Operating Room Technique

PREOPERATIVE PREPARATION

OF THE PATIENT

Regardless of the physical setting in which an invasive or

surgical procedure will be performed, each patient should 

be adequately assessed and prepared so that the impact

and potential risks of the surgical intervention are 

minimized. This involves both physical and emotional 

preparation. Preoperative caregivers should establish a

baseline for the patient's preoperative condition so that

changes that occur during the perioperative/perianasthe-

sia care period can be easily recognized.

HISTORICAL BACKGROUND 

For centuries before the proliferation of operating rooms

(ORs) in hospitals, surgical procedures were performed

on battlefields, in barber chairs, and on kitchen tables.

Hospitals focused on the care of the poor, crippled,

chronically ill, and insane until the eighteenth and nine-

teenth centuries. Even then, and on into the early twen-

tieth century, many surgeons operated in their offices and

in the homes of their patients. Nurses were dispatched to 

the homes to prepare a suitable room and to prepare the

patient for the surgeon.

     From the late nineteenth century, the achievements in

surgery as a medical discipline can be attributed to an

increase in the understanding of physiology, the introduc-

tion of safe anesthetics and methods of blood transfusion,

the development of antimicrobials, and the management

of the patient before, during, and after invasive procedures.

As surgeons moved into the OR arenas of hospitals, nurses

became responsible for physically preparing patients for

surgical procedures. In the early 1900s, patients were

admitted 4 or 5 days before the procedure; by the late

1930s, this time was reduced to 24 hours or less.

      From around 1920, nursing leaders advocated the

importance of both the physiologic and psychologic

preparation of surgical patients. The individual needs of

patients were recognized but were not emphasized in

nursing education until the 1940s. During the 1950s

patient teaching became a limited part of preoperative

preparation as surgeons recognized the value of early

ambulation. It was not until the 1960s and 1970s that

nursing research studies validated a link between pre-

operative preparation and postoperative recovery. The

risk of postoperative physiologic complications can be 

reduced by teaching deep breathing, coughing, and leg 

exercises and by preparing the patient for early ambula-

tion. Attention to the patient's preoperative psychosocial

and spiritual needs also has important consequences for

the management of post operative pain and the promo-

tion of desired outcomes. Studies showed that the patients

who recieved structured preoperative teaching had a

smoother postoperative recovery. During those decades,

OR nurses were encouraged to visit patients preopera-

tively and prepare them psychologically for the surgical

experience by helping alleviate their fears and anxieties.

PREOPERATIVE PREPARATION OF

ALL PATIENTS

Specific activities such as the preoperative history and

physical examination are completed and documented

before the patient arrives in the OR. This process can be

performed before admission to the hospital or ambula-

tory care facility, other activities are performed when the

patient arrives. The preoperative physical preparation is 

designed to help all patients overcome the stresses of

anesthesia, pain, fluid and blood loss, immobilization,

and tissue trauma. Preparation often begins before the 

patient's hospital admission with the institution of nutri-

tional or drug therapy. An attempt is made to bring all 

patients to their best possible physical status before

surgery. Appropriate consultations, such as cardiac

workup, are sought when necessary.

                                              

- Berry and Kohn's operating room technique, pp. 364, 365