Transoperative 812217287

Transoperative
General concepts
Definition
Period during which the surgical act takes place and in which a series of care and
controls is carried out that aim to keep the patient in a state as close as possible to
homeostasis (balance or organic stability in physiological constants).
Limits
It begins with the induction or administration of anesthesia and ends when the
surgeon applies the last stitch or, if appropriate, terminates the intervention.
Division
It is divided in:
◈ Surgical transoperative: refers to the technical aspects done by the surgeon
◈ Anesthetic transoperative: it comprehends whole surveillance system, and

according to the surgical and anesthetic risk, it may be classified in two systems:
1. Transoperative control system for surgical intervention in a low-risk
patient
2. Transoperative control system for surgical intervention in a high-risk
patient
Low Risk Control
Respiratory Circulatory Neurological Liquid and

Control Control control electrolyte
control
Respiratory control ● Tracheal cannulas
● Rusch
● Portex
● Magill
Check:
➢ Permeability of the respiratory tract
➢ Respiration Rate
➢ O2 administration
○ Specific to each patient
➢ Assisted ventilation
Evaluation of respiratory frecuency:

Respiration rate
➔ ● Endotracheal intubation
➔ Mucous membranes and tegument coloration ○ Macintosh
➔ Blood´s coloration laryngoscope
➔ Auscultation
Circulatory control
Check:
1. Heart rate, rhythm and intensity
2. Frequency, rhythm and amplitude of the pulse.
3. Blood pressure
4. Llenado capilar****
5. Body temperature
Neurological control
Parameters:
★ Consciousness
★ Pupilar diameter
★ Palpebral reflex
★ Photomotor reflex
★ Consensual reflex
★ Osteotendinous reflex
Liquid and electrolyte
control
Check:
● What goes in and what goes out.
Anesthesia sheet***:
All the medicine used should be written on
this paper.
The time of every procedure must be written
down too.
Legal and clinical value
Names of the surgical team-
High Risk Control
Respiratory Circulatory Neurological Liquid and

Control Control control electrolyte
control
Respiratory control
Gasometry:
➢ Normal oxygen pressure in blood:

○ 80 mmHg to sea level
○ 65 - 75 mmHg CDMX height
➢ Normal CO2 pressure:

○ 35- 45 mmHg to sea level
○ 30 . 40 mmHg CDMX height
➢ pH
○ 7.35 - 7.45
Circulatory control
● Plethysmography: maintenance of blood
pressure by sound control.
● PVC: used in important veins

○ Normal rate:
■ 5- 15 cmH2O or 8- 12 cmH2O
● Pulmonary artery pressure:

○ Swan- Ganz catheter
■ It passes through right cavities
of the heart till de pulmonary
artery. (normal 25 mmHg)
Circulatory control
● Cardiac output: Check the amount of blood
expelled by the heart per minute.
● Electrocardiography: control of the

electrical conduction of the heart, rhythm
and frequency.
● Diuresis Control: with Foley´s probe.

○ 50 ml/ hr normal
○ 30 ml/ hr low urinary control
Neurological control
★ Check:
○ Ocular reflexes
○ Brain activity with

electroencephalogram
Liquid and electrolyte
control
Check:
● What goes in and what goes out.
General care of the patient in the OR
MODERATE THE ATTITUDES AND LANGUAGE OF
THE HUMAN TEAM
◈ The attitude of the people who care for you in the

operating room is so important for the patient.
◈ The attachment to this behavior is a true
reflection of professionalism, technical capacity
and even human quality, for those who deserve
all the respect and dedication, the patient, who
trusts the surgeon and his team.
ADEQUATE AND COMFORTABLE POSITION OF
THE PATIENT ON THE OPERATING TABLE
◈ It should always be kept in mind that the

patient is anesthetized. either in a general
or regional way.
◈ Be careful with burns, artifacts that fall into
the body, not recharge, or otherwise
damage it
BODY TEMPERATURE
◈ Every person under anesthesia has depressed his

body control and defense systems; this is no
exception for thermoregulatory mechanisms, and
significant variations in body temperature may
occur.
◈ To prevent hypothermia, it should not be
forgotten that an effective and rapid measure is
to cover the patient with warm blankets since
entering the operating room, and during the
intervention
EYE AND CONJUNCTIVA CARE
◈ The main protection is to keep the eyeballs moist,

which is archived by gauze with saline solution and
applying some ointment or ophthalmic ointment al
the start of anesthesia.
◈ The eyelids should be kept closed during the
intervention
PROBE AND CATHETER MONITORING
◈ It should be understood that the

use of these resources implies
useful operation. No procedure is
harmless, so they must be
monitored continuously.
Transoperative complications
Tissue hypoxia
1) Hemodynamic dysfunction
Shock: tissue hypoperfusion & cellular hypoxia
Microcirculation Septic Neurogenic

Hypovolemic
Cardiogenic Hypotension
Tachycardia
Hemorrhage or loss Palness
Tachycardia
of Acidosis
Palness liquids/electrolytes Anaphylactic
Sweat
Transoperative complications
2) Respiratory dysfunction
Early: cyanosis, tachycardia, arterial hypotension.
Delayed: bradycardia, mydriasis, hypotension
Surgical positions
Optimal exposition of the anatomical region to be surgically intervene.
Factors:
- Anatomical region
- Surgical procedure
- Anesthesia technique
- Age of Px
- Cardiopulmonary state
- Weigh and height
Trendelenburg
Lumbotomy
Supine Inverted Trendelenburg
Lateral
Kraske
Lithotomy
Pronel l
Bibliography
◈ Dubois. S, s.f, Cirugía base del conocimiento quirúrgico y apoyo en trauma, Access
Medicina. Recuperado de: https://accessmedicina.mhmedical.com/content.aspx?bookid=1466&sectionid=101740005
Questions
1. The Swan- Ganz catheter is used to:
a. To check the aorta´s pressure
b. To check the pulmonary artery´s pressure
c. To check the pulmonary valve
d. To check the aortic valve
2.

Transoperative 812217287

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Transoperative

◈ Surgical transoperative: refers to the technical aspects done by the surgeon

◈ Anesthetic transoperative: it comprehends whole surveillance system, and

Respiratory Circulatory Neurological Liquid and

Evaluation of respiratory frecuency:

Respiratory Circulatory Neurological Liquid and

➢ Normal oxygen pressure in blood:

➢ Normal CO2 pressure:

● PVC: used in important veins

● Pulmonary artery pressure:

● Electrocardiography: control of the

● Diuresis Control: with Foley´s probe.

○ Brain activity with

◈ The attitude of the people who care for you in the

◈ It should always be kept in mind that the

◈ Every person under anesthesia has depressed his

◈ The main protection is to keep the eyeballs moist,

◈ It should be understood that the

Microcirculation Septic Neurogenic

Supine Inverted Trendelenburg

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