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After the patient is intubated and positioned, follow these steps to get the patient ready for surgery:

  • Make sure that the operating room (OR) bed is prepared before the patient is moved to the bed (Figure 2-1).

  • Place compression stockings and sequential compression devices (SCDs) on both legs, and make sure that the devices are connected and functioning.

  • The patient should have a Foley catheter and orogastric tube placed as a routine in all minimally invasive cases.

  • Both arms and hands should be well padded using foam or gel pads, and then both arms should be secured by tucking a bedsheet underneath the patient. Make sure that this wrap is not too tight on the arm (Figure 2-2).

  • All pressure points should be well padded. Make sure that both hands are in anatomical position, with the thumbs up. After doing this, check with the anesthesiologist that the intravenous (IV) lines and oxygen saturation sensors are working. If they are not, then check for kinks or compression. The oxygen saturation probe can be moved from the fingers to the earlobes.

  • The chest is taped to the OR table with 3-in. silk tape. This tape should be just below the nipple line, and the tape should be secured to the metal part on the back of the bed. Make sure that the tape is not too tight on the chest; otherwise, it might compromise the lung volume. Placing a hand under the tape while wrapping it around the patient is a simple method to avoid the wrap being too tight. After this, check with the anesthesiologist to make sure that the lung volumes are not restricted.

Figure 2-1

The OR bed setup, showing the gel pad, the blue bedsheet that will be used to tuck the patient’s arms, and then egg crate foam on top.

image If the tape is placed on the chest above the nipple line, the patient might sustain neck injury if she or he slips from the bed in a reverse Trendelenburg position.

  • Make sure that there is a safety strap across the thighs, without putting excessive compression on the legs.

  • The anesthesiologist should secure the head so that when the bed is tilted, the head does not move (Figure 2-2).

  • Add shoulder support as well. This will help to stabilize the patient during the steep Trendelenburg position. Make sure to put a gel pad between the shoulder and the shoulder support to prevent pressure injury to the shoulders.

  • Place a bear hugger on top of the tape placed on the chest. Ask the anesthesiologist not to turn it on until you drape the patient; otherwise, it might touch and contaminate the prepped operative field.

  • Perform the tilt test before you prep the abdomen, to make sure that the patient is well ...

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