Intraoperative Surgical Procedures Flashcards

During a laparoscopic procedure, the patient develops sudden hypotension, tachycardia, and a drop in end-tidal CO2. The CSFA should anticipate that these are signs of what critical complication?

Answer: Gas embolism

A sudden drop in end-tidal CO2, accompanied by hypotension and tachycardia during CO2 insufflation, is a classic presentation of a gas embolism. This occurs when CO2 enters the vascular system, creating a gas lock that obstructs pulmonary circulation. Hypercarbia would present with an elevated end-tidal CO2.

A surgeon is performing a bowel resection and needs to achieve hemostasis on the mesentery. Which electrosurgical unit (ESU) mode provides a combination of cutting and coagulation with a lower voltage, continuous waveform?

Answer: Blend

The 'Blend' mode on an electrosurgical unit combines the cutting waveform with a coagulation waveform. This allows the surgeon to cut through tissue while simultaneously achieving hemostasis, which is ideal for vascular tissues like the mesentery. 'Cut' mode has poor coagulation, while 'Coagulation' mode provides hemostasis without effective cutting.

The scrub person and circulator are performing the final count for a major abdominal procedure. A single ray-tec sponge is missing. After a thorough search of the sterile field, linen, and trash, it is not found. What is the most appropriate next step?

Answer: The surgeon performs a manual exploration of the wound while an intraoperative x-ray is ordered.

When a surgical item is missing and cannot be located after a thorough search, the surgeon must be notified to perform a manual exploration of the wound. Concurrently, an intraoperative x-ray must be ordered to rule out a retained foreign body before the final closure of the wound cavity.

A CSFA is assisting with the closure of a multi-layered abdominal incision. To approximate the fascial layer, which requires high tensile strength and prolonged support for healing, which suture technique is most appropriate?

Answer: Simple interrupted suture

The simple interrupted suture technique is ideal for closing fascia because each stitch is independent, providing secure closure and high tensile strength across the wound. If one suture breaks, the integrity of the rest of the closure is not compromised. Subcuticular sutures are for skin, vertical mattress sutures are for skin eversion, and pursestring sutures are for closing circular openings.

When passing a surgical specimen, such as a lymph node for frozen section, from the sterile field to the circulating nurse, what is the most critical step to ensure its integrity and prevent a diagnostic error?

Answer: Keeping the specimen moist with saline and confirming orientation with the surgeon.

Specimens for frozen section must be sent fresh, without formalin, to the pathology lab for immediate analysis. It is critical to keep the tissue from drying out, which can be done by placing it on a saline-moistened Telfa pad or in a sterile container with a few drops of saline. The CSFA must also confirm the identity and any specific orientation (e.g., marking sutures) with the surgeon before passing it off the field.

Which of the following is considered a 'passive' or 'mechanical' topical hemostatic agent that works by absorbing blood and providing a physical matrix for clot formation?

Answer: Regenerated Oxidized Cellulose

Regenerated oxidized cellulose (e.g., Surgicel) is a passive hemostatic agent. It does not contain active clotting factors but instead provides a physical scaffold that absorbs blood and promotes platelet aggregation, facilitating the natural clotting cascade. Topical thrombin is an active biological agent, TXA is an antifibrinolytic, and epinephrine is a vasoconstrictor.