Special Surgical Procedures II
LESSON 1: Eye, Ear, Nose, and Throat (EENT) Surgery
Section I: EYE SURGERY
1-2
1-2. SPECIAL PREPARATION OF THE OPERATING ROOM
a. Instruments. All instruments used for eye surgery are made for this purpose, and are unlike those for surgical procedures in other areas of the body. Preferences for instruments vary so widely among eye surgeons that it may be necessary to list all instruments used for each operation by each different surgeon. Therefore, the surgeon's card must be carefully checked when selecting instruments for an eye operation.
b. Sponges. Gauze sponges are considered much too rough for use on an eyeball. Instead, dampened cotton applicators are used. Special cellulose sponges, specifically designed and prepackaged sterile by manufacturers for eye surgery, are also available.
c. Magnifying Glasses. The surgeon may wish to use special magnifying glasses during the procedure; therefore, these must be cleansed and ready for use.
d. Lighting. Illumination for eye surgery may be furnished by a number of methods.
(1) One method is the use of the standard overhead light. The circulator may be responsible for adjusting the light during surgery. If this need occurs, he should pay particular attention to not contaminating the sterile field and scrubbed personnel.
(2) A second source is the use of an electric head lamp. This lamp is strapped to the surgeon's head and is used in the same manner as a coal miner's helmet. The surgeon may redirect the light during surgery.
(3) The third method is the use of the operating microscope. This is a device used to magnify the site of surgery and enable the surgeon to do very delicate work with excellent illumination. This device is draped with sterile material before the procedure is started, and the surgeon may make any adjustments. The microscope is being used more and more for eye and other delicate surgery.
e. Medications. As many as 5 or 6 solutions may be kept within the sterile field for use during eye procedures; examples of these are saline (for dampening the eyeball), local anesthetic agents, and epinephrine. If these are not prepackaged and sterilized in individually labeled doses, the specialist should label medicine glasses to show the name and the strength of each solution. During preparation for an operation, the circulator should pour the solutions needed into the medicine glasses, making sure that the
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solution he is pouring matches the label on the glass. Great care should be taken to assure that ophthalmic solutions of the desired drugs are used.
f. Sterile Setup. If both of the patient's eyes are to be operated on for correction of defects requiring muscle surgery or other extraocular procedures, only one Mayo table needs to be up. However, if intraocular surgery is to be performed on both eyes, the specialist sets up two tables--one for each eye. When the procedure on the first eye is completed, the surgeon and specialist change only their gloves in preparation for the second eye.
NOTE: A large percentage of intraocular surgery does not require double setups.
Advancement in techniques and equipment makes the practice ineffective
and costly.
