Within the operating theatre, perioperative practitioners will use a variety of different pieces of equipment to help them carry out their role and care for patients undergoing anaesthesia and surgery. Whether it is checking an anaesthetic machine, handling surgical instruments, or setting up an analgesic pump in the post-anaesthetic care unit, the management of medical equipment requires more understanding than just simply using it. This chapter explores the procurement, use, and maintenance of medical equipment.

Health and Safety within the perioperative area present unique challenges in terms of managing the unique hazards and risks that staff and patients can be exposed to. Hazards from lasers, electrical equipment, chemicals, moving and handling, exposure to noxious vapours and gases are just some of the common environmental risks staff are exposed to on a daily basis. This chapter focuses on putting some of the legislation and guidance into the perioperative context. One of the primary aims of the chapter is to foster a culture of appropriate risk assessment and safe practice which will reduce or minimise errors.

This chapter explains the fundamental elements of resuscitation. Patients in cardiorespiratory arrest require prompt and effective resuscitation to improve chances of a good outcome. Identification of the underlying cardiac rhythm and treatment of any reversible causes is critical to achieve patient survival. A structured ABCDE approach and the ALS algorithm are commonly adopted to optimise patient assessment and management. An awareness of both technical and non-technical skills are important when dealing with the acutely deteriorating patient.

Since initial experiments with nitrous oxide and ether in the nineteenth century, general anaesthesia has been near synonymous with inhaled agents. However, total intravenous anaesthesia may offer advantages in certain circumstances. Total intravenous anaesthesia can be defined as the induction and maintenance of general anaesthesia using agents given solely intravenously and in the absence of all inhalational agents including nitrous oxide. It may be necessary when volatile anaesthesia is contraindicated or infeasible or may be chosen for other benefits. This chapter provides an overview of the benefits and disadvantages of total intravenous anaesthesia, as well as describing the equipment and care required to use it safely.

This chapter explores the different kinds of sutures available, as well as some additional methods of skin closure. Surgical sutures are a medical device used to hold body tissue together following injury or surgery. There is evidence of suture use going back thousands of years. The application of a suture generally involves using a needle with an attached length of suture thread. Suture thread can be made from numerous materials. The original sutures were made from biological materials, such as catgut, cotton, and silk. Today, most sutures are made of synthetic polymer fibers, with silk being the only biological material still in use.

This chapter explains the key aspects of operating department design that facilitate a highly skilled multidisciplinary team to provide essential care to a vulnerable group of patients. It is important that the surgical facilities are designed to support the smooth flow of patients from admission to discharge. Surgical activities are broad ranging from scheduled or unscheduled, complex, to routine day surgery. Theatre services are central within the hospital system and rely on interdependant relationships with other hospital departments. This presents organisational, planning, and design challenges, as healthcare providers seek to improve services and utilise existing infrastructure to offer facilities that meet demand in a fast-paced and progressive field. Patients are entitled to receive high-quality healthcare, which is provided safely and effectively, and theatre teams should expect to deliver those high standards of care in an appropriate workspace. Theatre design is an essential component of the perioperative pathway, allowing surgical interventions to be carried out safely and efficiently to enable the best possible patient outcomes.

The ECG is a non-invasive representation of the activity of the cardiac electrical conducting system. ECGs are widely available in all hospitals and therefore interpretation is of great importance. ECGs allow assessment of cardiac rate, recognition of conduction blocks, myocardial ischaemia, life-threatening arrhythmias, and the effects of drugs. Therefore ECGs provide a wealth of information allowing safe and appropriate treatment strategies for patients. This chapter summarises the most salient features of common arrhythmias seen in clinical practice.

In the immediate post-anaesthesia phase the patient’s airway, breathing, and circulation are subject to dynamic change as the effects of anaesthesia begin to wear off. If not carefully managed, life threatening complications can occur rapidly. The experienced practitioner uses risk appraisal to inform physical assessment in order to pre-empt complications or correct them if they occur. This chapter focuses on the key priorities of assessment together with other essential factors such as pain control.

Care is a fundamental principle that is at the centre of operating department practice. It involves consideration of the patients‘ physical, psychological, and emotional needs whilst respecting their social and cultural beliefs. Perioperative care is not a single event but rather a process that starts with the assessment of patient needs and identification of risks, which are then planned for, implemented, and evaluated as the patient moves through each stage of their journey. The whole process is documented using the framework of a nursing model and perioperative practitioners become experienced in prompt care planning to ensure that the care delivered is safe, effective, and responsive. All perioperative practitioners are responsible for the care they deliver through a duty of care to their employer and the patient. Registered practitioners are also accountable to their regulatory body who set the standards for education and practice. Reflection, as part of continuing professional development, allows practitioners to gain a deeper understanding of the care they provide.

An understanding of the physiological role of blood and its role in the supply of oxygen to tissues is important for the perioperative care of the patient. A thorough approach to administration of blood components is vital in this setting. This chapter adresses the special properties of the red blood cells in promoting oxygen carriage, the methods of safe blood component transfusion, and consideration of the hazards of transfusion.

Critical ill patients are often haemodynamically unstable and accurate continuous monitoring is vital. Haemodynamic monitoring describes the measurement of the cardiovascular stability of the patient. Invasive blood pressure monitoring and central venous pressure monitoring provide a ‘real time’ measurement of the patients haemodynamic status and better allows clinicians to pre-emptively treat a patient before a more serious problem arises. Although invasive blood pressure monitoring has several advantages compared to non-invasive blood pressure monitoring, it is not without risk. Central venous pressure monitoring is similarly beneficial in that it supports the clinical decision making regarding a patient’s fluid status but also comes with additional risks. This chapter explores invasive blood pressure and central venous pressure monitoring in detail.

This chapter is written for practitioners working within the perioperative environment that require an understanding of how to assess and manage a patient’s airway. An introduction to airway anatomy highlights relevant anatomical landmarks, and a number of techniques that can be employed for both basic and advanced airway management are described. Airway equipment used by the anaesthetic practitioner will vary depending on requirements of the patient and procedure. Therefore, an overview of both standard and specialist airway equipment available, and how this is used to establish and maintain a patent airway, is provided.

This chapter provides an overview of artificial ventilation, an intervention that has developed from a basic resuscitation technique to highly sophisticated intensive care ventilators used today. Artificial ventilation is provided to unconscious patients, whether unconsciousness was caused by a medical problem (e.g., head injury) or by anaesthesia. Ventilation is usually provided through an endotracheal tube, via a breathing system which is attached to a ventilator. A heat and moisture exchange filter is used to warm and humidify the gases that reach the patient. The healthcare professional caring for the patient will adjust various parameters to ensure the ventilation strategy is appropriate for each patient and their specific needs. Positive-pressure ventilation is used to push gases into the airways of the patient and allow gas exchange to occur. Ventilators may have several different modes for delivering breaths to patients but usually are based around limiting tidal volume or peak inspiratory pressure. Artificial ventilation can affect many different physiological systems particularly the heart and blood vessels, the brain, and the kidneys.

This chapter explains the fundamental principles of respiratory physiology for the perioperative practitioner. First, it describes the relevant respiratory anatomy, its function, and how it applies to the anaesthetic context. Second, it describes the different lung volumes and their relevance and application during artificial ventilation. Finally, it explains the physiology of perfusion and its application to ventilation and how they can be affected by different patient positions during anaesthesia and surgery.

This chapter identifies and explains the fundamental role and responsibilities of the perioperative practitioner essential to the surgical scrub role; this includes surgical counts, sharps safety, specimen managements, and waste disposal. The scrub practitioner is a recognised member of the perioperative team, performing a crucial role in preparing the operating theatre environment for surgical procedures. They must ensure it is clean, ready, and safe to receive the surgical patient. The scrub practitioner should possess the requisite technical and non-technical skills, and theoretical underpinning knowledge of anatomy and physiology to optimally perform their role.

This chapter explains the fundamental aspects of decontamination and sterilisation. A working knowledge of the principles of sterilisation, disinfection, and infection control are essential for effective and safe perioperative practice. Decontamination is defined as the combination of methods—including cleaning, disinfection, and sterilisation—used to make a reusable item safe for further use on patients and for handling by staff. The term refers to the whole cycle, including processes such as cleaning, disinfection, and sterilisation. Aseptic techniques are fundamental to supporting a safe environment and to ensure patient and staff safety with regards to infection and its associated risks. It is essential that perioperative practitioners adhere to national and local standards and understand how the decontamination cycle can mitigate the risk of infection.

This chapter provides a detailed overview of the cardiovascular system in the context of perioperative care. The cardiovascular system is responsible for the delivery of oxygen around the body and the return of this blood to the heart. This blood is then pumped to the lungs and back to the heart. The systemic and pulmonary circulations have a number of important differences between them. The heart beats repeatedly in a process known as the cardiac cycle, which has two distinct phases, systole, and diastole. The conduction system of the heart allows for the chambers of the heart to contract in a well-coordinated manner. Problems with the cardiovascular system occur frequently under anaesthesia and can have numerous causes, some of which are explored in this chapter.

This chapter focuses on the perioperative care of the paediatric patient and aims to undermine the common misconception that children are just little adults. Providing safe and effective care for children requires a clear underpinning knowledge of their unique needs. Conscious consideration of age-dependent characteristics such as anatomical, physiological, psychological, and behavioural are essential in the delivery of paediatric patient care. The rationale for adaptations to the delivery of care is to ensure children receive anaesthesia and surgery in a safe and appropriate environment.

The provision and practice of healthcare is subject to a broad legal framework of accountability. Healthcare professionals must develop a sound understanding of their legal responsibilities and the underpinning ethical, professional and legal reasons for them. Ultimately, healthcare law is about people, their bodies, and those entrusted to care for them. Therefore, the aim of this chapter is to rationalise and offer insight into the link between legal accountability and quality of patient care. This chapter has been written to support all perioperative practitioners in developing their legal knowledge in the context of the operating theatre.