Care of HospitaliCare of Hospitalized Patientzed Patient
Operating room protocols. The patient’s operating dentist bears the ultimate responsibility for any mishaps that occur in the operating room other than those relating to duties relegated to anesthesiology. Therefore the dentist must be meticulous in monitoring all that is done to the patient and should take charge if anything is being done that may harm the patient.
The operating team usually consists of the operating surgeon and an assistant. The assistant should have suffidentfamiliarity with the planned procedure to help the dentist by suctioning, retracting, and cutting sutures,
Many hospitals allow the dentist to bring an office assistant to assist in the operating suite. Anesthesia may beprovided by an anesthesiologist (a medical physician) or by an anesthetist (a nurse. with special training in anesthesiology who usually must work under an anesthesiologist’s
supervision). A scrub nurse, who is sterilely gowned and gloved, passes instruments to the surgeonduring the procedure and, among other duties, keeps track of the sponges and needles used. The circulating
nurse remains ungowned and assists in setting up equipment, retrieving supplies, and completing nursing records of the operation. The dentist should try to see the patient in the preoperative area before anesthetic premedication to help clarify any final questions the patient may have, learn who the patient wants notified at the completion of the operation, and give emotional support to the patient. . During final preanesthetic patient preparation, the dentist should review the operative plans with the anesthesiologist.These plans include surgical site, length of procedure, oral hazards (e.g., loose teeth, restricted opening), route of intubation desired, and whether the patient will be admitted to the hospital. The dentist should
remain near the patient’s head during intubation to assist f necessary.
Once the patient is under general anesthesia, the dentist should ensure that steps are taken to prevent accidental injuries. Dental patients are usually operated on in a supine position, with the head end of the operating table raised about 15 degrees. The extremitiesmust be placed in physiologic positions ti.e., positionspatients would find comfortable for long periods if they were not anesthetized). Proper positioning helps pre-vent nerve injuries and excess loading of any part of the anatomy. In addition+padding should be placed in any area of pressure concentration, such as under heels and around elbows, particularly if the dental procedure is likely to last longerthan 1 hour. Most hospitals currently place all patients on foam or gel-filled cushions or airmattresses during surgery to help prevent pressure sores. The head should be placed on a contoured cushion to help prevent excessive movement of the head during surgery. Patient protection during anesthesia is also provided by several other means. Jf the procedure is expected to last more than 4 hours, a urinary (Foley) catheter should be
placed, to prevent overdistention of the bladder. The anesthesiologist
may want this done even for shorter operations for monitoring urinary output. If an electrocautery unit will be used, a grounding pad must be placed. To protect the patient’s eyes, a lubricating ointment should be
applied and the eyelids should be taped closed. Patients who are intubated nasally require close attention to proper tube stabilization; tubes that place excess pressure on the nasal alar cartilage can easily cause pressure sores that result in an unsightly deformity (Fig ~1-6). The final step before surgery IS preparation of the patient’s operative site. If necessary, any Iacial hair can be shaved. Then the skin in the maxillofacial and anterior
neck regions should be prepared by scrubbing with a . soap-containing solution and painted with a disinfecting solution, such as iodophor. The patient is then draped with two layers of linen material or one layer of waterproof paper material to cover all portions of the body except the operative site. The oral cavity is prepared for the procedure by first gently suctioning the pharynx, placing a moist throat pack, and using large volumes of irrigation solution to help decrease the bacterial count by
. dilution. Theuse of ~ sterile toothbrush and chlorhexidine improves the effectiveness of oral cavity preparation. The anesthesiologist and circulating nurse should be asked to make a note that the throat has been packed so they can help remind the surgeon to remove the pack after the surgery is complete. Local anesthesia is typically administered even when patients will be under general anesthesia to help delay the onset of any postoperative discomfort. Dental surgeon and assistant preparation. The
dental surgeon prepares for surgery by first checking that all instruments and patient records required to perform the surgery succe ssfully are available. This. preparation should ‘be done before the day of surgery if the dentist does not regularly use a particular facility (in case any essential equipment or records must be brought from the surgeon’s office on the day of surgery). Before entering the operating room suite, the surgical team changes from street clothes into surgical scrub uniforms. Shoes worn outside of the operating suite are covered with shoe covers. Scalp hair is covered with a cap. Members of the surgical team with long beards should
wear head covers that extend across the chin and nteriorneck. All jewelry, including watches, rings, necklaces, and earrings, should be’. removed before scrubbing. A mask that covers the nose and mouth should b tied in