Surgery
While informed consent discussions may be performed in a clinic or acute care setting, the pre-operative holding area is where documentation is reviewed and where family members can also meet the surgical team.
Nurses in the preoperative holding area confirm orders and answer additional questions of the family members of the patient prior to surgery.
The skin surface within the operating field is cleansed and prepared by applying an antiseptic (typically chlorhexidine gluconate in alcohol, as this is twice as effective as povidone-iodine at reducing the risk of infection).
Depending on the type of procedure, the cephalad drapes are secured to a pair of poles near the head of the bed to form an "ether screen", which separate the anesthetist/anesthesiologist's working area (unsterile) from the surgical site (sterile).
The person is typically intubated to protect their airway and placed on a mechanical ventilator, and anesthesia is produced by a combination of injected and inhaled agents.
It has been linked to many disorders such as obesity hypoventilation syndrome, atelectasis and pulmonary embolism, adverse cardiovascular effects, and wound healing complications.
For postoperative nausea and vomiting (PONV), solutions like saline, water, controlled breathing placebo and aromatherapy can be used in addition to medication.
[38] Postoperative recovery has been defined as an energy‐requiring process to decrease physical symptoms, reach a level of emotional well‐being, regain functions, and re‐establish activities.
[45] One frailty scale uses five items: unintentional weight loss, muscle weakness, exhaustion, low physical activity, and slowed walking speed.
Global surgery has been defined as 'the multidisciplinary enterprise of providing improved and equitable surgical care to the world's population, with its core belief as the issues of need, access and quality".
[49][51] In terms of the financial impact on the patients, the lack of adequate surgical and anesthesia care has resulted in 33 million individuals every year facing catastrophic health expenditure – the out-of-pocket healthcare cost exceeding 40% of a given household's income.
Additionally, the third edition of Disease Control Priorities (DCP3), published in 2015 by the World Bank, declared surgery as essential and featured an entire volume dedicated to building surgical capacity.
[57] Access to surgical care is increasingly recognized as an integral aspect of healthcare and therefore is evolving into a normative derivation of human right to health.
The 1966 ICESCR Article 12.2a described the need for "provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child"[61] which was subsequently interpreted to mean "requiring measures to improve… emergency obstetric services".
[53] The Lancet Commission for Global Surgery outlined the need for access to "available, affordable, timely and safe" surgical and anesthesia care;[66] dimensions paralleled in ICESCR General Comment No.
The oldest for which there is evidence is trepanation,[67] in which a hole is drilled or scraped into the skull, thus exposing the dura mater in order to treat health problems related to intracranial pressure.
Prehistoric surgical techniques are seen in Ancient Egypt, where a mandible dated to approximately 2650 BC shows two perforations just below the root of the first molar, indicating the draining of an abscessed tooth.
[78] In the Asclepieion of Epidaurus, some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place.
[30] The Greek Galen was one of the greatest surgeons of the ancient world and performed many audacious operations – including brain and eye surgery – that were not tried again for almost two millennia.
"[79] Researchers from the Adelphi University discovered in the Paliokastro on Thasos ten skeletal remains, four women and six men, who were buried between the fourth and seventh centuries A.D. Their bones illuminated their physical activities, traumas, and even a complex form of brain surgery.
[81] During the Islamic Golden Age, largely based upon Paul of Aegina's Pragmateia, the writings of Albucasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an Andalusian-Arab physician and scientist who practiced in the Zahra suburb of Córdoba, were influential.
The first clinical description of an operative procedure for hydrocephalus was given by Al-Zahrawi, who clearly describes the evacuation of superficial intracranial fluid in hydrocephalic children.
[citation needed] The second figure of importance in this era was Ambroise Paré (sometimes spelled "Ambrose"[89]), a French army surgeon from the 1530s until his death in 1590.
[91] He was also one of the first to understand the importance of pathology, the danger of the spread of infection and how the problem of inflammation of the wound, bone lesions and even tuberculosis often undid any benefit that was gained from the intervention.
Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether, first used by the American surgeon Crawford Long, and chloroform, discovered by Scottish obstetrician James Young Simpson and later pioneered by John Snow, physician to Queen Victoria.
The first progress in combating infection was made in 1847 by the Hungarian doctor Ignaz Semmelweis who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives.
[94] Lister became aware of the work of French chemist Louis Pasteur, who showed that rotting and fermentation could occur under anaerobic conditions if micro-organisms were present.
[96][97][98] His work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern antiseptic operating theatres widely used within 50 years.
[citation needed] Lister continued to develop improved methods of antisepsis and asepsis when he realised that infection could be better avoided by preventing bacteria from getting into wounds in the first place.
Lister introduced the Steam Steriliser to sterilize equipment, instituted rigorous hand washing and later implemented the wearing of rubber gloves.
