Intra-operative care involves monitoring and caring for patients during surgery. It includes activities like monitoring vital signs, blood oxygen levels, providing fluids and medications, and assisting with the surgical procedure. The goals are to maintain patient safety, homeostasis, and sterile technique. Precautions must be taken due to the vulnerable state induced by anesthesia. Complications can occur from surgery, anesthesia, or positioning and must be quickly addressed by the healthcare team working together in the operating room.

1. Intra-operative care
By
Monika Devi NR
M.Sc. Nursing
GMCH Jammu

2. Intra-operative care
Definition
The term "intra-operative" refers to the time during
surgery. Intra-operative care is patient care during
an operation and ancillary to that operation.

3. Activities such as monitoring the patient's vital
signs , blood oxygenation levels, fluid therapy,
medication transfusion, anesthesia, radiography, and
retrieving samples for laboratory tests, are examples of
intra-operative care. Intra-operative care is provided by
nurses, anesthesiologists, nurse anesthetists, surgical
technicians, surgeons, and residents, all working as a
team.
Intra-operative care

4. Purpose
The purpose of intra-operative care is
• To maintain patient safety and comfort during surgical
procedures.
• Maintaining homeostasis during the procedure,
• Maintaining strict sterile techniques to decrease the chance
of cross-infection,
• Ensuring that the patient is secure on the operating table,
• Taking measures to prevent hematomas from safety strips or
from positioning.

5. Precautions
• Patients undergoing surgery most often are given some type of
anesthesia.
• The administration of general anesthesia has a relaxing effect on
the patient's body, which can suppress cardiovascular function or
heighten cardiovascular irritability.
• It may also result in respiratory depression, loss of
consciousness, paralysis , and lack of sensation.
• These effects, some of which are intentional for the period of the
surgery, mean the patient is in a very vulnerable position.
• It is the responsibility of the health care team in the operating
room to maintain the patient's safety and yet facilitate surgery.

6. Cont..
• Ventilation should be assessed by continuous
auscultation of breath sounds,
• oxygenation should be monitored by continuous pulse
oximetry.
• Continuos electrocardiograph (ECG) showing the
patient's cardiac function should be in place,
• the patient's heart rate and blood pressure should be
monitored at least every five minutes.

7. Cont…
• A means to monitor the patient's temperature must be
available immediately for use.
• In case of an emergency backup personnel who are
experts in airway management , emergency intubation,
and advanced cardiac life support (ACLS) must be
available.
• An emergency cart containing the necessary supplies
and equipment must be immediately accessible.

8. Cont…
• The ACLS equipment should be checked daily to ensure
proper function.
• The health care team must keep this in mind when they
are positioning the patient for a surgical procedure.
• Areas of the operating table that come into contact with
the patient's bony prominences must be padded to
prevent skin trauma and hematomas.

9. Cont…
• It is the responsibility of the nurses working in the
operating room to maintain an accurate count of all
sponges, instruments, and sharps that may
become foreign bodies upon incision closure.
• Nurses who fail to make accurate counts can be held
legally liable.
• To decrease the risk, strict asepsis (sterile technique)
must be followed at all times.

10. Cont…
• It is recommended that the ventilation system in an
operative area provide a minimum of fifteen exchanges of
filtered air per hour.
• The temperature in the intraoperative area should be
maintained at 68–73°f (20–23°c), and the relative
humidity should be maintained at 30%–60%.
• Health care personnel who work in the operating room
must not be permitted to work if they have open lesions on
the hands or arms, eye infections, diarrhea , or respiratory
infections.

11. Description
Intra-operative care includes the activities performed by
the health care team during surgery that
• Ensure the patient's safety and comfort
• Implement the surgical procedure
• Monitor and maintain vital functions
• Document care given
The intra-operative time period can vary greatly from less
than one hour to 12 hours or more, depending on the
complexity of the surgery being performed.

12. Cont…
• Head and facial hair must be completely contained in a
lint-free cap or hood.
• Properly fitting disposable surgical masks must be worn
at all times and discarded immediately after use.
• Sterile gloves and sterile gowns must be worn by those
working in, and in proximity to, the sterile field.
• Careful skin preparation with appropriate antiseptic
solutions is preformed on the patient's arrival to the
operating area.

13. • A consent form must be signed by the patient or guardian and
witnessed by a staff member as well as the
• It is the duty of the RN admitting the patient to the surgical
suite to check the patient's ID band and ensure that all records
are intact and accounted for.
• After consent is given the patient may be taken to a holding
area where a large-bore intravenous catheter is inserted into
the patient's arm for use in fluid replacement and to infuse
medications during the procedure.
Preparation

14. Preparation
• The area of the body where the incision will be made is
meticulously prepared using drapes, and a skin preparation
that is antiseptic and may include the use of alcohol
solutions and iodophor.
• Monitoring devices such as continuous ECG nodes, pulse
oximetry probes, and a blood pressure cuff are usually
applied prior to skin preparation.
• Anesthesia, also, is begun before skin prep. Surgery is then
ready to begin. surgeon performing the procedure.

15. Aftercare
• The time after surgery is referred to as the
postoperative period and includes the recovery and
convalescence phases.
• The recovery phase is the time immediately after
surgery when the effects of anesthesia are wearing off
and the patient is waking up.
• The convalescence phase is spent either in the hospital,
in an interim care facility, or at home—depending on
the procedure and the preferences of the physician and
patient.

16. Complications
Intra-operative complications are :
• Surgery related,
• Anesthesia related,
• Position related.
One complication occurring during the intra-operative
period that is not common but can be life threatening is
an anaphylactic (allergic) reaction to anesthesia.

17. • Increased body metabolism ,
• Muscle rigidity,
• eventual hyperthermia which may exceed
110°F(43.3°c).
• Death may be caused by cardiac arrest
• Brain damage
• Internal hemorrhage,
• Failure of other body systems.
Complications

18. • Hypo-volemic shock (due to blood loss during
surgery),
• Injuries from poor positioning during surgery,
• Infection of the surgical wound,
• Fluid and electrolyte imbalances,
• Aspiration pneumonia ,
• Blood clots,
• Paralytic ileus (paralysis of the intestines, causing
distention).
Complications

19. KEY TERMS
• Anaphylactic reaction (anaphylaxis) —A hyper-
sensitive reaction to an antigen resulting in life-
threatening, progressive symptoms.
• Anesthesia —A classification of medications that are
intended to cause the loss of normal sensation.
• Aseptic technique —Strict sterile procedures instilled
to decrease the risk of contamination of a surgical site
or open wound.

20. • ECG —Abbreviation for electrocardiograph. Electro-
cardiograph is a tracing of the electrical activity of the
heart obtained through electrodes placed on a person's
skin in certain areas where electrical activity can be
easily be detected.
• Intraoperative care —Care provided to a patient during
surgery that is ancillary to the surgery.
• Hypovolemic shock —A state of shock caused by the
sudden loss of large amounts of blood.
KEY TERMS

21. KEY TERMS
• Informed consent —Written or oral permission given by a
patient or guardian for medical or surgical treatment after a
complete explanation is given and any questions the patient has
are answered. If consent is given orally, documentation must
have two witnesses.
• Malignant hyperthermia —A chain reaction triggered in
susceptible people by commonly used general anesthetics. Signs
include greatly increased body metabolism, muscle rigidity, and
eventual hyperthermia which may exceed 110°F(43.3°C). Death
may be caused by cardiac arrest, brain damage, internal
hemorrhage, or failure of other body systems.

22. KEY TERMS
• Pulmonary function tests —Tests used to determine
ventilation and perfusion capabilities of the lungs.
• Pulse oximetry —A method of measuring a patient's
blood oxygenation status. A measure of 100% is
optimal.

23. Thank you