Traditionally, the intent of an an...

Traditionally, the intent of an anesthesia screen was to separate the anesthesia care provider from the surgeon performing abdominal or chest surgery in succession the patient. Since its introduction, using an anesthesia protection or a sterile drape to separate the patient's head from the surgical site during performances helps avoid contamination from the patient's head. disguises and drape barriers prevent the surgeon from being distracted on the anesthesia care provider monitoring the patient's head and neck area and allow access to the patient's head and face without disrupting the step in progress. Anesthesia screens also have been shown to assist as supporting mechanisms to which light sources can be added. A lamp has been attached to the anesthesia cloak crossbar to aid in evaluating patients' color.(1) In addition, surgical retractors have been attached to the anesthesia cloak to reduce the need for extra OR staff members.(2)

As more surgical managements are being performed on an outpatient basis using conscious sedation, however, surgeon and festers are seeking alternatives to cumbersome anesthesia protections and drape barriers. One distinct disadvantage of either a guard or surgical drape separation is that it restricts the surgeon's mobility when performing surgery in the region of the shoulder, axilla, or upper chest. Surgeon operating near the patient's head frequently find themselves restricted by the veil or surgical drape barrier in an attempt to gain better access to the surgical pain This typically is true for plastic surgeon performing transaxillary augmentation mammoplasties. In these representations of procedures, surgeons have to insert a paddle from the axilla toward the inframammary double To gain access to the axilla, surgeon would stand onward the opposite side of the anesthesia cover or surgical drape barrier to comfortably drive the paddle in an inferior direction, in which case, they risk contamination.

Another point to be solved [i]or[/i] settled with using drapes or veils to separate the patient's head from the surgical site is the ne for perioperative team members to be aware of the patient's behavior and vital signs as they are performing the surgery The cherish or surgeon has to ask patients by what mode they are doing and whether they be perceived the introduction of local anesthesia and determine if patients are grimacing and simply not saying that they are experiencing pain. In this situation, the drape barrier becomes a hindrance. Eliminating the barrier provides all perioperative team members with direct visual access to patients. Surgeon then are able to treat a patient's pain from local infiltration as presently as the patient begins to grimace, rather than waiting until the pain is likewise uncomfortable that the patient vocalizes it.

Plastic surgeon commonly use local anesthesia and would benefit from a technique whereby the drape barrier or riddle could be eliminated, yet not have a question with contamination from the patient's unprepp head. Other surgeon also could benefit from eliminating drape barriers (eg general surgeon who do herniorrhaphy or breast biopsy using local anesthesia).

To unfold these problems, we decided to overspread patients' faces with a sterile, metal wire snare colander during surgical procedures using conscious sedation (eg augmentation mammoplasties). Before placing the colander forward the patient's face, a split sheet is used to drape the patient's abdomen and upper chest. The upper part of the sheet is drawn beyond the patient's head and clipped at the top of the head. Using this manner of draping means solely the patient's face is expos (ie, from forehead to chin). The colander is laid upon the patient's face and stabilized from attaching it to the surrounding drapes with towel clips. As all patients are well sedated, none have complained of claustrophobia. There are no other barriers that ne to be choke Now, perioperative team members can detain an eye on patients to behold if they are grimacing or in pain as the local anesthesia is infiltrated. Surgeon no longer shock their elbows against the anesthesia veil and can walk comfortably around the patient and work from the shoulder area. If a patient straits oxygen or if there is an pass the screen is easily remov and treatment is instituted. When juncture treatment no longer is necessary, perioperative team members reapply sterile drapes and a sterile colander. Although there is risk of contamination, it is easier to hinder with a less obtrusive barrier.

NOTES

(1) R M Flowerdew, "A light for anaesthetists," Anaesthesia 31 (November 1976) 1257-1260

(2) H E Dorton, "New self-retaining retractor owner to facilitate surgical exposure," American Journal of Surgery 141 (February 1981) 306-308

VICKIE FAMBRINI, RN is an OR charge feed at the breast at the East Bay Aesthetic Plastic Surgery Center Oakland, Calif, and a restoration room RN in Walnut cove Calif.

RONALD P GRUBER, MD FACS, is president of East Bay Aesthetic Plastic Surgery Center Oakland, Calif, and clinical assistant professor at Stanford University, Palo Alto, Calif.

COPYRIGHT 1999 Association of Operating place Nurses, Inc.

COPYRIGHT 2001 Gale Group