Ivette Juarez, Christine A. Valdez, and Marbella Lopez Department of Small Animal Surgery, Gulf Coast Veterinary Specialists, Houston, TX, USA This chapter focuses on the detailed preparation of the patient, operating room setup, instrumentation setup, and intraoperative and postoperative considerations when managing an abdominal exploratory procedure. Immediately prior to an abdominal procedure, the operating room is set up with the appropriate equipment and instrumentation depending on the type of abdominal procedure (Box 1.1, Figure 1.1). Creating a list of commonly used instruments and surgeon’s preferences for a variety of procedures may help with efficiency when setting up an operating room (Figure 1.2). Heating systems should be turned on. Intravenous fluids are spiked and primed. Anesthetic machines are checked for leaks (Figure 1.3), and an induction area is prepared (Figure 1.4) with the necessary materials (Box 1.1). At this point, the patient has had the appropriate diagnostic imaging and the required blood work, and an intravenous catheter has been placed. Once general anesthesia is induced, the patient is positioned in dorsal recumbency. Monitoring equipment may then be attached, including but not limited to electrocardiogram, pulse oximetry, noninvasive blood pressure, and a capnometer. If a patient’s position needs to be adjusted at any point, it is ideal to disconnect the breathing circuit from the patient’s endotracheal tube to prevent extubation or tracheal damage. Since the duration of anesthesia correlates with infection rates, preoperative preparation should be thorough but efficient. Clipping should be performed outside of the operating room to minimize contamination. The technician should wear exam gloves while clipping. With a #40 clipper blade, shave the patient’s ventrum cranial to the xiphoid (mid‐thorax), caudal to the pubis, and lateral to the mammary chain (Figure 1.5). Be sure to watch the temperature of the clipper blade. If the blade becomes palpably hot, either replace the blade or spray it with a cooling lubricant. In areas with friable, thin skin, it is advised to have steady movements to reduce the risk of unwanted abrasions. After clipping is completed, a vacuum can be used to pick up loose hair. Figure 1.1 (a) Equipment and instrumentation in the operating room. (b) Instrumentation for an exploratory laparotomy laid out. The cranial and lateral shave margins will remain the same. The caudal clip should extend to the scrotal region in dogs, and if a urology procedure is being performed in cats, the caudal clip should extend dorsal to the prepuce. When shaving around the prepuce, care should be taken near the mucocutaneous junction to not nick the edges. After the clipping is complete, the prepuce should be flushed with diluted povidone‐iodine using a syringe. This is done by grasping the edge of the prepuce, inserting the syringe tip, pinching the prepuce, and then injecting the povidone‐iodine (Figure 1.6). While still pinching with one hand, massage the prepuce with the other hand to loosen any debris. Place an absorbent pad over the prepuce and expel the flush. This is repeated three times or until the flush is clear. In urology procedures, include the vulva in your shaving margins for intraoperative catheterization. Figure 1.2 Example of a procedure instrument list. Figure 1.3 Anesthetic machine, intravenous fluids, monitoring equipment, and heating systems ready to be used. Figure 1.4 Induction area prepared. Figure 1.5 Patient has been shaved. Supplies for a “dirty” scrub are laid out. Figure 1.6 A syringe filled with diluted povidone‐iodine being inserted inside the prepuce. The technician should replace their gloves for the “dirty” scrub. Have two stacks of nonwoven gauze set aside. Keep one stack dry and the other one mildly dampened with water (Figure 1.5). Lightly pour chlorhexidine scrub onto the dampened gauze. Begin scrubbing from the center of the abdomen and continue moving outward in a spiral course until the shaved region has been covered. Avoid an aggressive scrubbing motion to reduce the risk of skin irritation and inflammation. Follow it with the dry gauze to clear excess lather. This combination is repeated a minimum of three times or until the gauze no longer contains visible debris. For long‐haired patients, water or ultrasonic gel can be used to push the hair down to keep it away from the surgical field.
1
Preparing for an Abdominal Procedure
Introduction
Preoperative Steps
Equipment Preparation
Skin Preparation
Male
Female
Transportation into the Operating Room
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