As surgical techniques advance in sophistication, there are a number of intraoperative procedures that could be taking place during your surgery. In fact, each surgical procedure is an expertly choreographed ballet and the medical personnel are the highly trained dancers. Want to know what the dance looks like when you are sleeping? This article will provide you with some of the intraoperative information that is only available to those who remain conscious during surgery.
Many things will happen during the intraoperative period before your surgeon even reaches the operating room. The anesthesiologist or technician will have placed an IV so that medicines can be delivered during the procedure. Several sensors and monitors will need to be attached to you to make sure you are doing okay throughout the surgery. The entire area will have been draped in sterile towels to set up an area called a sterile field. Something that looks like a large metal suitcase will be brought in containing the surgical tools needed for your surgery. These instruments will be laid out on high tables covered in sterile towels. Once you enter the room you will be moved to a very special stretcher/table. This contraption allows the person lying on it to be moved up, down, left and right—even individual limbs and can be raised and lowered independently. The anesthesiologist will place a small tube into your trachea (the pipe that connects your throat to your lungs) in a process called intubation. This is done so that a machine can help you breathe and certain anesthetic gases and oxygen can be delivered.
Finally, the surgeons (yes it is usually two or three for larger procedures) enter with hands and arms thoroughly scrubbed to the elbow. They are helped into sterile gowns by personnel called scrub nurses. During the entire procedure, their hands must never drop below the level of their waste, above their shoulder, or touch anything that is not already sterile. If this happens it is called “breaking scrub” and will need to repeat the re-glove at minimum and re-scrub and re-gown at maximum.
Depending on the surgery, several pieces of intraoperative information could be gathered about you and your case. The anesthesiologist is constantly monitoring heart rate, blood pressure, the oxygen content of the blood. A rapid increase in blood pressure and heart rate usually indicates that the anesthetic is too light, while a drop in these indices means the sedation is too deep. Often times X-rays will be taken or a specialized X-ray device may be used (called a fluoroscope) that allows anatomy to be visualized before making important cuts. During surgeries for cancer, once the tumor is removed, it may be sent immediately to the lab for rapid preparation so that the surgeon can know if the entire tumor was removed. Certain heart surgeries require that a machine divert blood flow so that the heart can be made still (being used less).
It is not uncommon for neurosurgeons to wake a person up during surgery. Once a portion of the skull has been removed the patient will be brought out of anesthesia so that intraoperative testing can occur. Surgeries for epilepsy or movement disorders may require that the patient’s brain be stimulated while awake to determine the precise area(s) to be altered. Without this essential intraoperative information, neurosurgeons may remove a vital part of the brain.