Chapter 12: Procedures

Overview

Surgical procedures require an understanding of the forms of anesthesia available and how they correspond to any surgery.

Invasive procedures require a good understanding of anatomical layers and the hazards of performing the procedure.

Reduction procedures require an understanding of the injury mechanism, its effect on the structures and the manipulation required to reverse the injury.

Airway procedures require an understanding of the urgency of the situation, the precise anatomy and any potential complications. Backup procedures need to be ready to be used.

Most procedures require follow-up investigations to confirm the success of the procedure and the absence of complications (cost and other factors such as irradiation should be taken into account when selecting such investigations).

Reading images may require knowledge of sectional anatomy.

There is an old rule - 'see one, do one, teach one'.

General Anesthesia

The surgeon has the advantage of a choice of anesthesia techniques and agents suited to the proposed operation - but the decision should be made in conjunction with the anesthesiologist (if involved).

The surgeon can concentrate on the operation if the anesthetic duties are left to the anesthesiologist. Co-operation is vital.

The aim of general anesthesia (GA) is to provide unconsciousness, analgesia and amnesia for surgical procedures or critical care.

It involves:

• i) Pre-anesthetic evaluation

  

• ii) Anesthetic

  

• iii) Post-operative management

  

Local Anesthesia

Local anesthesia (LA) is used extensively for clinical procedures. Costs of hospitalization have led to increased use of local. It brings with it many advantages. It can also be used to reduce post-operative pain.

Commonly used agents include bupivicaine and lignocaine (both amides). The duration of action may be increased by concomitant use of epinephrine (contra-indicated in structures supplied by end-arteries). It is an advantage to be familiar with a number of agents.

Usually the surgeon manages the local anesthesia but if the procedure is complex, an anesthesiologist should be present.

The basic techniques and blocks are:

• i) Topical (creams, ointments, sprays)

• ii) Direct (into the surgical site)

• iii) Field (around the surgical site)

• iv) Ring (circumferential - digits, penis)

• v) Simple nerve (infiltrate specific nerve)

• vi) Regional (major block - e.g. ...