The purpose of this reflective study is to discuss a thorough understanding of the procedure of anesthesia. The case that I worked on along with other operation theatre professionals and practitioners is of a patient who was undertaking hysteroscopy surgery. Before taking up the surgery, I along with her operation theatre professionals had to make sure that the procedure of anesthesia is being conducted carefully. In this paper, I shall introduce how the procedure was undertaken along with the surgical techniques which were employed for the purpose of safe procedures. The reflective essay follows the pattern of the Gibbs cycle. By following the Gibbs Cycle, I will be able to discuss core observations during the operation. Furthermore, a great deal of medical guides has also been referred to solve the case without any mishaps and risk to the patient. Along with the elaboration of the procedure, I have also mentioned the case of a circulator as to what makes it more imperative during a surgery in an operation theatre.
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Anesthetic procedure, Surgical Instruments, and Conflict
The hospital where I work uses the anesthetic machine checklist. It was prospered by the Association of Anesthetists of Great Britain and Ireland. Such checklists are applicable only for anesthesia arrangements which are set along with monitors and security features. I get a lot of help from the anesthetic machine checklist in carrying out a systematic check of the anesthetic apparatus without missing any apparatus which might have an effect on our patient care for the period of anesthesia (Association of Anaesthetists of Great Britain and Ireland 1994).
On my analysis of the case during the operation, I observed that the machine used for the purpose of anesthetic is rechecked. The authorities that are responsible for checking such a machine are professionals and practitioners working in the operation theatre. The reason behind such a step before solving any case is for the reduction of any sort of mortality or expected postoperative mishaps. During this case, I got to note that our hospital is basically following the code of the AGGBI checklist before any operation. Following the procedure, it was noted that all the practitioners who were conducting the Hysteroscopy surgery made sure that the AGGBI checklist was rechecked (Davies and Cashman 2005). This confirms the surgical techniques to work in a consistent manner without any flaws. Disproportion is not at all expected in surgeries or any other medical operations. Being a circulator, I had to make sure that all the practitioners and other operation theatre professionals had clearly checked the machines so that further actions for surgery could take place. I also noted during the operation of the hysteroscopy case that surgical instruments and any other equipment must be put in their particular positions. When I made a record of the checklist I had to make sure that I have put the report in its appropriate positions. As suggested, I put the report on the anesthetic drawer where it was put before the case (Baggish, Valle, and Guedj 2007).
I have already researched the reasons why anesthetic machines need to be rechecked. A number of professionals have researched and investigated why the re-checking of an anesthetic machine is required. According to my analysis, I came to know that during the procedure of checking the surgical types of equipment that the need of handling surgical instruments, most importantly, the anesthetic machine is important because, during the procedure, the patient is prone to get into any type of mortality mishap. It is the vulnerability of the patient that greatly emphasizes the precautionary measure. Re-checking of anesthetic machines is one of the precautions that are taken by the professionals during any case. A similar check was observed in the specific case of hysteroscopy case being reflected (Pinnock 2002).
Knowing the fact that it is very important for the operation theatre professionals to check the anesthetic machine, I re-confirmed and reported to other professionals. I was aware of the fact that a little carelessness could cause a great deal of trouble for the patients. Thus, I have learned in the case operation that one needs to be very careful about each and every step to make sure that the patient is not at any risk. Some of the risks that are associated with poor checking of anesthetic machines could be problems in the circulatory system of the patient, swelling of body organs, etc. that lead to the death of a patient (Aitkenhead, Smith and Rowbotham 2007).
Furthermore, I also noted that suction pumps were available with other equipment. I found the availability of suction very important because in case secretions are noted. The removal of secretion is very important and thus availability of suction could considerably decrease any sort of risk associated with it. Another purpose of making suction available was gastric content removal so that easy contamination is possible. Suction can also be used for the need of removal of excessive blood. Operation guidance also notes that equipment such as suction is very helpful during aesthetical procedures or surgical operations (Davies and Cashman 2005).
Another important pointer that I noted during the operation and the aesthetical procedure was to note that it is the responsibility of an anesthesia professional to note the re-checking report of an aesthetical machine. No other practitioner is responsible for the purpose of checking it. According to the research that I have studied to understand the duty of an aesthetician, there is an ongoing debate. Some of the medical practitioners claim that it is a joint responsibility of two operation theatre practitioners (Kirkup 2006). The practitioners that are claimed so far are anesthetic practitioners and anesthetists. Being a part of the operation theatre professionals, I for sure fulfilled my responsibility of checking the machine. During the operation, I also made sure that all the types of equipment were settled and ready to use without any mishaps associated with the assembly of the equipment. According to the ethical considerations, it is expected that a practitioner who will not be able to take care of the equipment and fails to check the machines can be charged for his negligence. It could also become a serious problem for the experience of the practitioner in the field as well (Spry 2005).
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In the case of anesthetic procedures, it came to my understanding that operation theatre professionals are given enough time to make sure that there is no equipment available in the operation theatre that could be risky. For instance, equipment that could be unsafe or may lead to some inappropriate incident should be suspended from the operation theatre (Yentis, Hirsch, and Smith 2009).
Some of the types of equipment that were significant for the usage of anesthesia procedure included the operation table along with its extensions that were to be utilized during surgery. The purpose of such extensions is to clean any type of excessive substance. Other types of equipment that are most important for the procedure of anesthesia are warming devices. Intubation of air is also important equipment which is very imperative during an anesthetic procedure. I along with other practitioners also successfully made the flow of airways incubated. I was also notified that emergency types of equipment and drugs must also be present in case the patient’s condition becomes critical. For instance, during anesthesia procedures, it is noted that most muscles of a patient get contracted. In such a situation, it is preferred that muscle relaxants be used to reduce such a risk. Therefore, during the preparatory steps for the anesthetic procedure, I managed to provide all the emergency drugs that could be useful for the purpose of handling the critical situation of the patient. It included antibiotics and other anti-allergic drugs that are more likely to be used during the process of anesthesia. Furthermore, it is also preferred that the handling of drugs should be done carefully. During this case, I also happened to note that the above-noted drugs were to be placed on a separate shelf. The shelf could be a cabinet that could be locked for safety purposes. The cabinet can be accessed by the operation theatre professionals e.g. nurses or approved practitioners. During this case, as I was made responsible for making the drugs available, I had the access to the drug cabinet (Edmonson 1997).
According to another research, it is obliged that any instrument should not be used for more than 10 years. It also refers that hospitals should be aware of how the instruments which they are using during the operations are manufactured. So that the nurses who are responsible for the surgical instruments are aware of what kind is it. According to the research, the counting of the instruments should be done in the room where they are being put together assets by the doctor who will be involved in the operation (Wilson 2006). All the instruments which are found broken during the process must be kept in the account as well. Another research claims that it is not safe to take the instruments from the operation theatre during the operation. The safety of the operation room, the patient, and the staff who are involved during the operation is far more than can be imagined. According to research, it is important to follow the methods and process on a daily basis while keeping the above requirements in mind. For a trainee it is very important to have an understanding of the surgical items which will help him/her in using that instrument without any problems, this will help in reducing the risk of injuries. According to my own research, the doctor in the operation theatre needs to know the functions of each instrument and how to properly use it with care (Medina and Font 2007).
It is found through research that the instruments which are used by doctors are usually made of stainless steel or polymeric materials. The covering of the instruments needs to be proper during keeping them in the storage and at the time of handling since they can be sharp. I have found through this research that the sterilization of the instrument is very necessary. The sterilization process includes the instrument being steamed in the first place. Then it is dried by a drying cycle which is validated to be perfect for a particular instrument. Last is to protect the instrument after sterilization therefore it is wrapped in such a material that the instrument remains sterilized (Valle 1998).
The surgical instruments or their cases can be damaged if they are used for longer than mentioned time, mishandling and if forcefully handled. It is important to use the instruments with perfect care to avoid reducing their life. Research states that it is necessary to avoid the risk of injury by doing an inspection of it at the time of receiving it and after every time it is used. It also advises the practitioner to use the instrument for its real purpose and while using sharp surgical instruments, proper safety measures should be taken to avoid the risk of injury (Falcone and Hurd 2007).
According to research, we have come to know that to avoid increments in the temperature and moisture the processed and wrapped instrument cases must be stored according to a way to maintain the sterility. Also, it is important to take care of the wrapped cases in order to prevent their harm from the sterile barrier. It is suggestible for the health care facility that they should establish a shelf life especially for the wrapped instrument cases whose basis will be on the sterile type used and the sterile wrap manufacture recommendations. Another report says that the following precautions are necessary also for the handler that he should know about the event-relatedness of sterility, about the fact that probability of occurrence of contaminating event increases by time, with handling, and finally about the knowledge of usage of woven or non-woven materials, pouches or containers systems as the package method.
By the Spry (2000) statement it is concluded that a great financial investment can be done by the business in surgical instruments but it is also necessary for this business that effective measures should be taken to protect the investment by following the various precautions. So, we can say that a surgical instrument depends on the way of carried or handled. It is basically the duty of a surgical team that they should make sure that the instruments are not being misused and are maintained in a good manner.
Hysteroscope includes the instruments and types of equipment which comprise of Hysteroscopy Pressure Device and the Sterile Tubing. Other things include the vaginal instruments; Hysteroscopic Insufflations Medium, Position Aides, and the Sterile back supplies. The anesthetic machine has been checked by me and my mentor. It is calibrated correctly by the instructions of the manufacturer and we also made sure that it is functioning correctly and is ready to use. In this manner, we were done with the instrument preparations under great supervision, and to reduce different infection risks I also took help from the aseptic technique.
The association of operative registered nurses suggested that instruments and types of equipment should be properly arranged and checked a few hours before the operation and all the surgical instruments should be set according to the guidelines of a specialist or a particular surgeon. According to Rothon with an aim to protect and promote the art of surgical instruments different types of tools and instruments have been invented each of them is designed for a particular type of surgery. He stated that surgical instrumentation is interchangeably used with surgical instruments and this activity is beneficially helping surgeons to handle the surgical instruments properly during the operation. On another hand, Taylor and Compell stressed that there are only four main categories namely dissectors, clamps, retractors, and ancillary instruments and there is no standard nomenclature for particular instruments.
As the preparation was done, the patient was invited into the room for an anesthetic procedure. The patient was introduced to the professionals and the nurses. Later on, a form for patient consent was also collected along with the signature of the patient. Furthermore, consent was also taken so that the types of equipment could have been used to treat the patient. It is because, according to ethics, patients are free to use the right of knowing and managing the actions that are being done to their bodies. The procedure started with the first step of using monitoring devices to check the pulse of the patient
As noted earlier, the patient was being operated on for hysteroscopy surgery for which the patient was required to undergo an anesthetic procedure. There are some of the fundamental rules that must be followed during the case operation and especially during the procedure of anesthesia. My experience of practice was scheduled with a new operation theatre professional. During this case practice, it has been noted that the patient suffered an anaphylactic shock. The reason behind the shock was due to the precautionary measure taken by one of the nurses. It is referred to the responsibility of an ODP to make sure that the patient is free from any type of allergy. It is an important step of diagnosing process as well as a step of surgical technique to follow. Working with the new ODP was rather frustrating because the new ODP did not want to get hold of the pre-surgical check. It is for this reason; I considered it better to keep myself on back observation. While reporting the pre-surgical check, the new ODP did not mention that the patient was in a state of allergy. The fact is that I was aware that the patient had a penicillin allergy. I also tried to help the ODP realize that the consideration of allergy has been ignored. Despite my effort to help ODP realize the scenario, she rather ignored that.
Before the surgical treatment could have started, I raised my voice and challenged the new ODP that the patient had an allergy. In order to solve the matter, the ODP left the operation theatre and shifted herself to the anesthetic room. A debate burst out in the room as the ODP mentioned that there were no allergy bands found and also there was no report of allergy in the admission report of the patient. I deflated from the claim of the ODP and mentioned that the admission report of the patient needs to be checked again because the allergy has been mentioned earlier. I was concerned about the condition of the patient and thus I kept on challenging the new ODP until it was settled and proved. Our discussion was also witnessed by other operation theatre professionals and anesthetists in the room.
At the beginning of the case, when I was made to learn different pointers regarding equipment setting and precautions, I was ecstatic and highly enthusiastic about the fact that I was practicing my understanding. But when the ODP joined other professionals right after the admission of the patient, it was very confusing that the mentor selected for helping students in practice could not motivate me. I had no support from my mentor which was quite frustrating but I somehow managed to stay assertive and follow the procedural setting. During my practice, I was concerned about the fact that the shock could have been reduced if my mentor could have really understood my observation. Knowing the fact that the ODP was called for the operation but she could not recheck the checklist. Just because of the fact that I was a student there who was there to observe and practice, I was led down, and whatever I mentioned was ignored. Thus I would mention that I had been through annoyance because it could have been a reason behind the death of the patient. It was a de-motivating factor that the ODP despite being qualified could not follow the policy of the medical association. It was a scary scene when I saw the patient’s body swelling.
Evaluating Hysteroscopy and effects of Anesthesia
Hysteroscopy is a procedure that “involves the insertion of a narrow telescope-like instrument which is connected to a light source to illuminate the area which has to be visualized” (Daftary 2008). Hysteroscope is inserted through the vagina and cervix into the endometrial cavity of the uterus then this cavity is expanded with a fluid such as sodium chloride. The pumping of fluids enables surgeons to visualize and operate in an enlarged area.
Hysteroscopy is simply a pervasive intercession that is used to diagnose and treat a number of the endocervix and intrauterine problems. Particularly, it could help in determining reasons for abnormal bleeding and severe cramping which could arise from the problematic uterus or scar tissue that could result in infertility.
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Hysteroscopy facilitates the surgeons to find out the blockage of tubes and treat them by using special heated tools for opening any blockades. Another medical condition that could be helped by this procedure is the reoccurrence of miscarriages as it could assist doctors to identify and remove small fibroids or polyps. In addition, it also investigates a misplaced intrauterine device and helps to reposition it (Daftary 2008).
Hysteroscopy is performed as a short stay at a hospital with general or regional anesthesia. When it is performed under general anesthesia, the patient should not have to take any kind of meal not even water a night before the operation. In addition, a patient is asked to empty her bladder before the procedure, Routine lab tests should be ordered and a mild tranquilizer should be administered in order to relax the patient. The patient will not feel any pain after having general anesthesia. Mostly local anesthesia is used around the cervix and regional anesthesia is used to block nerves connected to the pelvic region (Medina and Font 2007).
In addition, with respect to this reflective study, the procedure of anesthesia was a challenge for the professionals. In this case, I got to understand about effects of anesthesia on the patient. The effects of anesthesia depend upon the type of anesthesia that is being given to the patient. Local anesthesia has lesser effects on the patient while general anesthesia is stronger in terms of effects on the patient. The effect of anesthesia could be understood in the form of numb consciousness of the patient. It is the effect of anesthesia that it supports tissues while injections are given during surgery. In this case, the same instance was observed. When the procedure of anesthesia was undertaken, it became easy for the professionals to insert an injection as the body consciousness became numb (Association of Anaesthetists of Great Britain and Ireland 1994).
Being a circulator in the procedure of surgery with its initial step of providing anesthesia was quite an experience. It was quite important for me to make sure that my attention was fully directed towards the scrubs that were operating the procedures. It is considered to be a very imperative role of scrub to make an account of all the equipment that will be needed during the procedure of surgery. Equipment includes some of the tools and materials such as swabs which are used much throughout the procedure. It was my duty to make sure that I provide scrubs with all required equipment. I did not wait for the scrubs to mention the need for equipment but rather, I had to concentrate on the entire operation to come up with my idea behind the usage of materials (Baggish, Valle and Guedj 2007).
The main duty of a circulator is to make sure that he is attentive and keen to observe and learn. The nature of the job duty of a circulator is to count the number of swabs that have been used during the operation. The requirement to note the general, as well as the used amount of swab, is because according to the hospital’s policy, the count must be reported after the operation. Thus, a circulator has to be sure that all the types of equipment are set according to the requirement along with its sterilization (Falcone and Hurd 2007).
Despite the fact that the preparation as noted briefly above, was perfectly done along with all the necessary needs of equipment, the new ODP did avoid the allergic concerns of the patient. The instruments were arranged and installed according to the surgical practice pointers to be followed. The process of sterilization was also conducted that made the instruments free from any types of germs making the operation risk-free. But the fact remains that the patient had to suffer shocks which are termed as a failure of a professional during the treatment of a patient. Even though, I raised my voice to make sure that risk is reduced regarding allergy the new ODP did not consider it important to reconsider the diagnostic report of the patient. Other than that, it was observed that the process of operation went successful as the equipment was set according to the pointers to be followed. It was also noted at the end of the operation that all the professionals worked together in a team in a flawless manner. In this way, the operation theatre team was able to reduce all types of risks. As a result, the outcome received was flawless and positive. The monitoring devices made it convenient for the professionals to gauge the problems that were taking place within the body of the patient. But due to the availability of equipment, blood pressure, heart rate, and other notable measurements became normal. In the meantime, it was also observed that the perioperative team was able to deal with patients’ families. The team updated the family with good news so that they can get a better idea and have less strain. After the practice case, it was noted that the ODP agreed to her mistake and was ordained to make sure that she writes an incident report to notify her mistake. According to the incident report, she signed that she will follow the World Health Organization checklist before any practical case operation.
At the last step of Gibbs’s reflective study cycle, I would now mention my action plan for further operation and practical case. I take the oath of the fact that I have enough knowledge of the medical profession and practicing medical operation procedures. Based on my knowledge regarding medical operation practice I will follow the policy of practices. I will make sure that I follow my duty properly and observe even the slightest action at the operation theatre so that there is no risk associated with the patient. The reflective study rather helps me to understand the fact that a patient’s well-being is the success and end product of this profession. I will make sure that I remain assertive with my key responsibilities. I will make sure that I remain assertive with other operation theatre professionals. I have also learned from my practical experience that the avid need for communication is imperative in the medical profession. I will make sure that I get a positive conclusion after every attempt to save patients. I also include in my action plan that newly appointed ODPs should not be sent to help students learn during the practice phase. It shall be noted that the ODP achieves mentorship and then gets assigned to help students in observation of surgeries and other medical procedures.
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