Berry & Kohn's Operating Room Technique, 14th Edition

Front Cover
Inside front cover
Contents in brief
Front matter
Berry & Kohn’s Operating Room Technique
Copyright
Dedication
Preface to the fourteenth edition
Features of the fourteenth edition
New to the fourteenth edition
Organization
Preface to the first edition
Mary louise kohn, ab, rn, mn (1920-2019)
Acknowledgments
Table of Contents
SECTION 1 Fundamentals of Theory and Practice
1 Perioperative education
Chapter objectives
Key terms and definitions
The art and science of surgery
Perioperative learner
Perioperative educator
Behavioral objectives
Elements of effective instruction
Media and print learning resources
Application of theory to practice
Expected behaviors of perioperative caregivers
Personal attributes
Communication
Teamwork
Clinical competence
Realities of clinical practice
Reality shock
Dynamics of the psychologic climate: Preceptors, mentors, and role models
Eustress versus distress
Stress reduction
Listening to the body
Maintaining the mind
Evolve website
References
2 Foundations of perioperative patient care standards
Chapter objectives
Key terms and definitions
Surgical conscience
Patient rights
Patient advocacy
Accountability
Standardization of patient care
Importance of standardization
Professional sources of standards
Standards from regulatory bodies
Sources of standardization data within the health care facility
Recommended practices
Policies and procedures
Universal protocol
Identifying the patient
Identifying the surgical site
Protecting personal property
Observing the patient
Positioning the patient
Aseptic and sterile techniques
Accountability of accurate counts
Using equipment
Preventing skin injury
Administering drugs
Monitoring the patient
Preparing specimens
Patient teaching
Professionalism
Professional perioperative nursing
Patient-nurse relationship
Evidence-based practice
Nursing process
Integration of the nursing process into perioperative patient care
Perioperative nursing data set (pnds)
Preoperative phase
Intraoperative phase
Postoperative phase
Standards of perioperative nursing practice
Standard I: Assessment
Physiologic assessment
Psychosocial assessment
Documentation
Standard II: Diagnosis
Documentation
Standard III: Outcome identification
Documentation
Standard IV: Planning
Documentation
Standard V: Implementation
Documentation
Standard VI: Evaluation
Documentation
Clinical competency of the perioperative nurse
Scope of perioperative nursing practice
Surgical technology
Guidelines for surgical technologists
Teamwork I
Preparation II
Surgical expertise
Ethics
Aseptic technique
Clinical competency of the surgical technologist
Level I cst
Level I competencies
Level II cst (advanced)
Level II competencies
Level III cst (specialist)
Level III competencies
Continual performance evaluation and improvement
Performance improvement studies
Benchmarking
Peer review
Evolve website
Bibliography
3 Legal, regulatory, and ethical issues
Chapter objectives
Key terms and definitions
Legal issues
Liability
Liability prevention for the facility and the team
Liability insurance
Borrowed servant rule
Independent contractor
Doctrine of the reasonable man
Doctrine of res ipsa loquitur
Doctrine of respondeat superior
Doctrine of corporate negligence
Extension doctrine
Assault and battery
Invasion of privacy
Health insurance portability and accountability act
Abandonment
The joint commission and sentinel events
Root cause analysis
Institutional reporting of sentinel events
National patient safety goals
“never events” and reimbursement for hospitals and health care facilities
Consent
General consent
Informed consent
Informed consent for a surgical procedure
Responsibility for informed consent before a surgical procedure
Validation of consent
Witnessing a consent
Consent in emergency situations
Right to refuse a surgical procedure
Second opinion
Advance directives
Documentation of perioperative patient care
Benefits of documentation to the facility
Standards and methods for documentation of patient care
Charting modalities
Computerized documentation
Perioperative documentation
Incident report
Legal aspects of drugs and medical devices
Ethical issues
Bioethical situations
Reproductive sterilization
Abortion
Human experimentation
Fetal tissue and stem cell research
HIV and other infections
Quality of life
Euthanasia
Right to die
Organ donation and transplantation
Death and dying
Evolve website
References
Bibliography
SECTION 2 The Perioperative Patient Care Team
4 The perioperative patient care team and professional credentialing
Chapter objectives
Key terms and definitions
Dependence of the patient on the qualified team
Credentialing of qualified caregivers
Accreditation of schools and facilities
Licensure and registration
Certification
Perioperative patient care team
Nonsterile and sterile team members
Nonsterile team members
Perianesthesia team
Anesthesia provider
Circulating nurse
Cnor: The certified perioperative nurse
Sterile team members
Surgeon
First assistant
Scrub person
Cst: The certified surgical technologist
Evolve website
References
Bibliography
5 The surgical first assistant
Chapter objectives
Key terms and definitions
First assistant’s knowledge and skill level
Surgical anatomy and physiology
Pharmacology
Psychomotor dexterity
Procedure knowledge and techniques
Surgical site management
What does the first assistant do?
Position, prep, and drape the patient
Handle instrumentation
Provide exposure
Provide hemostasis
Handle tissue with instrumentation
Dissection
Suture
Recognize surgical hazards
Respond appropriately to emergency situations
Patient assessment
Disciplines associated with first-assisting in surgery
Registered nurse first assistant
Curriculum for the rn first assistant
Certified nurse midwife
Physician assistant
Surgical technologist
Evolve website
Bibliography
6 Administration of perioperative patient care services
Chapter objectives
Key terms and definitions
Establishing administrative roles
Magnet recognition
Leading the way to magnet status
Eligibility for magnet status
Maintaining magnet status
Benefits of magnet status
Management of surgical services
Perioperative administrative personnel
Perioperative nurse manager
People skills and communications
Barriers to effective communication
Managerial responsibilities
Clinical coordinator
Head nurse or charge nurse
Perioperative business manager
Advanced practice registered nurse or clinical nurse specialist
Perioperative education coordinator
Preceptor
Interdepartmental relationships
Patient care departments
Patient care division
Emergency department/trauma center
Intensive care unit
Obstetric services
Patient services departments
Radiology and nuclear medicine departments
Pharmacy
Blood bank
Pathology department
Clinical laboratory
Departmental service divisions
Medical records department
Environmental services
Facilities engineering
Clinical biomedical engineering
Materials management
Purchasing department
Central storeroom
Central processing department
Laundry services
Human resources department
Coordination through committees
Surgical services committee
Operating room safety committees
Radiation safety committee
Laser safety committee
Infection control committee
Infection control coordinator
Infection control program
Surveillance
Continuous performance improvement committee
Ethics committee
Hospital safety committee
Disaster planning committee
Surgical services management
Administrative and management behaviors
Accreditation
Leadership qualifications and competency
Leading by example
Rounding up those “sacred cows”
Professional involvement
Meetings
Setting the agenda
Minutes of the meeting
Personnel management
Motivation and building a unified team
Delegation of duties
Conflict management
Lateral violence
Downward violence
Documentation
Budgeting and financial responsibility
Operational budget
Capital budget
New product and equipment evaluation
Working with sales representatives
Evolve website
References
Bibliography
SECTION 3 The Patient as a Unique Individual
7 The patient: The reason for your existence
Chapter objectives
Key terms and definitions
The patient as an individual
Patients’ basic needs
Hierarchy of needs
Behavior
Adaptation
Stress
Patients’ perceptions of care
Family/significant others
The patient with individualized needs
The patient with sensory impairment or physical challenge
Sensory impairment
Language barrier
Hearing impairment/deafness
Visual impairment/blindness
Physical challenge
Impairment of cognitive function
The patient with alteration of nutrition
Malnutrition
Metabolism
Nutritional supplements
The patient with diabetes mellitus
Common complications
Special considerations
The obese patient
Common complications
Special considerations
The patient with cancer
Cancer risk avoidance behaviors
Extent of disease
Carcinoma in situ
Localized cancer
Regional cancer
Metastatic cancer
Disseminated cancer
Cancer treatment modalities
Adjuvant therapy
Surgical resection
Considerations for intraoperative care
Cancer therapy
Endocrine therapy
Hormonal receptor site studies
Endocrine ablation
Photodynamic (laser) therapy
Radiation therapy
Ionizing radiation
Effects of radiation on cells
Sources of radiation
Implantation of radiation sources
Interstitial needles. 
Interstitial seeds. 
Brachytherapy
Intracavitary capsules. 
Afterloading techniques. 
Preloading techniques. 
Intracavitary colloidal suspensions. 
External beam radiation therapy
Intraoperative radiation therapy
Stereotactic radiosurgery
Safety rules for handling radiation sources
Effects of radiation therapy on the perioperative patient
Chemotherapy
Indications for chemotherapy
Preoperative chemotherapy
Intraoperative chemotherapy
Postoperative chemotherapy
The patient with chronic comorbid disease
Cardiovascular disease
Pulmonary disease
The patient with induced or acquired immunosuppression
Immunosuppression
Common complications
Special considerations
Acquired immunodeficiency syndrome
Common complications
Special considerations
The patient who is a victim of crime
On arrival to the emergency department
Forensic evidence in the operating room
Assessment and documentation of the crime victim
The patient who is a victim of sexual assault
Considerations for the patient with sexual trauma
The patient who is a victim of domestic violence
The patient who is a victim of child abuse
Outcomes of victimization
End-of-life care
Death of a patient in the operating room
Coroner’s cases
Postmortem patient care
Evolve website
References
Bibliography
8 Perioperative pediatrics
Chapter objectives
Key terms and definitions
Indications for surgery
Congenital anomalies
Acquired disease processes
Trauma
Considerations in perioperative pediatrics
Chronologic age
Perioperative assessment of the pediatric patient
Pediatric psychosocial assessment
Pediatric physical assessment
Metabolism and nutritional considerations
Fluid and electrolyte balance considerations
Body temperature considerations
Indicators of thermoregulatory status
Cardiopulmonary status considerations
Pediatric infection risk considerations
Pediatric pain management considerations
Preoperative psychologic preparation of pediatric patients
Pediatric anesthesia
Preoperative assessment by the anesthesia provider
Premedication
Anesthesia equipment
Induction
Types of induction
Inhalation
Rectal induction
Intravenous infusion
Epidural block
Intubation and airway placement
Intubation
Anesthetic agents and maintenance
Emergence and extubation
Intraoperative pediatric patient care considerations
Instrumentation
Common surgical procedures
General surgery
Minimally invasive surgery
Robotics
Emergent procedures
Biliary atresia
Esophageal atresia
Imperforate anus
Intussusception
Pyloromyotomy
Herniorrhaphy
Omphalocele and gastroschisis
Appendectomy
Splenectomy
Bezoars
Genitourinary surgery
Cystoscopy
Nephrectomy, nephrostomy, or pyeloureteroplasty
Wilms’ tumor
Neurogenic bladder
Exstrophy of the bladder
Ureteral reimplantation
Urethral repair
Orchiopexy
Circumcision
Orthopedic and spinal surgery
Fractures
Tendon repair
Congenital dislocated hip
Leg length discrepancies
Talipes deformities
Talipes varus
Talipes equinovarus
Scoliosis
Ophthalmologic surgery
Congenital obstruction of the nasolacrimal duct
Oculoplastic procedures on the eyelids
Extraocular muscle procedures
Congenital cataract extraction
Goniotomy
Otorhinolaryngologic surgery
Foreign body removal
Myringotomy
Middle ear tympanoplasty
Correction of choanal atresia
Adenoidectomy
Tonsillectomy
Esophageal dilation
Laryngeal papillomas
Tracheal or laryngeal stenosis
Tracheotomy
Plastic and reconstructive surgery
Cleft lip
Cleft palate
Hemangioma
Otoplasty
Syndactyly
Polydactyly
Neurologic surgery
Craniosynostosis
Encephalocele
Hydrocephalus
Myelomeningocele
Spina bifida
Spastic cerebral palsy
Thoracic surgery
Pectus excavatum
Pectus carinatum
Cardiovascular surgery
Anomalous venous return
Coarctation of the aorta
Patent ductus arteriosus
Septal defects
Atrial septal defect
Ventricular septal defect
Atrioventricular canal defect
Tetralogy of fallot
Transposition of the great vessels
Tricuspid atresia
Truncus arteriosus
Valvular stenosis
Hypoplastic left heart syndrome
Postoperative pediatric patient care
Evolve website
References
9 Perioperative geriatrics
Chapter objectives
Key terms and definitions
Perspectives on aging
Cultural considerations
Theories of aging
Wear-and-tear theory
Genetic mutation theory
Viral theory
Environmental theory
Physical factor theory
Myths about aging
Perioperative assessment of the geriatric patient
Functional assessment
Activities of daily living
Functional activities
Functional capacity
External interactions
Resources
Barriers
Psychosocial assessment
Adaptation to the aging process
Self-perception of health
Physical assessment
Integumentary system
Musculoskeletal system
Cardiopulmonary system
Gastrointestinal system
Endocrine system
Genitourinary system
Nervous system
Intraoperative considerations
Anesthesia considerations
Postoperative considerations
Evolve website
References
Section 4: The Perioperative Environment
10 Physical facilities
Chapter objectives
Key terms and definitions
Physical layout of the surgical suite
Type of physical plant design
Location
Space allocation and traffic patterns
Unrestricted area
Semirestricted area
Restricted area
Transition zones
Preoperative admission and holding unit
Induction room
Postanesthesia care unit
Peripheral support areas
Control desk
Offices
Locker rooms and lounges
Conference room/classroom
Consultation room
Support services
Laboratory
Radiology services
Work and storage areas
Anesthesia work and storage areas
Housekeeping storage areas
Central processing area
Utility room
General workroom
Storage
Sterile supply room
Instrument room
Scrub room
Operating room
Categories of operating rooms
Size determinations
Operating room humidity
Operating room temperature
Substerile room
Doors
Ventilation
Obstacles to laminar airflow effectiveness
Floors
Walls and ceiling
Piped-in gases, computer lines, and electrical systems
Lighting
Monitoring screens
Radiograph screens or view boxes
Clocks
Cabinets or carts
Furniture and other equipment
Communication systems
Voice intercommunication system
Call-light system
Closed-circuit television
Computers
Special procedure rooms
Interventional radiography room
Minimally invasive surgery room
Endoscopy room
Cystoscopy room
Cesarean delivery room
Construction or renovation of the surgical suite
Considerations for planning and design
Principles in construction or renovation planning
Evolve website
References
Bibliography
11 Ambulatory surgery centers and alternative surgical locations
Chapter objectives
Key terms and definitions
Ambulatory surgical setting
Ambulatory surgery programs
Accreditation of ambulatory facilities
Patient selection for ambulatory surgery
Preoperative patient care
Intraoperative patient care
Postoperative patient care
Recovery centers
Interfacility transfer management
Follow-up phone calls and technology
Documentation of ambulatory procedures
Alternative sites where surgery is performed
Mobile army military hospital
Deployable medical systems
Surgery in a mobile hospital setting
Veterinary surgical facilities
Evolve website
References
12 Care of the perioperative environment
Chapter objectives
Key terms and definitions
Guidelines for cleanliness in the surgical environment
Establishing the surgical environment
Preliminary preparations
Before the first surgical procedure of the day
Room turnover between patients
Room turnover activities by the scrub person
Room turnover activities by the team
Cart system cleanup
Getting the room ready for the next patient
Individual patient setups
Daily terminal cleaning
In the operating room
Outside the operating room
Weekly or monthly cleaning
Greening of the or: Environmental responsibility
Evolve website
References
13 Potential sources of injury to the caregiver and the patient
Chapter objectives
Key terms and definitions
Environmental hazards
Classification of hazards
Regulation of hazards
Physical hazards and safeguards
Environment factors
Body mechanics
Ionizing radiation
Safety considerations in the use of ionizing radiation
Patient safety
Personnel safety
Time
Distance
Shielding
Monitoring radiation exposure
Nonionizing radiation
Magnetic resonance imaging
Electricity
Parameters of electricity
Voltage
Resistance
Current
Grounding
Equipotential grounding system
Isolation power system
Electric shock
Safeguards
Electrical and thermal burns
Static electricity
Fire and explosion
Safeguards
Flammable agents
Ignition sources
Fire safety
Chemical hazards and safeguards
Anesthetic gases
Sterilizing agents
Ethylene oxide
Formaldehyde
Glutaraldehyde
Disinfectants
Methyl methacrylate
Drugs and other chemicals
Safe handling of cytotoxic agents
Biologic hazards and safeguards
Infectious waste
Biohazards
Punctures and needlesticks
Surgical plume
Reproductive hazards
Male reproductive health implications
Female reproductive health implications
Latex sensitivity/allergy
Risk management
Evolve website
References
Section 5: Surgical Asepsis and Sterile Technique
14 Surgical microbiology and antimicrobial therapy
Chapter objectives
Key terms and definitions
Microorganisms: Nonpathogens versus pathogens
Identification of microorganisms
Viability of microorganisms
Three lines of defense
Pathogenic invasion
Infectious processes in the body
Who is at risk for exposure?
Biofilm
Mandatory reporting of health care–acquired infections
Types of pathogenic microorganisms
Bacteria
Characteristics
Differentiation of bacterial types
Gram stain
Endospores
Bacterial toxicity
Toxic shock syndrome
Septic shock
Tuberculosis
Sexually transmitted diseases
Gonorrhea
Syphilis
Chlamydia
Viruses
Characteristics
Viral disease examples
Hepatitis infection
Hepatitis A.
Hepatitis B.
Hepatitis C.
Hepatitis D.
Hepatitis E.
Hepatitis g.
Herpes infection
Herpes simplex infection.
Herpetic whitlow.
Cytomegalovirus infection
Human papillomavirus infection
Human immunodeficiency virus infection
Acute infection.
Acquired immunodeficiency syndrome.
Asymptomatic infection.
Persistent generalized lymphadenopathy.
Hiv-related clinical manifestations.
Prions
Creutzfeldt-jakob disease
Managing pathogenic prion-contaminated instruments
Transmission of prion disease
Postexposure prophylaxis for transmissible spongiform encephalopathy
Fungi
Characteristics
Fungal disease examples
Protozoa
Characteristics
Protozoan disease examples
Intracellular
Extracellular
Helminths
Characteristics
Helminth disease examples
Antimicrobial therapy
Antibiotics
Resistance to antibiotic therapy
Methicillin-resistant staphylococcus aureus
Antifungal and antiviral drugs
Microorganisms in mass casualty and bioterrorism
Evolve website
References
15 Principles of aseptic and sterile techniques
Chapter objectives
Key terms and definitions
What is the difference between aseptic and sterile techniques?
Spaulding’s levels of importance of patient care items
Aseptic technique
Sterile technique
Transmission of microorganisms
Human-borne sources of contamination
Skin
Hair
Human error
Cross-infection
Nonhuman factors in contamination
Fomites
Air
Sources of infection
Community-acquired infection
Communicable infection
Spontaneous infection
Health care–acquired infection
Exogenous
Endogenous
Criteria for defining a surgical site infection
Environmental controls
Environmental services/housekeeping
Control of airborne contamination
Laminar air system
Doors
Traffic and movement
Lint
Isolation precautions
Standard precautions
Principles of sterile technique
Only sterile items are used within the sterile field
Sterile personnel are gowned and gloved
Tables are sterile only at table level
Sterile personnel touch only sterile items or areas; unsterile personnel touch only unsterile items or areas
Unsterile personnel avoid reaching over the sterile field; sterile personnel avoid leaning over an unsterile area
The edges of anything that encloses sterile contents are considered unsterile
The sterile field is created as close as possible to the time of use
Sterile areas are continuously kept in view
Sterile personnel keep well within the sterile area
Sterile personnel keep contact with sterile areas to a minimum
Unsterile personnel avoid sterile areas
Destruction of the integrity of microbial barriers results in contamination
Microorganisms must be kept to an irreducible minimum
No compromise of sterility
Evolve website
References
Bibliography
16 Appropriate attire, surgical hand hygiene, and gowning and gloving
Chapter objectives
Key terms and definitions
Appropriate operating room attire
Purpose of appropriate attire
Definition
Considerations for appropriate attire
Components of appropriate attire
Body cover
Head cover
Shoe covers
Mask
Personal protective equipment
Surgical gown
Surgical gloves
Criteria for surgical attire
Surgical hand hygiene
Microbiology of the skin
Purpose of specialized hand hygiene
Antimicrobial skin-cleansing agents
Chlorhexidine gluconate
Iodophors
Triclosan
Alcohol
Parachlorometaxylenol
Opening the gown and gloves
Preparations immediately before surgical hand hygiene
Surgical hand and arm scrub with a brush
Surgical hand hygiene with antiseptic rub
Gowning and gloving
Purpose
General considerations
Drying the hands and arms
Gowning and gloving techniques
Gowning self
Closed-gloving technique
Open-gloving technique
Assisted-gowning and gloving of a team member
Gloving a team member
Removing or changing contaminated gown and gloves
Managing contaminated gloves or objects during the surgical procedure
Contamination when wearing two sets of gloves
Contamination when wearing a single set of gloves
Evolve website
References
Bibliography
17 Decontamination and disinfection
Chapter objectives
Key terms and definitions
Central processing department
Workflow in the processing areas
Central service personnel
Credentialing of central service personnel
Coordination of central service staff and operating room staff
Instrument cleaning and decontamination
Prerinsing/presoaking
Manual cleaning
Washer-sterilizer/washer-decontaminator
Ultrasonic cleaning
Lubrication
Inspecting and testing
Instrument marking for identification
Repairing or restoring versus replacing instruments
Repair
Restoration and resurfacing
Replacement
Disinfection of items used in patient care
Spaulding’s classification of patient care items
Levels of disinfection
Methods of disinfection
Chemical disinfectants
Alcohol
Effectiveness
Precautions
Chlorine compounds
Effectiveness
Precautions
Formaldehyde
Precautions
Glutaraldehyde
Effectiveness
Precautions
Iodophors
Effectiveness
Precautions
Phenolic compounds
Effectiveness
Precautions
Quaternary ammonium compounds
Effectiveness
Precautions
Hydrogen peroxide
Effectiveness
Precaution
Physical disinfectants
Boiling water
Pasteurization
Ultraviolet irradiation
Disposable products
Considerations for the use of disposable products
Advantages
Disadvantages
Other considerations
Reusing/reprocessing disposable single-use products/devices
Reuse
Reprocessing
Resterilization
Safety considerations
Evolve website
References
Bibliography
18 Sterilization
Chapter objectives
Key terms and definitions
Sterilization versus disinfection
Sterilization
Reliability parameters for sterilization
Product-associated parameters
Process-associated parameters
Methods of sterilization
Sterilization cycle
Monitoring the sterilization cycle
Administrative monitoring
Mechanical indicators
Chemical indicators
Biologic indicators
Assembly of instrument sets
Packaging instruments and other items for sterilization
Instrument packaging
Packaging considerations
Packaging materials and methods
Woven fabrics
Nonwoven fabrics
Peel packs or pouches
Sealants and labeling
Wrapped trays
Rigid closed containers
Specialized tray sets
Count sheets
Thermal sterilization
Steam under pressure (moist heat sterilization)
Special circumstances
Advantages of steam sterilization
Disadvantages of steam sterilization
Types of steam sterilizers
Gravity displacement sterilizer
Prevacuum sterilizer (dynamic air removal)
Immediate use/“flash” sterilization
Precautions
Preparing surgical instruments for steam sterilization
Powered equipment
Basin sets
Drape packs
Rubber goods and thermoplastics
Wood products
Loading the sterilizer
Timing the load
Drying the load
Biologic testing of the steam sterilizer
Gravity displacement sterilizer
Prevacuum sterilizer
Dry heat sterilization
Advantages of dry heat sterilization
Disadvantages of dry heat sterilization
Types of dry heat sterilizers
Mechanical convection oven
Gravity convection oven
Preparing items for dry heat sterilization
Oils
Talc
Packaging materials for dry heat sterilization
Glass
Stainless steel boats or trays
Aluminum foil
Woven fabric and peel pouches
Loading the sterilizer
Timing the load
Biologic testing of the dry heat sterilizer
Chemical sterilization
Ethylene oxide gas sterilization
Advantages of eo gas sterilization
Disadvantages of eo gas sterilization
Types of eo gas sterilizers
Preparing items for eo gas sterilization
All items
Lumens
Lensed instruments
Lubricated instruments
Cameras
Packaging materials for eo gas sterilization
Woven fabric
Nonwoven fabric
Peel packs and pouches
Loading the sterilizer
Timing the load
Aerating items after eo gas sterilization
Biologic testing of the eo gas sterilizer
Hydrogen peroxide plasma sterilization
Advantages of hydrogen peroxide sterilization
Disadvantages of hydrogen peroxide sterilization
Low-temperature gas plasma sterilizers
Sterrad by advanced sterilization products
Vapor phase sterilizer
Considerations for hydrogen peroxide sterilization
Ozone gas sterilization
Advantages of ozone gas sterilization
Disadvantages of ozone gas sterilization
Considerations for ozone sterilization
Chemical sterilants in solution
Advantages of chemical sterilants
Disadvantages of chemical sterilants
Types of chemical sterilants
Acetic acid
Glutaraldehyde
Peracetic acid
Hypochlorous acid
Containers for chemical sterilant in solution
Preparing items for sterilization by chemical immersion
Timing the immersion cycle
Rinsing after immersion
Radiation sterilization
Microwave sterilization
Gamma ray and beta particle sterilization
Control measures
Load control number
Wet packs
Causes/conditions of wet packs
Wet steam
Characteristics of the load
Sterilizer malfunctions
Reprocessing wet packs
Shelf life
Integrity of packaging material and handling
Dust cover
Storage conditions
Rotation of supplies
Loaner instrumentation
Custom packs
Case cart system
Evolve website
References
Bibliography
Section 6: Surgical Instrumentation and Equipment
19 Surgical instrumentation
Chapter objectives
Key terms and definitions
Fabrication of metal instruments
Stainless steel
Titanium
Vitallium
Other metals
Plated instruments
Classification of instruments
Dissecting and cutting instruments
Scalpels
Knives
Scissors
Bone cutters and saws
Blunt dissectors
Debulking instruments
Grasping and holding instruments
Delicate forceps
Adson forceps
Bayonet forceps
Smooth tissue forceps
Toothed tissue forceps
Allis forceps
Babcock forceps
Lahey forceps
Stone forceps
Tenaculums
Bone holders
Clamping and occluding instruments
Hemostatic clamps
Hemostats
Crushing clamps
Noncrushing clamps
Retracting and exposing instruments
Manual retractors
Malleable retractors
Hooks
Self-retaining retractors
Bed-mounted retractors
Closure and approximation instruments
Needle holders
Tungsten carbide jaws
Crosshatched jaws
Smooth jaws
Staplers
Clip appliers
Terminal end staplers
Internal anastomosis staplers
End-to-end circular staplers
Viewing instruments
Speculums
Endoscopes
Hollow endoscopes
Lensed endoscopes
Aspiration, instillation, and irrigation instruments
Aspiration
Poole abdominal tip
Frazier tip
Yankauer tip
Autotransfusion
Trocar
Cannula
Dilating and probing instruments
Measuring instruments
Accessory instruments
Microinstrumentation
Material and surface
Shape and tips
Handles
Primary uses
Knives
Scissors
Powered instruments
Spatulas and retractors
Forceps
Clamps
Needle holders
Powered surgical instruments
Power sources
Air-powered instruments
Electrically powered instruments
Battery power
Alternating current
Sonic energy
Handling powered instruments
Cleaning and sterilizing powered instruments
Handling instruments
Setting up the instrument table
Handling instruments during the surgical procedure
Dismantling the instrument table
Evolve website
References
Bibliography
20 Specialized surgical equipment
Chapter objectives
Key terms and definitions
Using specialized equipment in surgery
Electrosurgery
Principles of electrosurgery
Monopolar electrosurgery
Esu generator
Active electrode
Patient return electrode (inactive dispersive electrode)
Argon beam coagulator
Bipolar electrosurgery
Coblation
Generalized safety factors for the use of electrosurgery
Laser surgery
Physical properties of lasers
Types of lasers
Argon laser
Carbon dioxide laser
Excimer laser
Free electron laser
Holmium:yttrium aluminum garnet (ho:yag) laser
Krypton laser
Neodymium:yttrium aluminum garnet (nd:yag) laser
Potassium titanyl phosphate laser
Ruby laser
Tunable dye laser
Photodynamic therapy
Safety factors
Regulatory agencies
The center for devices and radiological health
American national standards institute
Occupational safety and health administration
State and local agencies
Policies and procedures
Patient safety
Personnel safety
Eye protection
Skin protection
Laser plume
Environmental safety
Laser team
Advantages of laser surgery
Disadvantages of laser surgery
Microsurgery
Technique of microsurgery
Advantages of microsurgery
Operating microscope
Optical lens system
Components
Magnification
Focus
Illumination system
Paraxial illuminators
Coaxial illuminators
Mounting systems
Floor mount
Ceiling mount
Wall mount
Operating bed mount
Electrical system
Accessories
Assistant’s binoculars
Broadfield viewing lens
Couplings
Cameras
Laser microadapter
Remote foot controls
Microscope drape
Care of the microscope
General considerations in microsurgery
Patient
Anesthesia
Stability of the surgical field
Armrests and chair
Duties of the scrub person
Ultrasonosurgery
Ultrasonic blade and scissors
Integrated technologies
Evolve website
References
Bibliography
Section 7: Preoperative Patient Care
21 Preoperative preparation of the patient
Chapter objectives
Key terms and definitions
Hospitalized patient
Preoperative preparation of all patients
Preadmission procedures
Before an elective surgical procedure
Preoperative visit by the perioperative/perianesthesia nurse
Pros of preoperative visits
Cons of preoperative visits
Interviewing skills
Structured preoperative visits
Gathering information
Addressing patient needs
Preoperative teaching
Effective teaching
Preoperative visit by the anesthesia provider
Anesthesia plan of care
Before taking the patient to the operating room
Emotional preparation
Transportation to the operating room suite
Admission to the operating room suite
Presurgical holding area
Admission to the presurgical holding area
Preanesthesia preparations
Transfer to the operating room
Before the induction of anesthesia
Circulating nurse’s role during induction
Evolve website
References
Bibliography
22 Diagnostics, specimens, and oncologic considerations
Chapter objectives
Key terms and definitions
Diagnosing pathology
Patient care considerations for diagnostic procedures
Specimens and pathologic examination
Cultures and smears
Cultures
Smears
Biopsies
Aspiration biopsy
Bone marrow biopsy
Percutaneous needle biopsy
Punch biopsy
Brush biopsy
Excisional biopsy
Incisional biopsy
Frozen section
Permanent section
Collecting surgical specimens
Radiologic examination
Types of radiologic equipment and accessories
Contrast media
Radiolucent gases
Radiologic table
Cassette
Processing equipment
Fixed x-ray equipment
Portable x-ray machine
Fluoroscope
Image intensifier
C-arm image intensifier
Computerized digital subtraction processor
Radiologic diagnostic procedures
Chest x-ray
X-ray studies for trauma
Mammography
Patient teaching
Stereotactic core breast tissue biopsy
Computed tomography
Ventriculography
Arthrography
Angiography and arteriography
Bronchography
Cholangiography
Gastrointestinal x-ray studies
Myelography
Urography
Incidental x-ray
Interventional radiology
Magnetic resonance imaging
Nuclear medicine studies
Radionuclides
Total-body scanning
Scintigraphy and lymph node mapping
Lymphoscintigraphy (sentinel node sampling)
Positron emission tomography
Ultrasonography
Doppler studies
Intraoperative ultrasonography
Hemodynamics
Air embolus
Localization of lesions
Percutaneous puncture
Sensory evoked potential
Plethysmography
Endoscopy
The patient with cancer
Clinical signs and symptoms of cancer
Potential causes of cancer
Risk-related factors
Extent of disease
Carcinoma in situ
Localized cancer
Regional cancer
Metastatic cancer
Disseminated cancer
Tumor identification system (tnm)
Monitoring tumor markers
Cancer treatment
Adjuvant therapy
Surgical resection and palliation
Preservation of reproductive system
Endocrine therapy
Hormonal receptor site studies
Endocrine ablation
Hormonal therapy
Photodynamic (laser) therapy
Radiation therapy
Ionizing radiation
Implantation of radiation sources
Interstitial needles. 
Interstitial seeds. 
Brachytherapy. 
Intracavitary capsules. 
Afterloading techniques. 
Preloading techniques. 
Intracavitary colloidal suspensions. 
Intraoperative radiation therapy
Stereotactic radiosurgery
Effects of radiation therapy on the perioperative patient
Chemotherapy
Indications for chemotherapy
Preoperative chemotherapy. 
Intraoperative chemotherapy. 
Postoperative chemotherapy. 
Delivery devices for chemotherapeutic agents
Infusion catheters. 
Central venous catheter. 
Hepatic artery catheter. 
Intraperitoneal catheter. 
Infusion devices
Subcutaneous infusion port. 
Implantable infusion pump. 
Perioperative care of the patient with cancer
Teaching patients risk avoidance behaviors
Evolve website
References
Bibliography
Section 8: Pharmacology and Anesthesia
23 Surgical pharmacology
Chapter objectives
Key terms and definitions
Pharmacology baselines
Avoiding pharmaceutical error
Pregnancy, lactation, and reproductive considerations
Drug development
Expedited drug approval
Drug names
Mathematics baselines
Decimals
Addition of decimals
Subtraction of decimals
Multiplication of decimals
Division of decimals
Percent
Fractions
Common denominator
Reduce a fraction to lowest terms
Improper fraction
Ratio and proportion
Ratio
Proportion
Pharmacologic conversions
Accepted abbreviations
Weights and measures
Considerations in surgical pharmacology
Handling drugs and pharmacologic materials in surgery
Surgical drug and pharmaceutical sources
Biologic sources
Animal sources
Plant sources
Mineral sources
Synthetic and semisynthetic sources
Chemical sources
Engineered protein from plant, animal, and chemical combinations
Pharmacologic forms used in surgery
Liquids
Solids
Powders
Semisolids
Gases
Medical gas terminology
Potential complications caused by pharmaceuticals and herbal medicine
Evolve website
References
Bibliography
24 Anesthesia: Techniques and agents
Chapter objectives
Key terms and definitions
The art and science of anesthesia
Choice of anesthesia
Anesthesia state
Knowledge of anesthetics
Types of anesthesia
General anesthesia
Induction of general anesthesia
Preoxygenation
Loss of consciousness
Intubation
Cricoid pressure
Awake intubation
Key points during induction
Maintenance of general anesthesia
Anesthesia machine
Waste gases. 
Inhalation systems. 
Administration techniques. 
Mask inhalation. 
Laryngeal mask. 
Endotracheal administration. 
Controlled respiration. 
Inhalation anesthetic agents
Nitrous oxide (n2o)
Advantages. 
Disadvantages. 
Halothane (fluothane)
Advantages. 
Disadvantages. 
Enflurane (ethrane)
Advantages. 
Disadvantages. 
Isoflurane (forane)
Advantages. 
Disadvantages. 
Desflurane (suprane)
Advantages. 
Disadvantages. 
Sevoflurane (ultane)
Advantages. 
Disadvantages. 
Intravenous anesthetic agents
Thiopental (pentothal)
Advantages. 
Disadvantages. 
Propofol (diprivan)
Advantages. 
Disadvantages. 
Ketamine (ketalar, ketaject)
Advantages. 
Disadvantages. 
Adjunctive drugs used in anesthesia
Narcotics
Narcotic reversal (narcotic antagonist). 
Naloxone (narcan). 
Flumazenil (romazicon). 
Muscle relaxants
Nondepolarizing neuromuscular blockers. 
Short-acting neuromuscular blocking agents
Intermediate-acting neuromuscular blocking agents
Long-acting neuromuscular blocking agents
Depolarizing neuromuscular blockers. 
Muscle relaxant reversal agents (cholinergics)
Monitoring the depth of general anesthesia
Emergence from general anesthesia
Balanced anesthesia
Induction
Maintenance
Emergence
Controlled homeostasis
Induced hypothermia
Attaining hypothermia. 
Complications in the use of hypothermia. 
Induced hypotension
Attaining hypotension. 
Precautions in the use of hypotension. 
Normovolemic hemodilution technique
Care of the anesthetized patient
Considerations
Intraoperative awareness
Safety factors
Care of general anesthesia equipment
Standard precautions
Hazards of equipment
Disposable equipment
Care of reusable equipment
Checking anesthesia equipment
Local and regional anesthesia
Preparation of the patient
Intraoperative patient care
Local anesthesia
Administration of local anesthesia
Moderate sedation
The perioperative nurse’s role during local anesthesia and moderate sedation
Monitored anesthesia care
Monitoring the patient receiving a local anesthetic
Considerations in the selection of local anesthetics
Advantages 
Disadvantages
Spinal and epidural anesthesia
Choices in regional drugs
Spinal anesthesia
Choice of agent
Duration of agent
Spinal anesthesia procedure
Advantages. 
Disadvantages. 
Epidural anesthesia
Thoracic and lumbar approaches
Caudal approach
Advantages. 
Disadvantages. 
Techniques of administration of local or regional anesthesia
Topical application
Cryoanesthesia
Simple local infiltration
Regional injection
Nerve block. 
Bier block. 
Field block. 
Complications of blocks. 
Actions of local and regional anesthetics
Drug pharmacodynamics
Conduction velocity. 
Blocking quality. 
Absorption rate and additives. 
Toxicity. 
Pharmacologic agent overview
Amino amides. 
Amino esters. 
Complications of local and regional anesthesia
Local effects
Systemic effects
Predisposing factors for hypersensitivity. 
Precautions. 
Signs and symptoms of systemic reactions. 
Treatment of adverse reactions
Unrelated effects
Alternatives to conventional anesthesia
Hypnosis
Acupuncture
Evolve website
References
Bibliography
Section 9: Intraoperative Patient Care
25 Coordinated roles of the scrub person and the circulating nurse
Chapter objectives
Division of duties
Setting up the room
Opening sterile supplies
Scrub person duties
Preparation of the sterile field
Gown and glove using the closed gloving method
Draping the mayo stand
Basin setup
Arranging the instrument table
Arranging the mayo stand
Establishing baselines
Managing sharps
Loading scalpels
Preparing sutures and ties for use
Handling medications and solutions on the sterile field
Syringes and their handling
After the surgeon and assistant(s) scrub
Draping the patient
Starting the surgical procedure
Providing sponges. 
Providing the esu. 
Towels and the sterile field
Maintaining the case flow. 
Suture and tie management. 
Specimen management on the sterile field. 
Irrigation of the surgical site. 
During closure. 
Application of the dressing. 
Circulating nurse duties
After the scrub person scrubs
After the patient arrives
Entering the or with the patient
During the induction of general anesthesia
After the patient is anesthetized
After the surgeon and assistant(s) scrub
Starting the procedure
The time out before the incision
During the surgical procedure
Sponge management by the circulating nurse
Monitoring blood loss
Specimen management by the circulating nurse
Documentation
During closure
After the surgical procedure is complete
Patient transfer from the operating room
Hand-over report to pacu nurse
Sponge, sharps, and instrument counts
Counting procedures
Initial count when the instrument tray is assembled
Baseline count during setup for the surgical procedure
Closing counts (first closing count)
Final count (second closing count)
Incorrect count
Sponges
Types of sponges
Counting sponges
Methods of accounting for sponges
By the scrub person 
By the circulating nurse
Sharps
Surgical needle counts
Counting needles and other sharps
Methods of accounting for sharps
By the scrub person
By the circulating nurse
Instruments
Counting instruments
Simplifying instrument counts
Efficiency of the operating room team
Productivity
Time and motion economy
Time is costly
Associations
Motion economy
Economical use of supplies and equipment
“just enough is enough”
Use supplies and equipment for intended use
Avoid damage
Evolve website
References
Bibliography
26 Positioning, prepping, and draping the patient
Chapter objectives
Key terms and definitions
Preliminary considerations
Responsibility for patient positioning
Timing of patient positioning and anesthetic administration
Preparations for positioning
Safety measures
Anatomic and physiologic considerations
Respiratory considerations
Circulatory considerations
Peripheral nerve considerations
Musculoskeletal considerations
Soft tissue considerations
Accessibility of the surgical site
Accessibility for anesthetic administration
Individual positioning considerations
Equipment for positioning
Operating room bed
Special equipment and bed attachments
Safety belt (thigh strap)
Anesthesia screen
Lift sheet (drawsheet)
Armboard
Double armboard
WRIST or arm strap
Upper extremity table
Shoulder bridge (thyroid elevator)
Shoulder braces or supports
Body rests and braces
Lateral positioner (kidney rests)
Body (hip) restraint strap
Positioning for anal procedures with adhesive tape
Adjustable arched spinal frame
Stirrups
Metal footboard
Headrests
Accessories
Pressure-minimizing mattress
Surgical vacuum positioning system
Surgical positions
Supine (dorsal) position
Trendelenburg’s position
Reverse trendelenburg’s position
Semi-fowler’s position
Sitting position
Beach chair or modified sitting position
Lithotomy position
Prone position
Modified prone positions
Kraske (jackknife) position
Knee-chest position
Lateral positions
Sims recumbent position
Kidney position
Lateral chest (thoracotomy) position
Anterior chest position
Modifications for individual patient needs
Documentation
Physical preparation and draping of the surgical site
Urinary catheterization
Principles of patient skin preparation
Preliminary preparation of the patient’s skin
Hair removal
Clippers
Razor
Skin degreasing
Surgical skin cleansing fundamentals
Setup and procedure for a two-step skin prep
Setup and procedure for a one-step skin prep
Preparing areas considered contaminated
Umbilicus
Stoma
Other contaminated areas
Foreign substances
Traumatic wounds
Areas prepared for grafts
Antiseptic solutions
Chlorhexidine gluconate
Iodine and iodophors
Alcohol
Parachlorometaxylenol
Skin preparation for specific anatomic areas
Head and neck
Eye 
Ears, face, and nose
Neck
Chest and trunk
Lateral thoracoabdominal area
Chest and breast
Shoulder
Rectoperineal area
Vagina
Extremities
Upper arm
Elbow and forearm
Hand
Hip
Thigh
Knee and lower leg
Ankle and foot
Documentation
Draping
Draping materials
Self-adhering sheeting
Incise drape.
Towel drape.
Aperture drape.
Advantages of self-adhering drape material
Nonwoven disposable drapes
Laser-resistant drape.
Thermal drape.
Woven textile fabrics
Styles/types of drapes
Towels
Fenestrated sheets
Laparotomy sheet.
Thyroid sheet.
Chest sheet.
Hip sheet.
Perineal sheet.
Laparoscopy sheet.
Separate sheets
Split sheet.
Minor sheet.
Medium sheet.
Single sheet.
Leggings.
Stockinette.
Principles of draping
Unusual circumstances considered potentially contaminated
Procedures for draping the patient
Laparotomy
Head
Face
Eye
Ear
Chest and breast
Shoulder
Elbow
Hand
Perineum
Hip
Knee
Lower leg and ankle
Foot
Draping of equipment
Plastic isolator
Evolve website
References
Bibliography
27 Physiologic maintenance and monitoring of the perioperative patient
Chapter objectives
Key terms and definitions
Monitoring physiologic functions
Invasive hemodynamic monitoring
Intravascular cannulation
Intravascular catheters
Catheter insertion
Drawing blood samples
Physiologic parameters monitored
Electrocardiogram
Echocardiogram
Stethoscopy
Arterial blood pressure
Sphygmomanometer
Doppler ultrasound flowmeter
Infrared beams
Direct arterial pressure
Mean arterial pressure
Blood gases, oxygenation, and ph
Pulse oximetry
Niroscope
Capnometry
Optode
Direct arterial blood gas analysis
Central venous pressure
Central venous cannulation
Pulmonary artery pressure monitoring
Pulmonary artery cannulation
Swan-ganz thermodilution catheter
Interpretation of pressures
Right atrial pressure. 
Right ventricular pressure. 
Pulmonary artery pressure. 
Pulmonary capillary wedge pressure. 
Complications of pulmonary artery catheter monitoring
Cardiac output
Cardiac index
Total blood volume
Respiratory tidal volume
Body temperature
Urinary output
Chest x-ray
Electroencephalogram
Cerebral function monitor
Compressed spectral array
Neurometrics monitor
Bispectral index monitoring
Evoked potentials
Auditory evoked potentials
Somatosensory evoked potentials
Intracranial pressure monitoring
Evolve website
References
Bibliography
Section 10: Surgical Site Management
28 Surgical incisions, implants, and wound closure
Chapter objectives
Key terms and definitions
The surgical incision
Anatomy and physiology of the integument
Langer’s lines
Epidermis
Dermis
Glandular structures and ducts in the integument
Oil glands (sebaceous glands)
Sweat glands (sudoriferous glands)
Blood supply and innervation
Tissue layers under the integument
Subcutaneous adipose layer
Fascia
Peritoneum
Accessory appendages to the integument
Hair follicles
Nails (ungues)
Surgical landmarks
Placement of the surgical incision
Abdominal surgery
Wound closure
Suture basics
Suturing techniques
Halsted suture technique
Principles of suturing
Methods of suturing
Knot placement
Cutting sutures
Retention sutures
Retention bridges, bolsters, and bumpers
Traction suture
Endoscopic suturing
Specifications for suture material
Choice of suture material
Absorbable sutures (table 28.2)
Surgical gut.
Collagen sutures.
Handling characteristics of surgical gut and collagen.
Synthetic absorbable polymers.
Handling characteristics of synthetic absorbable polymers.
Nonabsorbable sutures (table 28.3)
Surgical silk.
Surgical cotton.
Surgical stainless steel.
Handling characteristics of surgical stainless steel suture.
Synthetic nonabsorbable polymers.
Surgical nylon.
Polyester fiber.
Polypropylene suture.
Handling characteristics of synthetic nonabsorbable polymers.
Barbed suture (table 28.4)
Barbed suture.
Surgical needles
Point of the needle
Cutting point
Conventional cutting needles.
Reverse-cutting needles.
Side-cutting needles.
Trocar point
Taper point
Blunt point
Body of the needle
Eye of the needle
Eyed free needle
French eye needle
Handling of free needles.
Swaged-on needle
Placement of the needle in the needle holder
Considerations in the choice of sutures and needles
Packaging and preparation of sutures and needles
Preparation of reusable needles
Packaging of suture materials
Box
Overwrap
Primary sterile packet
Inner dispenser matrix
Preparation of suture material
Standard length
Ligating reels
Precut lengths
Swaged needle-suture
Surgical staples
Advantages of using staples
Stapling instruments
Skin stapler
Internal staplers
Linear stapler
Intraluminal circular stapler
Ligating and dividing stapler
Endoscopic stapler
Clips
Tissue adhesives
Biologic adhesives
Autologous or homologous plasma
Pooled-donor plasma
Synthetic adhesives
Cyanoacrylate
Methyl methacrylate
Implantable materials
Biologic materials
Cargile membrane
Fascia lata
Synthetic materials
Synthetic meshes
Polyester fiber mesh (mersilene mesh).
Polyglactin 910 mesh (vicryl mesh).
Polypropylene mesh (prolene mesh, marlex mesh).
Polytetrafluoroethylene (gore-tex soft tissue patch).
Tissue replacement materials
Biologic wound cover
Autograft
Allograft
Cryopreserved skin.
Amniotic membrane.
Xenograft
Porcine dermis.
Artificial skin.
Biologic materials
Bone grafts
Bone bank.
Xenograft bone implant
Organ transplants
Tissue transplants
Human dura mater.
Human umbilical cord vein graft
Xenograft biomaterials
Arteriovenous shunts.
Collagen.
Corium.
Human skin equivalent.
Synthetic materials
Carbon fiber
Metal
Methyl methacrylate
Polyester fiber
Polyethylene
Polytetrafluoroethylene (teflon)
Silicone
Skin closure
Wound silo
Skin closure strips
Evolve website
References
Bibliography
29 Wound healing and hemostasis
Chapter objectives
Key terms and definitions
Mechanism of wound healing
First intention/primary union
Second intention
Third intention/delayed primary closure
Types of wounds
Intentional wounds
Surgical-site incision or excision
Other types of intentional wounds
Occlusion banding
Chemical wounds
Traumatic wounds
Closed wounds
Open wounds
Simple wounds
Complicated wounds
Clean wounds
Contaminated wounds
Delayed full-thickness injury
Incidental and chronic wounds
Ulcers
Iatrogenic wounds
Factors influencing wound healing
Surgical wound classification
Generalized health condition of the patient
Circulatory status
Smoking
Age
Nutritional status
Fluid and electrolyte balance
Hematology
Inflammatory and immune responses
Allergic response
Immunosuppression
Drug therapy
Radiation therapy
Surgical technique
Aseptic technique
Method of hemostasis
Tissue handling
Tissue approximation
Wound security
Postoperative complications
Physical activity
Hemostasis
Hemostatic process
Bleeding during a surgical procedure
Methods of hemostasis
Chemical methods of hemostasis
Absorbable gelatin
Absorbable collagen
Microfibrillar collagen
Oxidized cellulose
Zeolite beads
Kaolin-based product
Oxytocin
Monsel’s solution
Phenol and alcohol
Styptics
Epinephrine
Silver nitrate
Aluminum chloride 30%
Zinc chloride paste
Tannic acid
Thrombin
Sclerotherapy
Bentonite powder
Embolization
Mechanical methods of hemostasis
External mechanical methods
Antiembolic stockings. 
Sequential compression device. 
Mast pneumatic counterpressure device. 
Tourniquets. 
Pneumatic tourniquet. 
Contraindications for tourniquet use. 
Pressure dressings. 
Packing. 
Internal mechanical methods
Hemostatic clamps. 
Ligating clips. 
Ligatures. 
Pledgets. 
Packs. 
Compressed absorbent patties. 
Bone wax. 
Bone wax alternatives. 
Digital compression. 
Suction-irrigation. 
Drains. 
Thermal methods of hemostasis
Cold methods of hemostasis
Cryosurgery. 
Hypothermia. 
Hot methods of hemostasis
Diathermy. 
Electrocautery. 
Electrosurgery. 
Fulguration. 
Argon beam coagulator. 
Hemostatic scalpel. 
Plasma scalpel. 
Ultrasonic-harmonic scalpel. 
Laser. 
Photocoagulation. 
Wound management
Drains
Intraoperative drainage
Gastrointestinal decompression
Urinary drainage
Postoperative drainage
Passive drains
Penrose drain. 
Constant gravity drainage
Active drains
Closed wound suction systems. 
Sump drains. 
Chest drainage. 
Patient care considerations
Dressings
Types of dressings
One-layer dressing
Skin-closure dressing
Dry sterile dressing
Three-layer dressing
Contact layer. 
Intermediate layer. 
Outer layer. 
Pressure dressing
Stent dressing
Bolster/tie-over dressing
Wet-to-dry dressing
Wet-to-wet dressing
Silicone dressing
Dialkylcarbamoyl chloride–coated dressing
Negative pressure dressing
Application of dressings
Complications of wound healing
Hematoma/seroma
Scar/surgical cicatrix
Adhesions
Postoperative wound disruption
Symptoms
Treatment at the bedside
Compartment syndrome
Postoperative wound infections
Necrotizing fasciitis
Prevention of wound infections
Wound assessment
Objective inspection of the postoperative wound
Basic wound care
Evolve website
References
Bibliography
Section 11: Perianesthesia and Postprocedural Patient Care
30 Postoperative patient care
Chapter objectives
Key terms and definitions
Postanesthesia care
Postanesthesia care unit
Postoperative observation of the patient
Perianesthesia patient care personnel
Professional activities
Admission to the postanesthesia care unit
Postoperative hand-over report
Anesthesia provider’s report
Surgeon’s report
Circulating nurse’s hand-over report
Patient care activities
Patient assessment for pain
Postoperative care orders
Postsurgical overflow considerations
Documentation
Discharge from the postanesthesia care unit
Postoperative evaluation of expected outcomes
Evolve website
References
Bibliography
31 Potential perioperative complications
Chapter objectives
Key terms and definitions
Potential for complications during and after surgery
Respiratory complications
Aspiration
Etiology
Symptoms
Treatment
Prevention
Laryngospasm and bronchospasm
Etiology
Symptoms
Treatment
Prevention
Airway and respiratory obstruction
Etiology
Symptoms
Treatment
Hypoventilation
Etiology
Symptoms
Treatment
Prevention
Emboli
Pneumothorax
Intercostal muscle spasm
Atelectasis (pulmonary collapse)
Etiology
Symptoms
Treatment and prevention
Pulmonary edema
Cardiovascular complications
Hypotension
Etiology
Symptoms
Diagnosis
Treatment
Prevention
Hypertension
Venospasm
Coronary thrombosis
Venous stasis
Deep vein thrombosis
Disseminated intravascular coagulation
Cardiac dysrhythmias
Etiology
Ventricular dysrhythmias
Premature ventricular contraction
Ventricular tachycardia
Ventricular flutter
Ventricular fibrillation
Treatment
Defibrillation: Equipment and technique. 
External defibrillation. 
Internal defibrillation. 
Cardiac arrest
Incidence
Etiology
Symptoms
Diagnosis
Treatment
Prevention
Intravenous cardiovascular drugs
Pharmacodynamics
Receptor mechanisms
Adrenergic receptors. 
Cholinergic receptors. 
Opiate receptors. 
Drug interactions
Intravenous administration
Continuous intravenous drip. 
Bolus. 
Intravenous push. 
Titration. 
Considerations for drug administration
Drugs by classification
Antidysrhythmics
Lidocaine (xylocaine). 
Amiodarone. 
Bretylium (bretylol). 
Procainamide (pronestyl). 
Adenosine (adenocard). 
Verapamil (isoptin, calan). 
Propranolol (inderal). 
Isoproterenol (isuprel). 
Antimuscarinics/anticholinergics
Atropine. 
Vasodilators
Sodium nitroprusside (nipride, nitropress). 
Nitroglycerin (nitrostat IV, nitrol IV, tridil). 
Trimethaphan (arfonad). 
Cardiotonics
Inamrinone (inocor). 
Dobutamine (dobutrex). 
Catecholamines
Epinephrine (adrenalin). 
Norepinephrine (levophed). 
Diuretics
Vasopressors
Dopamine (intropin). 
Metaraminol (aramine). 
Other vasopressors. 
Other drugs
Calcium salts. 
Sodium bicarbonate. 
Cardiopulmonary resuscitation
Basic cardiac life support
Ventilation
Circulation
Internal cardiac compression. 
Checking the effectiveness of cardiopulmonary resuscitation
Advanced cardiac life support
Intravenous drugs
Crash cart
Personnel responsibilities
Duration of cardiopulmonary resuscitation
Postresuscitation care
Staff education
Fluid and electrolyte imbalances
Acid-base balance
Electrolytes
Hypovolemia
Etiology
Signs and symptoms
Treatment
Prevention
Hypervolemia
Blood volume complications
Blood loss considerations
Hemorrhage
Estimation of blood loss
Weighing sponges
Reduction of blood loss
Hemodilution
Blood volume expanders
Pharmacologic agents
Desmopressin acetate
Vasodilators
Anticoagulants
Hypotensive anesthesia
Hematologic disorders
Anemia
Sickle cell hemoglobinopathies
Hemorrhagic disorders
Hemophilia
Blood loss replacement
Allogeneic blood
Autologous blood
Preoperative blood donation
Intraoperative autotransfusion
Postoperative autotransfusion
Blood substitutes
Complications of blood loss or replacement
Shock
Hypovolemic and traumatic shock
Hemorrhagic shock
Cardiogenic shock
Neurogenic shock
Vasogenic shock
Metabolic crises
Convulsions
Etiology
Symptoms
Treatment
Prevention
Inadvertent hypothermia
Etiology
Symptoms
Treatment
Prevention
Malignant hyperthermia
Etiology
Susceptible patients
Triggers
Symptoms
Monitoring
Treatment
Supplies for malignant hyperthermia
Prevention
Prophylaxis
Iatrogenic injury
Evolve website
References
Bibliography
Section 12: Surgical Specialties
32 Endoscopy and robotic-assisted surgery
Chapter objectives
Key terms and definitions
Eight essential elements of endoscopy
Access portal into the body
Working space within the body
Illumination of the working space
Vision within the working space
Manipulation and maneuverability within the working space
Capture of specimens within the working space
Evacuation of gases, fluids, and solids from the body
Closure or minimizing of the access portal(s)
Knowledge and skill for a safe endoscopic environment
Attributes of the endoscopic team
Attributes of the surgeon
Types of endoscopic procedures
Laparoscopic procedure
Pediatric endoscopy
Procedural considerations for laparoscopy in children
Endoscopy and the pregnant patient
Hazards of endoscopy
Care of endoscopes
Cleaning
Sterilization
Storage
Considerations for patient safety
Duties of the assistant for flexible endoscopy
Robotic-assisted endoscopy
Environmental control by robotics
Functional peripheral equipment
Instrument manipulating robot and the master console
Virtual reality
Human intervention during robotic-assisted procedures
Advantages and disadvantages of robotic-assisted surgery
Evolve website
References
Bibliography
33 General surgery
Chapter objectives
Key terms and definitions
Special considerations for general surgery
Breast procedures
Incision and drainage
Breast biopsy
Lumpectomy
Segmental mastectomy
Simple mastectomy
Modified radical mastectomy
Radical mastectomy
Extended radical mastectomy
Considerations for female breast procedures
Abdominal procedures
Biliary tract procedures
Cholecystectomy
Open abdominal cholecystectomy
Laparoscopic cholecystectomy
Common bile duct exploration
Intraoperative cholangiograms
Ultrasonography
Choledochoscopy
Cholelithotripsy
Choledochostomy and choledochotomy
Cholecystoduodenostomy and cholecystojejunostomy
Liver procedures
Liver needle biopsy
Drainage of subphrenic and subhepatic abscesses
Intraoperative hepatic ultrasound
Hepatic resection
Portosystemic shunts
Splenic procedures
Splenectomy
Splenorrhaphy
Pancreatic procedures
Pancreaticojejunostomy
Pancreaticoduodenectomy (whipple procedure)
Pancreatectomy
Pancreaticoduodenal trauma
Esophageal procedures
Esophageal hiatal herniorrhaphy
Esophagogastrectomy
Surgical procedures for esophageal varices
Gastrointestinal surgery
Considerations for gastrointestinal surgery
Gastric procedures
Gastroscopy
Gastrostomy
Simple gastrostomy
Percutaneous endoscopic gastrostomy
Gastric resections
Total gastrectomy
Subtotal gastrectomy
Vagotomy
Gastrojejunostomy (roux-en-y gastroenterostomy)
Bariatric surgery
Gastroplasty
Gastric bypass
Intestinal procedures
Resection of the small intestine
Hemicolectomy, transverse colectomy, anterior resection, and total colectomy
Intestinal stomas
Ileostomy
Cecostomy
Colostomy
Appendectomy
Laparoscopic appendectomy
Colorectal procedures
Sigmoidoscopy
Colonoscopy
Polypectomy
Abdominoperineal resection
Low anterior colon resection
Abdominal trauma
Planning perioperative care for abdominal trauma patients
Systematic approach to evaluation
Peritoneal lavage
Emergency exploratory laparotomy
Complications of abdominal surgery
Anorectal procedures
Anoscopy, proctoscopy, and sigmoidoscopy
Hemorrhoidectomy
Incision and drainage of an anal abscess
Fistulotomy and fistulectomy
Fissurectomy
Treatment of rectal tumors
Excision of pilonidal cysts and sinuses
Hernia procedures
Inguinal herniorrhaphy
Direct hernia
Indirect hernia
Laparoscopic repair
Femoral herniorrhaphy
Umbilical herniorrhaphy
Ventral (incisional) herniorrhaphy
Hiatal (diaphragmatic) herniorrhaphy
Amputation of extremities
Amputations of the lower extremity
Above-knee amputation
Below-knee amputation
Toe and transmetatarsal amputations
Syme amputation
Hip disarticulation and hemipelvectomy
Amputations of the upper extremity
Amputations of the hand
Forearm and forequarter amputation
Rehabilitation
Evolve website
References
Bibliography
34 Gynecologic and obstetric surgery
Chapter objectives
Key terms and definitions
Anatomy and physiology of the female reproductive system
External female genitalia
Labia majora
Labia minora
Clitoris
Vestibule
Bartholin glands
Hymen
Perineum
Internal female reproductive organs
Vagina
Uterus
Fallopian tubes (salpinges)
Ovaries
Muscles and ligaments
Broad ligaments
Round ligaments
Cardinal ligaments
Uterosacral ligaments
Physiology
Gynecology: General considerations
Examination with the patient under anesthesia
Special features of gynecologic surgery
Vaginal approach
Abdominal approach
Abdominal complications
Combined vaginal-abdominal approach
Diagnostic techniques
Biopsy of the cervix
Excisional biopsy
Incisional biopsy
Cone biopsy
Fractional curettage
Colposcopy
Culdocentesis and colpotomy
Culdocentesis
Posterior colpotomy
Fallopian tube diagnostic procedures
Tubal perfusion
Tubal insufflation
Hysterosalpingography
Pediatric and adolescent gynecology
Adolescent pregnancy
Gynecologic pathology in infants
Pelvic endoscopy
Culdoscopy
Hysteroscopy
Laparoscopy
Vulvar procedures
Diseases of the vulva
Simple vulvectomy without node dissection
Total vulvectomy
Radical vulvectomy with bilateral inguinal-femoral lymphadenectomy
Bartholin glands
Marsupialization of bartholin gland cyst
Vaginal procedures
Vaginal wall
Excision of a vaginal lesion
Vaginectomy
Vaginoplasty
Procedures for repair of the pelvic outlet
Anterior colporrhaphy
Posterior colpoperineorrhaphy
Repair of an enterocele
Repair of a prolapsed uterus
Repair of vaginal eversion
Colpocleisis
Procedures for repair of genital fistulas
Repair of a vesicovaginal fistula
Repair of a rectovaginal fistula
Cervix
Cauterization
Trachelorrhaphy
Trachelectomy
Uterus
Dilation and curettage
Intrauterine thermal balloon ablation
Vaginal hysterectomy
Radical vaginal hysterectomy
Laparoscopic-assisted vaginal hysterectomy
Abdominal procedures
Congenital abnormal uterine development
Myomectomy
Fibroid embolization through the uterine artery
Abdominal hysterectomy
Total abdominal hysterectomy
Radical hysterectomy with pelvic lymph node dissection
Salpingo-oophorectomy
Pelvic exenteration
Fallopian tube procedures
Tubal ligation for reproductive sterilization
Tuboplasty
Salpingolysis
Salpingostomy
Tubal anastomosis
Salpingectomy and salpingo-oophorectomy
Ovaries
Screening for ovarian cancer
Excision or biopsy
Ovarian cystectomy
Oophorectomy
Intraoperative intraperitoneal chemotherapy
Muscles and ligaments of the pelvic floor
Urinary stress incontinence procedures
Marshall-marchetti-krantz vesicourethral suspension
Perioperative obstetrics
Considerations for the care of the pregnant patient
Positioning the pregnant patient
Anesthesia
Preoxygenation precedes induction
Threatened abortion
Cerclage
Shirodkar procedure
Mcdonald procedure
Aborted pregnancy
Suction curettage
Uterine evacuation
Dilation and evacuation
Ectopic pregnancy
Complicated birth
Difficult vaginal delivery
Placental problems
Cesarean birth
Setup
Incision and delivery
Neonate
Father or support person in the delivery room
Prenatal testing
Ultrasonography
Blood and chorionic villus sampling
Amniocentesis
Fetoscopy
Intrauterine fetal surgery
Assisted reproduction
In vitro fertilization
Patient selection
Induction of ovulation
Ovum retrieval
Fertilization
Embryo transfer
Gamete intrafallopian transfer
Artificial insemination
Uterus transplants
Nonobstetric surgical procedures and the pregnant patient
Anesthesia considerations in pregnancy
Special considerations
Intraoperative care of the pregnant patient
Intraoperative risks
Psychologic considerations
Evolve website
References
35 Urologic surgery
Chapter objectives
Key terms and definitions
Anatomy and physiology of the urinary system
Kidneys
Ureters
Urinary bladder
Urethra
Special features of urologic surgery
Urologic endoscopy
Urologic bed
Patient preparation for a cystoscopic examination
Urologic endoscopes
Sheath
Obturator
Telescope
Light source
Types of urologic endoscopes
Brown-buerger cystoscope
Blue light video cystoscope
Mccarthy panendoscope
Wappler cystourethroscope
Resectoscope
Endoscopic accessories
Electrodes
Lasers
Irrigating equipment
Evacuators
Care and preventive maintenance of urologic endoscopes
Surgical procedures of the genitourinary system
Kidney
Nephrectomy
Partial nephrectomy or heminephrectomy
Radical nephrectomy
Bilateral nephrectomy
Nephrostomy or pyelostomy
Pyeloplasty
Renal revascularization
In situ vascular reconstructive techniques
Ex vivo extracorporeal kidney surgery
Traumatic injury
Dialysis
Hemodialysis
Peritoneal dialysis
Urolithiasis (urinary calculus)
Percutaneous nephrostolithotomy or nephrolithotripsy
Ultrasonic lithotripsy. 
Electrohydraulic lithotripsy. 
Nephrolithotomy or pyelolithotomy
Extracorporeal shock-wave lithotripsy
Water bag lithotripsy
Ureters
Ureteroscopy
Ureteral catheters
Ureteral stent
Percutaneous ureterolithotomy
Transurethral ureteroscopic lithotripsy or lithotomy
Laser lithotripsy
Ureteral stone extraction
Ureterolithotomy
Litholapaxy and cystolithotomy
Ureteroneocystostomy
Ureteroureterostomy
Vesico-psoas hitch procedure
Urinary bladder
Cystometrogram
Cystoscopy
Suprapubic cystostomy
Cutaneous vesicostomy
Cystotomy and cystoplasty
Cystectomy
Continent urinary diversion procedures
Indiana pouch. 
Kock pouch. 
Mainz II pouch. 
Mitrofanoff technique. 
Ureterosigmoidostomy. 
Orthotopic neobladder. 
Studer pouch. 
Camey pouch. 
Augmentation bladder. 
Transcutaneous urinary diversion
Ileal conduit. 
Cutaneous ureterostomy. 
Urinary incontinence
Transvaginal bladder neck suspension
Pereyra procedure. 
Stamey procedure. 
Artificial urinary sphincter
Neurostimulation for bladder control
Periurethral injection of bulking agent
Bladder flap urethroplasty
Urethra
Perineal urethrostomy
Urethral dilation
Urethral stent
Urethrotomy
Urethroplasty
Perineum and genital surface procedures
Ablation of condylomata acuminata
Male reproductive organs
Testes
Orchiectomy
Retroperitoneal lymphadenectomy
Scrotal-testicular trauma
Testicular torsion
Hydrocelectomy
Spermatocelectomy
Varicocele ligation
Vas deferens
Vasectomy
Vasovasostomy
Male infertility
Prostate gland
Balloon dilation and stenting of prostatic urethra
Transurethral microwave thermotherapy
Transurethral needle ablation
Transurethral prostatectomy
Suprapubic prostatectomy
Retropubic prostatectomy
Radical retropubic prostatectomy
Perineal prostatectomy
Robotic-assisted prostatectomy
Transperineal prostatic cryoablation
Pelvic lymphadenectomy
Penis
Adult male circumcision
Impotence
Dorsal vein ligation
Penile prosthesis
Penectomy
Endocrine glands
Adrenal glands
Transsexual surgery (sex reassignment)
Male to female
Female to male
Postoperative complications of urologic surgery
Evolve website
References
Bibliography
36 Orthopedic surgery
Chapter objectives
Key terms and definitions
The art and science of orthopedic surgery
Anatomy and physiology of the musculoskeletal system
Bones
Bone healing
Cartilage
Joints
Ligaments
Muscles
Tendons
Special features of orthopedic surgery
Instrumentation
Exposing instruments
Grasping instruments
Dissecting and debulking instruments
Power-driven cutting instruments
Measuring devices
Implant-related instruments
Materials and equipment used frequently
Bone grafts
Soft tissue allografts
Fixation devices
Prosthetic implants
Lasers
Carbon dioxide (co2) laser
Holmium:yag laser
Neodymium:yag laser
Bone wax
Nerve stimulator
Sutures
Casts and braces
Cast room
Laminar air system
Fracture table
X-ray equipment
Special considerations in orthopedic surgery
Extremity procedures
General considerations
Indications for orthopedic surgery
Fractures
Closed reduction
Skeletal traction
Forearm or lower leg
Finger
External fixation
Femur and tibia
Stabilization bar
Ilizarov technique
Open reduction and internal fixation (orif)
Screws, plates, and nails
Screws
Compression plates and screws
Eggers plate and screws
Sherman plate and screws
Nails
Intramedullary nailing.
Interlocking nail fixation.
Joint procedures
Dislocations
Arthrodesis
Arthroplasty
Femoral and humeral head replacement
Femoral head surface replacement
Total joint replacement
Total hip replacement
Total knee replacement
Total ankle replacement
Total metatarsophalangeal joint replacement
Total shoulder replacement
Total elbow replacement
Total WRIST replacement
Trapeziometacarpal joint replacement
Metacarpophalangeal joint replacement
Patient care considerations in arthroplasty
Arthroscopy
Patient care considerations in arthroscopy
Arthrotomy
Bunionectomy
Hammer toes
Neurolysis
Repair of tendons and ligaments
Hand surgery
Sports medicine
Knee injuries
Anterior cruciate ligament
Meniscus
Ankle injuries
Shoulder injuries
Cast application
Fiberglass casts
Plaster casts
Application of plaster
Padding under casts
Common cast configurations
Trimming, removing, and changing casts
Complications after orthopedic surgery
Embolus
Compartment syndrome
Evolve website
References
37 Neurosurgery of the brain and peripheral nerves
Chapter objectives
Key terms and definitions
Anatomy and physiology of the brain
Cranium
Meninges
Brain
Cerebrum
Brainstem
Pons and cerebellum
Medulla
Ventricles
Special considerations in neurosurgery
Diagnostics
Magnetic resonance imaging
Computed tomography
Positron emission tomography
Digital holography
Prognostics
Methods of hemostasis
Scalp clips
Bone wax
Antibiotic paste
Compressed absorbent patties (cottonoids)
Chemical agents
Ligating clips
Electrosurgery
Lasers
Ultrasonic aspiration
Interventional neuroradiology
Adjuncts to visibility
Irrigation
Suction
Retractors
Headlight
Endoscope
Neuroguide intraoperative viewing system
Operating microscope
Patient care considerations for craniotomy
Patient preparation
Patient positioning
Supine position
Prone position
Seated position
Controlled hypothermia
Intracranial pressure control
Position of the instrument table
Hemostasis
Physiologic monitoring
Doppler ultrasound scan
Evoked potentials
Intracranial pressure
Electroencephalogram
Surgical procedures of the cranium
Craniectomy
Brain pacemaker
Craniotomy
Intracranial tumors
Cranioplasty
Intracranial microneurosurgery
Other cranial procedures
Excision of an acoustic neuroma
Decompression of cranial nerves
Surgery of cranial blood vessels
Cerebral revascularization
Arteriovenous malformation
Occlusion of aneurysms
Stereotaxis
Aspiration
Functional neurosurgery
Electrostimulation
Radiofrequency retrogasserian rhizotomy
Thalamotomy
Cingulotomy
Pallidotomy
Psychosurgery
Transcranial magnetic stimulation
Intracranial neoplasms
Cryohypophysectomy
Interstitial radiation
Interstitial hyperthermia
Stereotactic radiosurgery
Control of epilepsy
Cortical resection
Corpus callosotomy
Hemispherectomy
Extracranial procedures
External occlusion of the carotid artery
Endovascular procedures
Transsphenoidal procedures
Treatment of head trauma
Complications of cranial surgery
Peripheral nerve surgery
Autonomic nervous system
Sympathectomy
Upper cervical sympathectomy
Cervicothoracic sympathectomy
Thoracic sympathectomy
Thoracolumbar sympathectomy
Lumbar sympathectomy
Presacral neurectomy
Vagotomy
Somatic nervous system
Neurorrhaphy
Neurolysis
Neurotomy, neurectomy, and neurexeresis
Evolve website
References
Bibliography
38 Spinal surgery
Chapter objectives
Key terms and definitions
Anatomy and physiology of the spinal cord and vertebral column
Curvatures of the spine
The spinal cord and spinal nerves
Vertebrae
Special considerations for spinal surgery
Diagnostics
Positioning for spinal surgery
Anesthesia considerations
Airway
Instruments used for spinal surgery
Intraoperative neural monitoring of the spinal cord
Radiologic use during spine surgery
Modeling with scans
Microscope
Robotic-assisted spinal surgery
Hemostasis
Graft materials and stabilization of the vertebrae
Pathology of the vertebrae and spinal cord
Disc degeneration and rupture
Compression on the spinal cord or nerve roots
Vertebral deformity and degeneration
Scoliosis
Kyphosis
Spinal tumors
Spinal trauma
Surgical procedures of the spine
Discectomy
Percutaneous discectomy
Total disc replacement
Cervical spine
Transoral approach
Anterior cervical approach
Posterior cervical approach
Thoracic spine
Anterior thoracic approach
Posterior thoracic approach
Lumbar spine
Anterior transperitoneal lumbar approach
Anterior retroperitoneal lumbar approach
Posterior lumbar approach
Evolve website
References
Bibliography
39 Ophthalmic surgery
Chapter objectives
Key terms and definitions
Anatomy and physiology of the eye
Ophthalmic surgical patient care
Special features of ophthalmic surgery
Ophthalmic instrumentation
Operating microscope
Ophthalmic drugs
Mydriatic and miotic drugs
Local and topical anesthesia
Ophthalmic solutions
Ocular surgical procedures
Extraocular procedures
Eyelid
Excision of neoplasm of the eyelid
Correction of ptosis
Repair of acquired malformation of the eyelid
Blepharoplasty
Lacrimal apparatus
Lacrimal duct dilation
Dacryocystectomy
Dacryocystorhinostomy
Extraocular muscle
Orbit
Decompression
Orbital tumors
Surgical removal of the eye
Enucleation
Evisceration
Exenteration
Cornea
Cauterization
Pterygium
Corneal transplantation (keratoplasty)
Phototherapeutic keratectomy
Refractive keratoplasty
Intraocular procedures
Iris
Excision of iris prolapse
Glaucoma
Cataract
Extracapsular extraction
Intracapsular extraction
Linear extraction
Phacoemulsification
Clear corneal cataract procedure
Rehabilitation after cataract extraction
Implantation of intraocular lens
Anterior chamber (angle fixation)
Posterior chamber (capsular or ciliary body fixation)
Pros and cons of intraocular lens implantation
Retina
Repair of detached retina
Laser therapy
Photocoagulation
Vitrectomy
Eye injuries
Nonpenetrating injuries
Burns
Contusions of the globe
Penetrating injuries
Without a foreign body
Eyelid laceration
Conjunctival laceration
Corneal and scleral lacerations
Posterior rupture of the globe
With a foreign body
Ophthalmic lasers
Evolve website
References
Bibliography
40 Plastic and reconstructive surgery
Chapter objectives
Key terms and definitions
Special features of plastic and reconstructive surgery
General considerations in plastic surgery
Psychologic support for patients undergoing plastic and reconstructive surgery
Categories of plastic and reconstructive surgery
Skin and tissue grafting
Skin graft knives and dermatomes
Freehand skin graft knives and dermatomes
Drum-style skin graft dermatomes
Powered skin graft dermatomes
Types of skin and tissue grafts
Skin grafts
Split-thickness thiersch graft
Split-thickness mesh graft
Full-thickness wolfe graft
Free composite grafts
Free omental grafts
Pedicle flaps
Arterialized tissue flap
Rotational flap.
Cross-finger flap.
Tissue expansion flap.
Myocutaneous flap
Fasciocutaneous flap
Muscle flap
Neurosensory flap
Omental flap
Microsurgical free-flap transfer
Fasciocutaneous graft
Free muscle graft
Vascularized muscle pedicle free flap
Neurovascular free flap
Free autologous bone graft
Composite myoosteocutaneous free flap
Digital transfer
Replantation of amputated parts
General considerations for all tissue autografts
Head and neck plastic and reconstructive procedures
Soft tissue reconstruction
Craniofacial surgical procedures
Maxillofacial and oral surgical procedures
Facial nerve grafting
Repair of lacerations of the lip or mouth
Excision of leukoplakia
Excision of a lip tumor
Lip reconstruction
Aesthetic procedures
Blepharoplasty
Otoplasty
Rhinoplasty
Mentoplasty
Rhytidoplasty
Face transplantation
Soft tissue augmentation
Hair replacement
Plastic and reconstructive procedures of other body areas
Adipose tissue
Liposuction
Abdominoplasty
Breast
Augmentation mammoplasty
Reconstructive mammoplasty
Reduction mammoplasty
Reduction of the male breast
Scars
Scar revision
Dermabrasion
Skin cancer
Mohs micrographic surgery
Burns
Classification of burns
Estimation of burn damage
Lund-browder chart
Rule of nines
Initial care of the burn patient
Methods of surgical treatment
Excisional debridement
Wound bed cover after debridement
Tangential excision
Escharectomy
Other surgical procedures
Escharotomy
Fasciotomy
Amputation of digits
Debridement
Full-thickness skin grafts
Split-thickness skin grafts
Tissue expansion
Myocutaneous flaps
Biologic dressing changes
Dressing changes
Serial biopsy cultures
Treatment of curling’s ulcer
Treatment of marjolin ulcer
Environmental considerations for burn patients
Evolve website
References
41 Otorhinolaryngologic and head and neck surgery
Chapter objectives
Key terms and definitions
General considerations in ear, nose, and throat procedures
Anesthesia considerations
Pharmacologic considerations
Positioning, prepping, and draping
Equipment and instrumentation
Hemostasis and drugs on the sterile field
Tissue grafts and implants
Ear
Anatomy of the ear
External ear
Middle ear
Inner ear
Proximal structures
Physiology of hearing
Pathology of hearing
Differential diagnosis
Surgical procedures of the ear
General considerations
External ear procedures
Removal of a foreign body
Drainage of a hematoma
Excision of a tumor
Middle ear procedures
Mastoidectomy
Simple mastoidectomy. 
Modified radical mastoidectomy. 
Radical mastoidectomy. 
Tympanoplasty
Tympanomastoid reconstruction
Stapedectomy and stapedotomy
Stapes mobilization
Removal of middle ear vascular tumors
Inner ear procedures
Endolymphatic sac shunt
Labyrinthectomy
Vestibular neurectomy
Removal of an acoustic neuroma
Implantation of a cochlear prosthesis
Nose
Anatomy of the nose
Physiology of the nose
Surgical procedures of the nose
General considerations
Nasal cavity procedures
Epistaxis
Anterior pack. 
Posterior pack. 
Artery ligation. 
Turbinectomy
Nasal obstruction
Polypectomy. 
Nasal deformity
Reduction of a nasal fracture. 
Septoplasty, septal reconstruction, and submucous resection. 
Rhinoplasty. 
Repair of a perforated septum. 
Paranasal sinus procedures
Maxillary sinus procedure
Caldwell-luc procedure (antrostomy). 
Ethmoid sinus procedures
Ethmoidectomy. 
Turbinectomy. 
Frontal sinus procedures
Osteoplastic flap procedure. 
Killian procedure. 
Sphenoid sinus procedure
Sphenoidotomy. 
Endoscopic sinus surgery
Functional endoscopic sinus procedure. 
Exenteration. 
Resection of tumors
Oral cavity and throat
Anatomy and physiology of the oral cavity and throat
Surgical procedures of the oral cavity and throat
Excision of salivary gland tumors
Parotidectomy
Excision of oral carcinoma
Subtotal glossectomy or hemiglossectomy
Total glossectomy
Procedures of the nasopharynx
Uvulopalatopharyngoplasty
Hypoglossal nerve stimulation
Adenoidectomy
Procedures of the oropharynx
Tonsillectomy
Incision and drainage of a peritonsillar abscess
Resection of a tonsillar tumor
Pharyngeal diverticulectomy (zenker’s diverticulum)
Dental procedures
Periodontics
Gingivectomy
Mucogingivoplasty
Alveolar ridge reconstruction
Inlay bone grafts
Dental implant
Mandibular staple
Neck
Anatomy and physiology of the neck
Larynx
Trachea
Surgical procedures of the larynx
Laryngoscopy
Indirect laryngoscopy
Direct laryngoscopy
Suspension microlaryngoscopy
Laser microlaryngoscopy
Laser safety. 
Laryngeal injuries
Procedures for carcinoma of the larynx
Laryngofissure with partial laryngectomy
Supraglottic laryngectomy
Vertical hemilaryngectomy
Total laryngectomy
Laryngeal transplantation
Surgical procedures of the esophagus
Esophagoscopy
Removal of foreign bodies
Dilation of a stricture
Neoplasms of the esophagus
Cervical esophageal reconstruction
Surgical procedures of the trachea
Tracheotomy and tracheostomy
Tracheostomy tubes
Tracheal resection
Surgical procedures of the anterior neck
Thyroid procedures
Thyroid biopsy
Thyroidectomy
Thyroid lobectomy. 
Subtotal thyroidectomy. 
Total thyroidectomy. 
Substernal intrathoracic thyroidectomy. 
Parathyroid gland procedures
Subtotal parathyroidectomy
Total parathyroidectomy with autotransplantation
Thyroglossal duct cystectomy. 
Cervical and scalene lymph node biopsy. 
Neck dissections
Radical neck dissection
Face and skull
Anatomy and physiology of the face
Considerations for craniofacial surgery
Craniofacial anomalies
Craniofacial procedures
Midface advancement
Procedures of the orbit
Resection of nasal or paranasal sinus tumors
Resection of craniofacial tumors and dysplasia
Midfacial fractures
Reduction of orbital fractures
Reduction of nasal fractures
Reduction of zygomatic fractures
Maxillofacial and mandibular procedures
Intermaxillary fixation of fractures
Mandibular fractures
Mandibular reconstruction
Temporomandibular joint syndrome
Arthroscopy. 
Arthroplasty. 
Orthognathic surgery
Le fort osteotomy. 
Mandibular osteotomy. 
Mandibulectomy. 
Evolve website
References
42 Thoracic surgery
Chapter objectives
Key terms and definitions
Anatomy and physiology of the thorax
Thoracic cavity
Lungs
Mediastinum
Diaphragm
Physiology
Special features of thoracic surgery
Access to the thorax
Endoscopy
Bronchoscopy
Airway stents
Mediastinoscopy
Thoracostomy
Thoracoscopy
Thoracic incisional approaches
Posterolateral thoracotomy
Anterolateral thoracotomy
Thoracoabdominal incision
Median sternotomy
Partial sternotomy
Parasternotomy
Alternative thoracotomy incisions
Lung-assist devices
Extracorporeal membrane oxygenator
Intravascular oxygenator
Thoracic surgical procedures
Rib resection
Mediastinotomy
Excision of lesions
Correction of a pectus deformity
Thoracotomy
Exploratory thoracotomy
Lung resection
Segmental resection
Wedge resection
Lobectomy
Bronchoplastic reconstruction
Pneumonectomy
Lung reduction
Thoracoplasty
Transplantation of thoracic organs
Thymectomy
Thoracic outlet syndrome
Chest trauma
Blunt trauma
Fractured ribs
Ruptured organs
Penetrating wounds
Sucking chest wound
Thoracentesis
Intrathoracic esophageal procedures
Esophagectomy
Repair of a hiatal hernia
Diaphragmatic pacemaker
Complications of thoracic surgery
Evolve website
References
43 Cardiac surgery
Chapter objectives
Key terms and definitions
Anatomy of the heart and great vessels
Heart
Valves
Coronary circulation
Physiology of the heart
Electrical conduction system
Cardiac cycle
Special features of cardiac surgery
Commonly used incisions for cardiac surgery
Median sternotomy
Paramedian thoracotomy
Transsternal bilateral thoracotomy
Anterolateral or posterolateral thoracotomy
Invasive hemodynamic monitoring
Intraoperative monitoring
Cardiopulmonary bypass
Components of a bypass system
Oxygenator
Heat exchanger
Pump
Perfusion
De-airing
Myocardial preservation
Complications of cardiopulmonary bypass
Diagnostic procedures
Noninvasive procedures
Invasive procedures
Radionuclide imaging
Angiography
Cardiac catheterization
Cardiac surgical procedures
Valvular heart disease
Restorative valve procedures
Valve replacement
Mechanical valves
Biologic valves
Mitral valve replacement
Aortic valve replacement
Transcatheter aortic valve replacement
Transfemoral
Transapical
Transaortic
Percutaneous transluminal balloon valvuloplasty
Coronary artery disease
Coronary artery bypass graft
Internal mammary artery conduit
Saphenous vein conduit
Radial artery conduit
Coronary artery angioplasty
Percutaneous transluminal coronary angioplasty
Laser angioplasty
Intracoronary stent
Transmyocardial revascularization (tmr)
Cardiac dysrhythmias
Maze procedure
Maze III procedure
Mini maze procedure
Radiofrequency ablation
Cryoablation
Ventricular aneurysm
Modified endoventricular circular patch plasty (dor procedure)
Septal myectomy
Atrial myxoma
Cardiac transplantation
Mechanical assist devices
Cardiac pacemaker
Endocardial pacemaker
Epicardial electrodes
Precautions with pacemakers
Cardioverter-defibrillator
Intraaortic balloon pump
Ventricular assist device
Extracorporeal membrane oxygenator
Artificial heart
Artificial heart history
Recent advances in artificial heart technology
Complications of cardiac surgery
Evolve website
References
Bibliography
44 Vascular surgery
Chapter objectives
Key terms and definitions
Anatomy and physiology of the vascular system
Arterial anatomy
Venous anatomy
Capillary anatomy
Vascular pathology
Diagnostic procedures
Invasive procedures
Special features of vascular surgery
Vascular grafts
Biologic vascular grafts
Arterial conduit
Venous conduit
Synthetic vascular prostheses
Knitted polyester
Filamentous velour
Woven polyester
Polytetrafluoroethylene
Composite vein grafts
Conservative interventional techniques
Percutaneous transluminal angioplasty
Balloon angioplasty
Intraluminal stent
Laser angioplasty
Intravascular ultrasonic energy
Atherectomy
Thrombectomy and embolectomy
Closure devices
Thrombolytic therapy
Streptokinase
Urokinase
Tissue-type plasminogen activator
Vascular surgical procedures
Arterial bypass
Femoropopliteal bypass
Endarterectomy
Carotid endarterectomy
Aneurysmectomy
Open resection of an abdominal aortic aneurysm
Pseudoaneurysm
Endovascular repair of abdominal aortic aneurysm
Embolectomy
Pulmonary embolus
Pulmonary embolectomy
Pulmonary thromboendarterectomy
Vena cava filter
Venous stasis disease
Ligation and stripping of varicose veins
Fasciotomy
Epidural spinal electrical stimulation
Vascular shunts
Portosystemic shunts
Distal splenorenal shunt
Mesocaval shunt
Portacaval shunt
Arteriovenous shunts and fistulas
Vascular anastomosis
Limb salvage
Evolve website
References
45 Organ procurement and transplantation
Chapter objectives
Key terms and definitions
Types of transplants
Tissue transplantation
Bone marrow transplantation
Organ transplantation
Organ procurement
Cadaver donor
Multiple organ procurement
Additional considerations in cadaver organ procurement
Psychologic support of the or team. 
Psychologic support for the family of the donor. 
Living related donor
Preservation of organ allografts
Immunologic rejection
Combating rejection
Preoperative matching of the donor to the recipient
Immunosuppressive therapy in the recipient
Pretransplantation transfusions
Kidney transplantation
Transplantation procedure
Donor nephrectomy
Recipient procedure
Complications of renal transplantation
Heart transplantation
Combined heart-lung transplantation
Lung transplantation
Liver transplantation
Pancreas transplantation
Small intestine transplantation
Evolve website
References
Bibliography
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z