinct but related factors: patient (age and comorbidities), surgical (urgency, indication and duration) and anaesthetic. This chapter is an introduction to intravenous fluids, highlighting the physiological control mechanisms, the composition of intravenous fluids, and important clinical assessment principles.

This chapter explains the aims of patient positioning and the complications that can arise from incorrectly positioning patients as well as the physiological changes different positions can cause. The correct positioning and alignment of limbs for surgical procedures is vital, and all perioperative practitioners should understand their role and responsibility for safe patient positioning, and the rationale for it. Safe patient positioning is always a multidisciplinary team effort, whereby all members of the perioperative team should be present in the operating theatre at the crucial moment.