Bedside Surgical Procedures 

Bedside Surgical Procedures

The intensive care unit (ICU) is indicated by bedside. The ICU is where these surgeries are performed. 

Facilities Available Inside An Operation Theatre

The best place to operate is in the operation theatre (OT), which is equipped with all the equipment needed for anaesthesia, personnel, and necessary tools. Additionally, the room is thoroughly fumigated before each surgery, ensuring that there is no possibility of infection after the procedure. Additionally, the OT maintains safety standards.

Why Should one Operate in an ICU?

A critically ill patient can be transported with less risk because to the ICU's flexibility with regard to timing.  The ICU can use less money and resources.  In the event that the OT is not available, it may even save lives.

Also Read: Sutures- Types, Strength And Features

What Are The Procedures That Can Be Considered In The ICU?

• Procedures are regularly done in the ICU
  • Bedside laparotomy  
  • Tracheostomy 
  • Percutaneous endoscopic feeding access (PEG tube)
  • Percutaneous drainage procedure 
  • Placement of IVC filter
• Other procedures which may perform in the ICU
  • Irrigation and debridement of the wound
  • Orthopaedic stabilization of fractures
  • Fasciotomy 
  • Amputation 
  • Diagnostic laparoscopy

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Is It Safe to Consider a Beside Surgery?

Successful bedside surgeries can be performed if the following conditions are met: the cases are carefully chosen; the procedure is followed (to minimize mistakes and accidents); and there is a backup anesthesia team.

What are the Other Things Needed?

It is important to have the correct mindset when performing bedside surgery. It is also important to follow management criteria for procedures, personnel, and equipment.

Adequate supply chain should be in place; the intensive care unit may not be utilized on a daily basis. Procedural support staff, akin to the OT technician who can assist during the bedside operation, should be present. But items in the ICU need to be routinely inspected, maintained, and their expiration dates verified.  Successful ICU procedures are possible when all of the aforementioned variables are taken into account.

WHO Programme

 The "Safe Surgery Saves Lives" program was put into action by WHO.
It decreased mortality and morbidity during surgery.

The 10 objectives of the Safe Surgery Saves Lives Initiative

1. The team will operate at the appropriate location on the appropriate patient.
2. The team will employ techniques that are proven to shield the patient from pain while preventing injury from the administration of anesthetics.
3. If there is a life-threatening loss of respiratory or airway function, the team will notice it and take appropriate action.
4. The group will identify the possibility of significant blood loss and take appropriate action.
5. If the patient is known to be significantly at risk for an allergic reaction or an unfavorable pharmacological reaction, the team will refrain from causing it.
6. The group will constantly employ techniques that are shown to reduce the chance of surgical site infections.
7. The group will stop sponges and tools from unintentionally getting stuck in surgical wounds.
8. Every surgical specimen shall be properly identified and stored by the team.
9. The group will successfully communicate and share vital information to ensure the operation is carried out safely.
10. The public health system and hospitals will set up routing surveillance for surgery volume, capability, and outcomes.

Also Read: Image Based Questions On Retractors

Procedure Support Personnel

These individuals possess training in a specific process, are aware of the necessary instruments and protocol, etc.

If a procedure support people (PSP) is assigned during a surgical procedure, the following benefits will occur:

Lessens variability: The level of knowledge among the general staff members may vary; some may be conversant with ENT procedures while others may not be able to perform a tracheostomy. Employee training will assist prevent this from happening.

Guarantees adherence to standard operating procedures: A surgeon cannot perform surgery without competent support. PSP will assist the surgeon with the necessary measures and procedures.

Decreases miscommunication: PSPs are skilled and aware of what is required during surgery. Errors in communication are extremely rare.  Preserves the necessary skill set: PSPs are specially trained to assist the team and participate in procedures.

Protocols

In order to preserve consistency, protocols are necessary.
A protocol is a written document that aids in the following: Case selection;  Required staff;  Equipment;  Medication; Monitoring, which includes;  Blood pressure (BP);  ECG;  SPO2; Ventilation

The requirements may vary depending on the surgery.  It becomes simple to have a protocol ready for every type of operation that highlights the amount of personnel, equipment, and medications needed as well as the type of monitoring required. For example, a tracheostomy may require less personnel than a laparotomy.

ICU Time Our Checklist

Each intensive care unit has a separate time-out checklist, therefore they are not all the same. Before the surgical incision or the operation begins, the entire ICU team evaluates the patient's identity, the procedure, and the surgical site during the time-out. Team members are also given the opportunity to address any concerns they may have regarding the patient's safety or the process during this time.

Also Read: Image Based Discussion On Laproscopic, Diathermy Or Electrosurgery

Types of Procedures: Bedside Laparotomy

 Historically, laparotomies were viewed as the surgeon's heroic last resort.  Abdominal compartment syndrome is a common condition these days. This results in a large amount of fluid collecting, which raises intra-abdominal pressure; the diaphragm splints, respiration decreases, and pressure builds up on main vessels, producing numerous physiological abnormalities.

Consideration may need to be given to decompressive laparotomy if a patient has abdominal compartment syndrome (grade 3 or 4). Bedside laparotomies are now rather prevalent thanks to decompressive laparotomy.

Indications Of Bedside Laparotomy

Emergency Cases Where A Bedside Laparotomy Is Considered

 Packing and managing recurrent bleeding following damage control surgery (note: damage control surgery entails opening the abdomen, tending to bleeders, and then temporarily closing the abdomen) in patients with abdominal compartment syndrome  Intraabdominal collection in people who are very sick

Semi-Elective Procedures That Include Bedside Laparotomy Include

Remove the pack following damage control surgery;  Cleanse and drain the exposed abdomen (performed in patients suffering from mesenteric ischemia or necrotizing pancreatitis)..
Traumatic abdominal defects;  Source control for sepsis originating from intra-abdominal disease;

About 50% of patients die following a bedside laparotomy. This is so that bedside surgery can be considered for these extremely ill patients who cannot be moved from the intensive care unit to the outpatient department.

Hope you found this blog helpful for your NEET SS General Surgery preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.