Operating Room
Operating Room
Definition
Purpose
Description
Surgery centers
Definition
An operating room (OR), also called surgery center, is the unit of a hospital where surgical procedures are performed.
Purpose
An operating room may be designed and equipped to provide care to patients with a range of conditions, or it may be designed and equipped to provide specialized care to patients with specific conditions.
Description
OR environment
Operating rooms are sterile environments. All personnel wear protective clothing called scrubs, as well as shoe covers, masks, caps, eye shields, and other coverings to prevent the spread of germs. The operating room is brightly lit and the temperature is very cool; operating rooms are air-conditioned to help prevent infection.
KEY TERMS
Advance directives— Legal documents that increase a patient’s control over medical decisions. A patient may select medical treatment in advance, in the event that he or she becomes physically or mentally unable to communicate his or her wishes. Advance directives either state what kind of treatment the patient wants to receive (living will), or authorize another person to make medical decisions for the patient when he or she is unable to do so (durable power of attorney).
Anesthesiologist— A specially trained physician who administers anesthesia.
Arterial line— A catheter inserted into an artery and connected to a physiologic monitoring system to allow direct measurement of oxygen, carbon dioxide, and invasive blood pressure.
Catheter— A small, flexible tube used to deliver fluids or medications. A catheter may also be used to drain fluid or urine from the body.
Central venous line— A catheter inserted into a vein and connected to a physiologic monitoring system to directly measure venous blood pressure.
Chest tube— A tube inserted into the chest to drain fluid and air from around the lungs.
Critical care— The multidisciplinary healthcare specialty that provides care to patients with acute, life-threatening illness or injury.
Edema— An abnormal accumulation of fluids in intercellular spaces in the body; causes swelling.
Endotracheal tube— A tube inserted through the patient’s nose or mouth that functions as an airway and is connected to a ventilator.
Foley catheter— A tube inserted into the bladder to drain urine into an external bag.
Gastrointestinal tube— A tube surgically inserted into the stomach for feeding a patient who is unable to eat by mouth.
Infectious disease team— A team of physicians and hospital staff who help control the hospital environment to protect patients against harmful sources of infection.
Inpatient surgery— Surgery that requires an overnight stay of one or more days in the hospital. The number of days spent in the hospital after surgery depends on the type of procedure performed.
Life support— Methods of replacing or supporting a failing bodily function, such as using mechanical ventilation to support breathing. In treatable or curable conditions, life support is used temporarily to aid healing until the body can resume normal functioning.
Nasogastric tube— A tube inserted through the nose and throat and into the stomach for directly feeding the patient.
Nothing by mouth (NPO)— NPO refers to the time after which the patient is not allowed to eat or drink prior to a procedure or treatment.
Outpatient surgery— Also called same-day or ambulatory surgery. The patient arrives for surgery and returns home on the same day. Outpatient surgery can take place in a hospital, surgical center, or outpatient clinic.
Swan-Ganz catheter— Also called a pulmonary artery catheter, this is a type of tubing inserted into a large vessel in the neck or chest. It is used to measure the amount of fluid in the heart, and to determine how well the heart is functioning.
The patient is brought to the operating room in a wheelchair or a bed with wheels called a gurney. The patient is transferred to the operating table, which is narrow and has safety straps to keep him or her positioned correctly.
The monitoring equipment and anesthesia used during surgery are usually kept at the head of the operating table. The anesthesiologist sits here to monitor the patient’s condition during surgery.
Depending on the nature of the surgery, various forms of anesthesia or sedation are administered. The surgical site is cleansed and surrounded by a sterile drape.
The instruments used during a surgical procedure are different for external and internal treatment; different tools are used on the outside and on the inside of the body. Once internal surgery is started, the surgeon uses smaller, more delicate devices.
OR equipment
An operating room has special equipment such as respiratory and cardiac support, emergency resuscitative devices, patient monitors, and diagnostic tools.
Life support and emergency resuscitative equipment
Equipment for life support and emergency resuscitation includes:
- Heart-lung bypass machine, also called a cardiopulmonary bypass pump, which takes over for the heart and lungs during some surgeries, especially heart or lung procedures. The heart-lung machine removes carbon dioxide from the blood and replaces it with oxygen. A tube is inserted into the aorta to carry the oxygenated blood from the bypass machine to the aorta for circulation to the body. The heart-lung machine allows the heart’s beating to be stopped during surgery.
- Ventilator, also called a respirator, which assists with or controls pulmonary ventilation. Ventilators consist of a flexible breathing circuit, gas supply, heating/humidification mechanism, monitors, and alarms. They are microprocessor-controlled and programmable, and regulate the volume, pressure, and flow of respiration.
- Infusion pump is a device that delivers fluids intravenously or epidurally through a catheter. Infusion pumps employ automatic, programmable pumping mechanisms to deliver continuous anesthesia, drugs, and blood infusions to the patient.
- Crash cart, also called resuscitation cart or code cart, is a portable cart containing emergency resuscitation equipment for patients who are “coding” (i.e., vital signs are in a dangerous range). The emergency equipment includes a defibrillator, airway intubation devices, resuscitation bag/mask, and medication box. Crash carts are strategically located in the operating room for immediate accessibility if a patient experiences cardiorespiratory failure.
- Intra-aortic balloon pump is a device that helps reduce the heart’s workload and helps blood flow to the coronary arteries for patients with unstable angina, myocardial infarction, or those awaiting organ transplants. Intra-aortic balloon pumps use a balloon placed in the patient’s aorta. The balloon is on the end of a catheter that is connected to the pump’s console, which displays heart rate, pressure, and electrocardiogram (ECG) readings. The patient’s ECG is used to time the inflation and deflation of the balloon.
Patient monitoring equipment
Patient monitoring equipment includes:
- Acute care physiologic monitoring system is a comprehensive patient monitoring system that can be configured to continuously measure and display various parameters via electrodes and sensors connected
- to the patient. Parameters monitored may include the electrical activity of the heart via an ECG, respiratory (breathing) rate, blood pressure (noninvasive and invasive), body temperature, cardiac output, arterial hemoglobin oxygen saturation (blood oxygen level), mixed venous oxygenation, and end-tidalcarbon dioxide.
- Pulse oximeter monitors the arterial hemoglobin oxygen saturation (oxygen level) of the patient’s blood with a sensor clipped over the finger or toe.
- Intracranial pressure monitor measures the pressure of fluid in the brain in patients with head trauma or other conditions affecting the brain (such as tumors, edema, or hemorrhage). Intracranial pressure monitors are connected to sensors inserted into the brain through a cannula (tube) or bur hole. These devices signal elevated pressure and record or display pressure trends. Intracranial pressure monitoring may be a capability included in a physiologic monitor.
Diagnostic equipment
The use of diagnostic equipment may be required in the operating room. Mobile x-ray units are used for bedside radiography, particularly of the chest. These portable units use a battery-operated generator that powers an x-ray tube. Handheld portable clinical laboratory devices, called point-of-care analyzers, are used for blood analysis at the bedside. A small amount of whole blood is required, and blood chemistry parameters can be provided much faster than if samples were sent to the central laboratory.
Other OR equipment
Disposable OR equipment includes urinary (Foley) catheters to drain urine during surgery, catheters used for arterial and central venous lines to monitor blood pressure during surgery or to withdraw blood samples, Swan-Ganz catheters to measure the amount of fluid in the heart and to determine how well the heart is functioning, chest and endotracheal tubes, and monitoring electrodes.
New surgical techniques
Minimally invasive surgery, also called laparoscopic surgery, is an operative technique performed through a few small incisions, rather than one large incision. Through these small incisions, surgeons insert a laparoscope (viewing instrument that displays the site on a computer screen for easier viewing) and endoscopic instruments to perform the surgery.
Robot-assisted surgery allows surgeons to perform certain procedures through small incisions. In robotic surgery, a surgeon sits at a console several feet from the operating table and uses a joystick, similar to that used for video games, to guide the movement of robotic arms that hold endoscopic instruments, as well as an endoscope (small camera). The surgeon uses the robotic arms to perform precise, fine hand movements and to provide access to parts of the body that are difficult to reach manually. In addition, robotic surgery provides a three-dimensional image, and the surgical field can be magnified to a greater extent than traditional or minimally invasive surgery. The goal of robotic surgery is to decrease incision size and length of hospital stay, while improving patient comfort and lessening recovery time.
Lasers are “scalpels of light” that offer new alternatives for some surgical procedures. Lasers can be used to cut, burn, or destroy abnormal or diseased tissue; shrink or destroy lesions or tumors; sculpt tissue; and seal blood vessels. Lasers may help surgeons perform some procedures more effectively than other traditional methods. Because lasers cause minimal bleeding, the operative area may be more clearly viewed by the surgeon. Lasers may also provide access to parts of the body that may not have been as easily reached manually.
Surgery centers
Freestanding surgery centers are available in many communities, primarily for the purpose of providing outpatient surgical procedures. The patient should make sure that the surgery center has been accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), a professionally sponsored program that stimulates a high quality of patient care in healthcare facilities. There is also an accreditation option that is available for ambulatory surgery centers.
Choosing a surgery center with experienced staff is important. Here are some questions to consider when choosing a surgery center:
- How many surgeries are performed annually and what are the outcomes and survival rates for those procedures?
- How does the surgery center’s outcomes compare with the national average?
- Does the surgery center offer procedures to treat a particular disease?
- Does the surgery center have experience treating patients in certain age groups?
- How much does surgery cost at this facility?
- Is financial assistance available?
- If the surgery center is far from the patient’s home, will accommodations be provided for caregivers?
Resources
BOOKS
Deardoff, PhD, William, and John Reeves, PhD. Preparing for Surgery: A Mind-Body Approach to Enhance Healing and Recovery. Oakland, CA: New Harbinger Publications, 1997.
Furlong, Monica Winefryck. Going Under: Preparing Yourself for Anesthesia: Your Guide to Pain Control and Healing Techniques Before, During and After Surgery. Albuquerque, NM: Autonomy Publishing Company, 1993.
Goldman, Maxine A. Pocket Guide to the Operating Room, 2nd Edition. Philadelphia, PA: F.A. Davis Co., 1996.
PERIODICALS
“Recommended practices for managing the patient receiving anesthesia.” AORN Journal 75, no.4 (April 2002): 849.
ORGANIZATIONS
American Board of Surgery. 1617 John F. Kennedy Boulevard, Suite 860, Philadelphia, PA 19103. (215) 568-4000. http://www.absurgery.org/ (accessed April 3, 2008).
American College of Surgeons. 633 N. Saint Clair Street, Chicago, IL 60611-3211. (312) 202-5000. http://www.facs.org/ (accessed April 2, 2008).
American Society of Anesthesiologists. 520 N. Northwest Highway, Park Ridge, IL 60068-2573. (847) 825-5586. E-mail: [email protected] http://www.asahq.org/ (accessed April 2, 2008).
Association of Perioperative Registered Nurses (AORN, Inc.). 2170 South Parker Road. Suite 300, Denver, CO 80231. (800) 755-2676 or (303) 755-6304. http://www.aorn.org/ (accessed April 2, 2008).
National Heart, Lung and Blood Institute. Information Center. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-2222. http://www.nhlbi.nih.gov (accessed April 2, 2008).
National Institutes of Health. U.S. Department of Health and Human Services, 9000 Rockville Pike, Bethesda, MD 20892. (301) 496-4000. http://www.nih.gov (accessed April 2, 2008).
OTHER
preSurgery.com.http://www.presurgery.com (accessed April 2, 2008).
Reports of the Surgeon General, National Library of Medicine. http://sgreports.nlm.nih.gov/NN (accessed April 2, 2008).
Surgery Linx (surgery medical news and newsletters from top medical journals). MDLinx, Inc. 1025 Vermont Avenue, NW, Suite 810, Washington, DC 20005. (202) 543–6544.
Surgical Procedures, Operative, (collection of links). http://www.mic.ki.se/Diseases/e4.html (accessed April 2, 2008).
Angela M. Costello
Fran Hodgkins
Operating Room
Operating room
Definition
An operating room (OR), also called surgery center, is the unit of a hospital where surgical procedures are performed.
Purpose
An operating room may be designed and equipped to provide care to patients with a range of conditions, or it may be designed and equipped to provide specialized care to patients with specific conditions.
Description
OR environment
Operating rooms are sterile environments; all personnel wear protective clothing called scrubs. They also wear shoe covers, masks, caps, eye shields, and other coverings to prevent the spread of germs. The operating room is brightly lit and the temperature is very cool; operating rooms are air-conditioned to help prevent infection.
The patient is brought to the operating room on a wheelchair or bed with wheels (called a gurney). The patient is transferred from the gurney to the operating table, which is narrow and has safety straps to keep him or her positioned correctly.
The monitoring equipment and anesthesia used during surgery are usually kept at the head of the bed. The anesthesiologist sits here to monitor the patient's condition during surgery.
Depending on the nature of the surgery, various forms of anesthesia or sedation are administered. The surgical site is cleansed and surrounded by a sterile drape.
The instruments used during a surgical procedure are different for external and internal treatment; the same tools are not used on the outside and inside of the body. Once internal surgery is started, the surgeon uses smaller, more delicate devices.
Operating room equipment
An operating room has special equipment such as respiratory and cardiac support, emergency resuscitative devices, patient monitors, and diagnostic tools.
Life support and emergency resuscitative equipment
Equipment for life support and emergency resuscitation includes the following:
- Heart-lung bypass machine, also called a cardiopulmonary bypass pump—takes over for the heart and lungs during some surgeries, especially heart or lung procedures. The heart-lung machine removes carbon dioxide from the blood and replaces it with oxygen. A tube is inserted into the aorta to carry the oxygenated blood from the bypass machine to the aorta for circulation to the body. The heart-lung machine allows the heart's beating to be stopped during surgery.
- Ventilator (also called a respirator)—assists with or controls pulmonary ventilation. Ventilators consist of a flexible breathing circuit, gas supply, heating/humidification mechanism, monitors, and alarms. They are microprocessor-controlled and programmable, and regulate the volume, pressure, and flow of respiration.
- Infusion pump—device that delivers fluids intravenously or epidurally through a catheter. Infusion pumps employ automatic, programmable pumping mechanisms to deliver continuous anesthesia, drugs, and blood infusions to the patient. The pump hangs from an intravenous pole that is located next to the patient's bed.
- Crash cart—also called resuscitation cart or code cart. A crash cart is a portable cart containing emergency resuscitation equipment for patients who are "coding" (i.e., vital signs are in a dangerous range). The emergency equipment includes a defibrillator, airway intubation devices, resuscitation bag/mask, and medication box. Crash carts are strategically located in the operating room for immediate accessibility if a patient experiences cardiorespiratory failure.
- Intra-aortic balloon pump—a device that helps reduce the heart's workload and helps blood flow to the coronary arteries for patients with unstable angina, myocardial infarction, or those awaiting organ transplants. Intra-aortic balloon pumps use a balloon placed in the patient's aorta. The balloon is on the end of a catheter that is connected to the pump's console, which displays heart rate, pressure, and electrocardiogram (ECG) readings. The patient's ECG is used to time the inflation and deflation of the balloon.
Patient monitoring equipment
Patient monitoring equipment includes the following:
- Acute care physiologic monitoring system—comprehensive patient monitoring systems that can be configured to continuously measure and display various parameters via electrodes and sensors connected to the patient. Parameters monitored may include the electrical activity of the heart via an ECG, respiratory (breathing) rate, blood pressure (noninvasive and invasive), body temperature, cardiac output, arterial hemoglobin oxygen saturation (blood oxygen level), mixed venous oxygenation, and end-tidal carbon dioxide.
- Pulse oximeter—monitors the arterial hemoglobin oxygen saturation (oxygen level) of the patient's blood with a sensor clipped over the finger or toe.
- Intracranial pressure monitor—measures the pressure of fluid in the brain in patients with head trauma or other conditions affecting the brain (such as tumors, edema, or hemorrhage). Intracranial pressure monitors are connected to sensors inserted into the brain through a cannula or bur hole. These devices signal elevated pressure and record or display pressure trends. Intracranial pressure monitoring may be a capability included in a physiologic monitor.
Diagnostic equipment
The use of diagnostic equipment may be required in the operating room. Mobile x ray units are used for bedside radiography, particularly of the chest. These portable units use a battery-operated generator that powers an x ray tube. Handheld portable clinical laboratory devices, called point-of-care analyzers, are used for blood analysis at the bedside. A small amount of whole blood is required, and blood chemistry parameters can be provided much faster than if samples were sent to the central laboratory.
Other operating room equipment
Disposable OR equipment includes urinary (Foley) catheters to drain urine during surgery, catheters used for arterial and central venous lines to monitor blood pressure during surgery or withdraw blood samples), Swan-Ganz catheters to measure the amount of fluid in the heart and to determine how well the heart is functioning, chest and endotracheal tubes, and monitoring electrodes.
New surgical techniques
Minimally invasive surgery, also called laparoscopic surgery, is an operative technique performed through a few small incisions, rather than one large incision. Through these small incisions, surgeons insert a laparoscope (viewing instrument that displays the surgery on a computer screen for easier viewing) and endoscopic instruments to perform the surgery.
Robot-assisted surgery allows surgeons to perform certain procedures through small incisions. In robotic surgery, a surgeon sits at a console several feet from the operating table and uses a joystick, similar to that used for video games, to guide the movement of robotic arms that hold endoscopic instruments and an endoscope (small camera). The robotic arms allow the surgeon to perform precise, fine hand movements, and provides access to parts of the body that are difficult to reach manually. In addition, robotic surgery provides a three-dimensional image, and the surgical field can be magnified to a greater extent than traditional or minimally invasive surgery. The goal of robotic surgery is to decrease incision size and length of hospital stay, while improving patient comfort and lessening recovery time.
Lasers are "scalpels of light" that may offer a new alternative for some surgical procedures. Lasers can be used to cut, burn, or destroy abnormal or diseased tissue; shrink or destroy lesions or tumors; sculpt tissue; and seal blood vessels. Lasers may help surgeons perform some procedures more effectively than other traditional methods. Because lasers cause minimal bleeding, the operative area may be more clearly viewed by the surgeon. Lasers may also provide access to parts of the body that may not have been as easily reached manually.
Surgery centers
Freestanding surgery centers are available in many communities, primarily for the purpose of providing outpatient surgical procedures. The patient should make sure that the surgery center has been accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), a professionally sponsored program that stimulates a high quality of patient care in health care facilities. There is also an accreditation option that is available for ambulatory surgery centers .
Choosing a surgery center with experienced staff is important. Here are some questions to consider when choosing a surgery center:
- How many surgeries are performed annually and what are the outcomes and survival rates for those procedures?
- How does the surgery center's outcomes compare with the national average?
- Does the surgery center offer procedures to treat a particular disease?
- Does the surgery center have experience treating patients in certain age groups?
- How much does surgery cost at this facility?
- Is financial assistance available?
- If the surgery center is far from the patient's home, will accommodations be provided for caregivers?
Resources
books
Deardoff, Ph.D., William and John Reeves, Ph.D. Preparing for Surgery: A Mind-Body Approach to Enhance Healing and Recovery. New Harbinger Publications, Oakland, CA: June 1997. (800) 748-6273. <http://www.newharbinger.com/>.
Furlong, Monica Winefryck. Going Under: Preparing Yourself for Anesthesia: Your Guide to Pain Control and Healing Techniques Before, During and After Surgery. Autonomy Publishing Company, November 1993.
Goldman, Maxine A. Pocket Guide to the Operating Room 2nd Edition. F.A. Davis Col, January 1996.
periodicals
"Recommended practices for managing the patient receiving anesthesia." AORN Journal 75, no.4 (April 2002): 849.
organizations
American Board of Surgery. 1617 John F. Kennedy Boulevard, Suite 860, Philadelphia, PA 19103. (215) 568-4000. <http://www.absurgery.org/>.
American College of Surgeons. 633 N. Saint Clair Street, Chicago, IL 60611-3211. (312) 202-5000. <http://www.facs.org/>.
American Society of Anesthesiologists. 520 N. Northwest Highway, Park Ridge, IL 60068-2573. (847) 825-5586. E-mail: [email protected]. <http://www.asahq.org/>.
Association of Perioperative Registered Nurses (AORN, Inc.). 2170 South Parker Road. Suite 300, Denver, CO 80231. (800) 755-2676 or (303) 755-6304. <http://www.aorn.org/>.
National Heart, Lung and Blood Institute. Information Center. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-2222. <http://www.nhlbi.nih.gov>.
National Institutes of Health. U.S. Department of Health and Human Services, 9000 Rockville Pike, Bethesda, MD 20892. (301) 496-4000. <http://www.nih.gov>.
other
preSurgery.com. <http://www.presurgery.com>.
Reports of the Surgeon General. National Library of Medicine. <http://sgreports.nlm.nih.gov/NN/>.
SurgeryLinx. (surgery medical news and newsletters from top medical journals). MDLinx, Inc. 1025 Vermont Avenue, NW, Suite 810, Washington, DC 20005. (202) 543-6544. <http://sgreports.nlm.nih.gov/NN/>.
Surgical Procedures, Operative. (collection of links). <http://www.mic.ki.se/Diseases/e4.html>.
Angela M. Costello