What happens when a patient is brought into the surgical suite? The patient becomes the center of focus for a team of professionals and paraprofessionals whose sole purpose is to do their best to ensure a good outcome for the patient. The team consists of at minimum, three people: an anesthesiologist or certified nurse anesthetist, a registered nurse who remains "unscrubbed" or "circulates" for the room, and a nurse or technician who "scrubs" the case. There may also be co-surgeons, surgeon assistants, and additional scrubs.
The anesthesiologist has by this time, already interviewed the patient or family to determine any risk factors which may complicate the administration of anesthesia. These risk factors can include existing disease processes like diabetes, high blood pressure, previous cardiac conditions, allergies to medications, or previous surgeries which may make it difficult to place an airway, such as neck surgery. The anesthesiologist prepares a specific array of drugs which will help the patient remain comfortable, sedated, and ultimately safely asleep for the duration of the procedure. If an IV was not started in the pre-operative holding area before coming back to the suite, it will be started now.
The circulating nurse or the anesthesiologist will place monitoring devices on the patient before anesthesia is started. These monitoring devices usually include a blood pressure cuff, pads for reading a continuous electrocardiogram (ECG), a blood oxygenation sensor, and possibly a brain oxygenation monitor. Other monitoring devices may be placed if needed for certain procedures.
Throughout this preparation phase, the patient's identity is checked and the procedure to be done is verified by many people. It may seem irritating to have to repeat the same information to every person who walks by, but it is essential that the correct procedure is done for the correct patient at the correct site. According to JCAHO, as of 2001 there were 150 reports of procedures done on the wrong patient, or the wrong site, or doing the wrong procedure.
Once the patient is asleep, a breathing tube is usually placed in the patient's airway to facilitate the delivery of anesthetic gases. In addition, a catheter may be placed into the bladder to monitor urine output and sometimes temperature for the duration of the procedure. This may or may not be removed at the end of the surgery.
The area of the surgical procedure is now exposed and prepared. The "prep" consists of removing any hair in the area, and then washing the site with antibiotic solution.
It is at this point that the sterile drapes are placed by the scrub and the surgeon to isolate the area and create a sterile field in which the scrub and surgeon can work.
The actual procedure now begins. During the case, other team members may be called in or called on to provide assistance. These other people may be xray techs to take xrays during the case, or perhaps pathologists to identify tissue samples.
At the conclusion of the procedure, sponges, needles and instruments which where counted prior to the patient entering the room are now recounted. The dressing is placed on the surgical site and the drapes are removed. The still groggy but awakening patient is moved to a gurney or bed and transferred to the post-anesthesia recovery unit.
Most patients remember very little of their time spent in the actual surgical suite, but during their brief stay they are the number one focus of a number of professional, caring people.