Electro Surgical Unit

(Surgical Diathermy Machine)

Function

• Cutting
  
• Haemostasis
  

 

Types

• Monopolar Electrosurgery
  
  • Advantages
    
    • Easy to use
      
    • Faster, more effective
      
    • Familiar to surgeons
      
  • Disadvantages
    
    • Potential thermal damage to surrounding tissue
      
    • Potential alternate site burn
      
• Bipolar
  
  • Advantages
    
    • Less tissue damage
      
    • Effective haemostasis
      
    • Less parking
      
    • Surgery can be performed closer other vital organ
      
    • No grounding pad
      
  • Disadvantages
    
    • Less familiar to surgeon
      
    • Possible slower coagulation
      
    • May not effectively coagulate large blood vessels
      

    
     

Sutures

Suture

Is the stand of material used for sewing by bringing tissue together and holding them until healing has taken place.

 

Tie

Is a material to tie around a blood vessel to occlude the lumen.

 

Monofilament Suture

• Made of a single atrand of material
  
• Less resistant when pass through tissue
  
• Cause for infection less
  

 

Multifilament Suture (braided)

• Made by several filaments strands together
  
• Cause for infection higher
  

 

Absorbable Suture

• Natural Absorbable
  
  • Plan Catgut
    
  • Chromic Catgut
    
• Synthetic Absorbable Suture
  
  • PDS
    
  • Monocryl
    
  • Vicryl
    

 

Non-absorbable Suture

• Natural Non-absorbable Suture
  
  • Mersilk
    
  • Surgical Cotton
    
• Synthetic Non-absorbable Suture
  
  • Nylon
    
  • Prolene
    

Anaesthetisiology

Type of Anaesthesia

• General Anaesthesia
  
• Regional Anaesthesia
  
  • Spinal
    
  • Epidural
    
  • Caural
    
  • Nerve block
    
• Local Aneasthesia
  

 

The Drugs Used in GA

Induction Agent – To put patient into deep sleep

• Intravenous injection
  
  • Thiopental
    
  • Propofol
    
  • Etomidate (old age & cardiac problem)
    

 

Induction Agent

• Inhalation
  
  • Nitrous Oxide
    
• Volatile Agent
  
  • Sevorane
    
  • Isoflourane
    
  • Desflouran
    

To keep patient in deep sleep condition throughout the surgery.

 

Muscle Relaxant

• Long Acting
  
  • Tracium
    
  • Mivacuron
    
  • Esmeron
    
• Short Acting
  
  • Scoline
    

 

Analgesic

• For pain relief
  
  • Dynastat
    
  • Fentanyl
    
• Dangerous Drugs
  
  • Pethedine
    
  • Morphine
    
  • Suphenta
    

 

Endotrachial Tube (ETT)

• Usual Endotrachial Tube
  
  • Abdominal Surgury-Supine Position
    
  • Orthopaedic
    
• Oral Rae
  
  • Operation o the face, eye, ENT or neuro surgery
    
• Nasal Rae
  
  • Surgery on the neck (Thyroid)
    
  • Dental
    
• Around (Flexometalic Tube)
  
  • Thyroid, neuro & PCNL (prone position)
    
• Double Lumen Tube
  
  • Thoracotomy
    

 

Selection of the Tube

• Female – 7
  
• Male – 7.5
  

 

Preparation for Intubation

• Fasted
  
  • 4 hours – drinks
    
  • 6 hours – solid food
    

To prevent aspiration during intubation & after extubation

• Pre-oxygenation
  
  • To remove all the air in the lung and fill up the lung with 100% oxygen to prevent hypoxia during intubation.
    

 

Reversal of Patient

• To help the patient gains back their muscle tone by help to clear the residual effect of muscle relaxant.
  
  • Atropine 1mg – dry up the secretion in the throat
    
  • Neostigmine 2.5mg – to washout the residual effect of muscle relaxant.
    

 

Post Op Pain Management

• Patient Control Anaesthesia (PCA)
  
• Epidural – Chirocaine top up
  
• IV infusion – morphine
  
• Voltaren suppository – body weight

About

Zone Area

• Protected Zone / Restricted Zone
  
  • 18°C - 20°C
    
  • Well ventilated
    
  • 55 – 60 humidity
    
  • OR, induction room, sterile store room
    

    
     

• Semi-restricted Zone
  
  • Equipment room, staff room, clean corridor, store room, reception, recovery bay
    

    
     

• Non-restricted Zone
  
  • Changing room, air-log (main entrance to OT), day care room
    

    
     

• Sluice Area
  
  • Sluice room, dirty corridor (sending soiled instrument), washing area