Developing Skills in Operating Department Case Study Sample

Introduction To Developing Skills In Operating Department Practice

Thorough preoperative evaluations are essential in the complex world of medical operations because they guarantee patient safety and best possible results. Especially, emphasis is placed on the need of a full blood count, which is intended to reveal any possible infections as well as the existence of eclampsia, a disease that has major consequences for the perioperative period.

The implications of eclampsia in surgical settings are explained since these patients are more likely to have higher oxygen requirements, be more susceptible to infection, and also require blood transfusions. Recognizing the seriousness of severe eclampsia, the discussion highlights how it can lead to organ damage and death, highlighting the critical necessity of a prudent pre-operative assessment.

Background

The patient is a 29-year-old female who was also a frequent smoker. She was diagnosed with a high level of BMI, which is abnormal for such a condition. The medical history of the patient was such that other than high BMI, she also had the problem of hypertension and secondary effects of COVID-19. She also had the problem of eclampsia and required frequent blood transfusions regarding changing of the blood. This is a serious condition that occurs in the second half of pregnancy. Severe eclampsia could lead to a large-scale damage of organs and even death of an individual as a result of high blood pressure, headaches, convulsions and blurred vision. (Slavchev, & Yordanov, 2022). Before that, she was being tested using X-rays, electrocardiographs (ECG), urine tests, covid-19 tests, among others.

A complete blood count assessment was also carried out regarding the assessment of the complete body fluid. The results of these tests would help the physicians to determine whether the surgical process is needed for the treatment of her. Or whether no surgical operational process was needed. After the assessment, she was being found with a difficult knee problem, and that needed urgent knee replacement surgery (Agarwala, & Morrison, 2022). The anaesthesia for the surgical procedure was needed to follow the standard surgical rule of physicians, that is “Enhanced Recovery After Surgery (ERAS)”. This is a standard mechanism for the pre-operative evaluation of the patients (Macones, 2020). The role of ‘operating department practitioner (ODP)' is critical in this regard. Which is being discussed below.

Discussion

About Anesthesia

After the confirmation that the patient needs an urgent caesarean section due to severe pain and distress. As a complete surgical operation is needed, a complete anaesthesia is required for the pain management of the patient. A spinal anaesthesia could be needed during this surgical procedure. And, the “nonsteroidal anti-inflammatory medications (NSAIDs)” could be delivered across the body for pain relief, although it was needed only at the lower part of the body.

A pre-operative evaluation of the patient who will undergo a surgical process is important. It helps the physicians regarding the success or failure of the intervention that should be given to the patients. (Klein, & Earnshaw, 2020). It also helped the physicians in designing the anaesthesia dose, along with the time and place of the body to be most accurate regarding giving of anaesthesia care. The blood count was done to utilize the information gathered from the result for measuring the conditions for blood transfusion in case of a surgical emergency. Different factors like the age, medical history, the nature of the surgery to be implemented on the patient played an important role in determining whether the patient needed a general anaesthesia that covers the complete human body. The anaesthesia for the surgical procedure was needed to follow the standard surgical rule of physicians, that is “Enhanced Recovery After Surgery (ERAS)”. This is a standard mechanism for the pre-operative evaluation of the patients.

In this case, the patient was a 29-year-old female, who needed urgent caesarean section surgery. She was diagnosed with a high level of BMI. She was a frequent smoker and had respiratory issues. She also had a problem related to the secondary effects of COVID-19 and hypertension. She also had the problem of eclampsia, which is a serious condition that occurs in the second half of pregnancy (Fitzgerald, et al. 2020). She required frequent blood transfusions regarding changing of the blood. Before that, she was being tested using COVID-19 tests, X-rays, electrocardiographs (ECG), and urine tests, among others. A complete blood count assessment was also carried out. The results of these tests would help the physicians to determine whether the surgical process is needed for the treatment of her (Kaye, et al. 2020). Or whether no surgical operational process was needed.

About Spinal anaesthesia

Spinal anaesthesia, commonly referred to as a spinal block, is a form of regional anaesthesia used in surgery. Since no opioids or induction agents are used at first, the patient is less likely to become ill. It entails injecting a local anaesthetic into the subarachnoid cord. This induces transient tingling and paralysis of the lower extremities, making the surgery painless. Correctly positioning of a patient for spinal anaesthesia is critical for both safety and efficacy (Naftalovich, Singal, & Iskander, 2022). The right placement required the patient to sit on the edge of the operating table, with their back arched and their head and shoulders falling in the forward direction, which would be supported by the operating department practitioner (ODP). In the case of the female patient, since the knee replacement surgery was to be carried out the anaesthesia that was carried out involved injecting the anaesthetic drug into the area around the knee of concern. Spinal anaesthesia is also better option for the elective surgery. As, during pregnancy spinal and epidermis allowed a good binding between the mother and the baby. Also, spinal anaesthesia during caesarean section would allow a relatively better experience during baby birth due to skin-to-skin interactions.

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The role of OPD

The role of ‘operating department practitioner (OPD)' was been vital regarding the successful completion of the caesarean section surgery. Before and during the surgical period, the principle role of an OPD was as the circulating and scrubbed practitioner. As a scrubbed practitioner, an OPD should be focused on delivering a safe and excellent patient care during the surgery. With the other team members of the surgeons, doctors among others. The work includes, preparation of the operation theatre before the surgery and anesthesia. Also, check whether all the materials those will be required for the surgery were sterile or not (Makoko, et al. 2019). Also, to ensure the operation theatre remain cleared of any negative obstacles. After the surgery, a comprehensive analysis of the “Airway, Breathing, Circulation, Disability, and Exposure (ABCDE)”. In this case, since a caesarean section had to be carried out, the OPD should focus more on the blood transfusion and maintenance of sterility in the operating room. Also, disinfection of the body surface.

About allergic Diabetes

The patient had a problem of diabetes as well. Those people who had the issue of allergic diabetes was mainly because of the specific allergic reactions to insulin and other medications of the disease. As, she had a high level of BMI, which is linked to the diabetic process, the issue of potential allergy over the medication could be serious.

ERAS protocols and elements

Also, she was been diagnosed with all the necessary diagnostic tests, which would help the physicians to determine whether the process of surgery is suitable or not for the surgery. And, it is a standard operating mechanism regarding the preoperative, operative and postoperative scenario of a patient. In the first step, all the relevant diagnostic tests was done. Also factors like the availability of blood, the availability of blood, any comorbidities present with the patient was also discussed (Crone, et al. 2020). This would also help in the establishment of better communication among the surgical team members, and the family members of the patient among others. In the case of the female patient, since she had comorbidities like respiratory distress, anaemia, hypertension, high level of BMI, she was thoroughly tested by the physicians regarding the association of any potential impact of the surgical procedure on her physical health.

After the completion of the relevant preoperative diagnostic tests, a relevant consent form was taken from the family members of the patient. Just before the commencement of the surgery. This was done so that the physicians and other associated healthcare workers had a clear consent from the patient regarding the surgery. After this, the patient was taken into the anaesthetic room for the process to begin. Where, again a professional practitioner of anaesthesia completed the relevant checks of the patient's body so that it could be ensured that just before the start of the surgery everything was okay (Sen, et al. 2019). Questions like what procedure, allergies, metalworking, and when was the last time the patient ate or drank are all part of this process. The patient can then begin to receive monitoring using devices such an oxygen saturation probe, ECG, and blood pressure cuff after the ODP is satisfied. Before the surgery, it is crucial to keep a constant watch on the patient's vital signs. As the patient in this case was a patient of hypertension, special care was given regarding the monitoring of the blood pressure. A constant watch on the body temperature and saturation level of oxygen in her blood was also ensured (Ljungqvist, et al. 2021). Her pulse and heart rate was also under constant watch of the surgeons. His blood pressure was found to be at the level of 130/82. And heart rate was 80. The anaesthetists were ready to start the normal operating procedure.

Another important element of patient cases as per the ERAS protocol is the successful management of the body fluid. And, as per the standard medical practices, the process began at the preoperative period. And, the process continued throughout the operative and postoperative period. To enable the patient to be euvolemic upon arrival in the anaesthetic chamber is the goal of perioperative fluid management. It has been shown that due to the complex medical history of the patient, providing them with complex carbohydrate drinks after surgery decreases the risk associated with the procedure and reduces the length of hospital stay (Street, et al. 2020). Preserving intravascular volume and reducing salt and water consumption by intravenous crystalloid infusions are the goals of intraoperative fluid management. Intravenous fluids are not essential after a patient is able to consume fluids orally; they should only be given if absolutely necessary clinically (Macones, 2019). As she has issues regarding respiratory distress along with the renal issues, she was advised by the physicians to stop drinking any fluid, which should continue about 8 hours after the completion of her surgery. This would help her to maintain a stable concentration of liquid during and after the completion of the surgery.

During the completion of the surgical procedures, the physicians and anaesthetists in general had given the patients crystalloid solutions. This would help the patients regarding stabilisation of the cardiovascular system by compensating for any major loss of blood from the body. It would also help in maintaining a stable output of urine. These solutions range from saline to plasma and to salt solutions of sodium (Wainwright, 2021). The patient was given the solution of sodium lactate. In general, these solutions act as electrolytes also, the composition of which is very similar to that of the human plasma. Colloids are those particles with a higher molecular weight that were suspended in the crystalloid solutions. Since crystalloids containing glucose have properties that contribute to cellular dehydration, only isotonic crystalloids should be used as solution types. Sodium chloride is known to have intravenous adverse effects such as chills, fever, hypervolaemia, hypertension, vascular irritation, and others. Thus, compounds like sodium lactate can be used in place of isotonic sodium chloride.

“Deep Vein Thrombosis (DVT)” is a phenomenon that directly occurs when there is a single or multiple blood clots in the deep vein of the body. It can lead to pain and swelling of the body part where the blood clot actually happened. In this case, the patient had come to the physician for the surgical procedure regarding knee replacement, as the pain on her legs became severe as a result of DVT (Rossoni, et al. 2020). As per the guidelines of the ‘World Health Organisation (WHO)', the disease could be prevented by regular exercise like walking for 1 to 2 hours daily. Also, raising and lowering and raising the heels while keeping the toes on the floor.

Conclusion

In conclusion, it could be said that the patient had a severe problem During pregnancy as a result of eclampsia. She also had some comorbidities as per her past medical history. Like high BMI, hypertension, respiratory distress and secondary effects of COVID-19. She also had the problem of anaemia and required frequent blood transfusions regarding changing of the blood. For the, the caesarean section necessary anaesthesia protocol as per ERAS rules were discussed in the study.

References

Journals

• Agarwala, R., & Morrison, B. (2022). Neuraxial anaesthesia and its role in enhanced recovery after surgery: a narrative review. Dig Med Res, 5, 20. Retrieved from: https://cdn.amegroups.cn/journals/ales/files/journals/34/articles/8168/public/8168-PB5-5719-R3.pdf [Retrieved on: 22.11.2023]
• Crone, V., Hasselager, R. P., Fransgaard, T., & Gögenur, I. (2020). Anaesthetic technique and outcomes after colorectal cancer surgery. Dan Med J, 67(4), A04190255. Retrieved from: https://www.researchgate.net/profile/Vera-Crone/publication/340655556_Anaesthetic_technique_and_outcomes_after_colorectal_cancer_surgery/links/63b3f28fc3c99660ebc6dff1/Anaesthetic-technique-and-outcomes-after-colorectal-cancer-surgery.pdf [Retrieved on: 22.11.2023]
• Fitzgerald, J. P., Fedoruk, K. A., Jadin, S. M., Carvalho, B., & Halpern, S. H. (2020). Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta?analysis of randomised controlled trials. Anaesthesia, 75(1), 109-121. Retrieved from: https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/pdf/10.1111/anae.14841 [Retrieved on: 22.11.2023]
• Kaye, A., Renschler, J., Cramer, K., Klein, K., Granier, A., Hart, B., ... & Viswanath, O. (2020). The role of clinical pharmacology in enhanced recovery after surgery protocols: a comprehensive review. Anaesthesiology Intensive Therapy, 52(2), 154-164. Retrieved from: https://www.termedia.pl/Journal/-118/pdf-40563-10?filename=The%20role%20of%20clinical.pdf [Retrieved on: 22.11.2023]
• Klein, A. A., & Earnshaw, J. J. (2020). Perioperative care and collaboration between surgeons and anaesthetists–it's about time. Journal of British Surgery, 107(2), e6-e7. Retrieved from: https://bjssjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/bjs.11445 [Retrieved on: 22.11.2023]
• Ljungqvist, O., de Boer, H. D., Balfour, A., Fawcett, W. J., Lobo, D. N., Nelson, G., ... & Demartines, N. (2021). Opportunities and challenges for the next phase of enhanced recovery after surgery: a review. JAMA surgery, 156(8), 775-784. Retrieved from: https://eprints.bournemouth.ac.uk/35484/1/ERAS%202.0%20manuscript%20revised%20Jan%2013%20clean_ACCEPTED%20VERSION.pdf [Retrieved on: 22.11.2023]
• Macones, G. A., Caughey, A. B., Wood, S. L., Wrench, I. J., Huang, J., Norman, M., ... & Wilson, R. D. (2019). Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3). American journal of obstetrics and gynecology, 221(3), 247-e1. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0002937819305721 [Retrieved on: 22.11.2023]
• Macones, G. A., Caughey, A. B., Wood, S. L., Wrench, I. J., Huang, J., Norman, M., ... & Wilson, R. D. (2020). Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) society recommendations (part 3). Obstetric Anesthesia Digest, 40(2), 69-70. Retrieved from: https://www.ingentaconnect.com/content/wk/aoa/2020/00000040/00000002/art00018 [Retrieved on: 22.11.2023]
• Makoko, U. M., Modiba, L. M., & Nzaumvila, D. K. (2019). Satisfaction with spinal anaesthesia for Caesarean section at Tembisa Hospital, South Africa: a cross-sectional study. South African Family Practice, 61(2), 39-47. Retrieved from: https://www.tandfonline.com/doi/pdf/10.1080/20786190.2018.1531585 [Retrieved on: 22.11.2023]
• Naftalovich, R., Singal, A., & Iskander, A. J. (2022). Enhanced Recovery After Surgery (ERAS) protocols for spine surgery–review of literature. Anaesthesiology Intensive Therapy, 54(1), 71-79. Retrieved from: https://www.termedia.pl/Journal/-118/pdf-46489-10?filename=Enhanced%20Recovery.pdf [Retrieved on: 22.11.2023]
• Rossoni, C., Oliveira Magro, D., Santos, Z. C., Cambi, M. P. C., Patias, L., Bragança, R., ... & Ribeiro, R. (2020). Enhanced Recovery After Surgery (ERAS) protocol in bariatric and metabolic surgery (BMS)—analysis of practices in nutritional aspects from five continents. Obesity surgery, 30(11), 4510-4518. Retrieved from: https://comum.rcaap.pt/bitstream/10400.26/33299/1/Rossoni2020_Article_EnhancedRecoveryAfterSurgeryER.pdf [Retrieved on: 22.11.2023]
• Sen, S., Morrison, B., O'Rourke, K., & Jones, C. (2019). Analgesia for enhanced recovery after surgery in laparoscopic surgery. Dig Med Res, 2, 25. Retrieved from: https://cdn.amegroups.cn/journals/ales/files/journals/34/articles/5404/public/5404-PB1-7035-R2.pdf [Retrieved on: 22.11.2023]
• Slavchev, S., & Yordanov, A. (2022). Basic principles of anaesthesia and postoperative analgesia in patients operated within an enhanced recovery after surgery (ERAS) protocol. Journal of Medical Pharmaceutical and Allied Sciences. Retrieved from: https://jmpas.com/admin/assets/article_issue/1651690661JMPAS_MARCH_-_APRIL_2022.pdf [Retrieved on: 22.11.2023]
• Street, A. D., Elia, J. M., McBroom, M. M., Hamilton, A. J., Grundt, J. E., Blackwell, J. M. N., & Romito, B. T. (2020). The impact of implementation of a hysterectomy enhanced recovery pathway on anesthetic medication costs. Journal of Comparative Effectiveness Research, 9(15), 1067-1077. Retrieved from: https://becarispublishing.com/doi/pdf/10.2217/cer-2020-0142?download=true [Retrieved on: 22.11.2023]
• Wainwright, T. W. (2021). Enhanced recovery after surgery (ERAS) for hip and knee replacement—why and how it should be implemented following the COVID-19 pandemic. Medicina, 57(1), 81. Retrieved from: https://www.mdpi.com/1648-9144/57/1/81/pdf [Retrieved on: 22.11.2023]