Key Terms

3-D printing

manufacturing process that creates three-dimensional (3-D) objects from digital files

amnesia

temporary or permanent loss of memory

analgesia

pain relief so the patient does not respond to painful stimuli during surgery

anesthesia awareness

the experience of consciousness and even pain during surgery with possible recall of events while under general anesthesia

anesthesia provider

a physician (anesthesiologist) or advanced practice RN (certified RN anesthetist [CRNA]) who is specialized in administering anesthesia and managing perioperative care

antisialagogue

medication (e.g., glycopyrrolate) that reduces salivation, minimizing the risk of aspiration during surgery

anxiolytic

a type of drug that reduces anxiety

appendectomy

surgical removal of an appendix

artificial intelligence (AI)

a robot or other computer system designed to perform tasks that typically require human intelligence

atelectasis

partial or complete collapse of lung tissue affecting gas exchange

bariatric surgery

surgical procedures on the stomach or intestines to induce weight loss

bowel preparation (bowel prep)

a medical procedure that involves the cleansing of the gastrointestinal tract, particularly the colon, in preparation for certain medical procedures or surgeries

cognitive awareness

a level of attention that results in a positive presence by being consciously aware of all the components in an interaction

dumping syndrome

after gastric bypass surgery, food gets “dumped” directly from the stomach pouch into the small intestine too rapidly without being digested, causing nausea, vomiting and abdominal cramping, and diarrhea

elective surgery

a nonemergent surgical procedure scheduled in advance to repair injuries or enhance appearance and function

electrosurgery

a technique or device that uses electricity to stop bleeding by burning tissue

emergent surgery

surgery that is performed without delay to address critical situations such as potentially life-, limb-, or organ-threatening conditions

expedited (scheduled) surgery

a planned, nonemergency surgical procedure for a chronic or progressive condition that, while not life-threatening in the immediate term, can lead to significant complications and impair quality of life if left untreated

general anesthesia

a potent cocktail of IV and inhalation medications that induce a state of controlled, reversible unconsciousness, amnesia, and analgesia with or without reversible muscle paralysis; the patient remains unarousable to painful stimuli

geriatrics

the study of the diseases of older adults

gerontology

the biological, psychological, and cultural science of old age and the aging process of adults throughout their lives

haptic interface

a type of human-computer interaction technology that is created by using force feedback via movement of a limb or the head to simulate bodily tactile sensations and movements, which can mimic the feel of touching natural objects

intraoperative stage

the period during a surgical procedure from arrival in the OR to closure and transfer to the PACU

intubation

insertion of an endotracheal tube into the mouth or nose and into the trachea to maintain an open airway, support breathing and ventilation, and provide oxygen delivery

laparotomy

a surgical procedure where a large incision is made in the abdomen to expose the abdominal cavity

laser

concentrated light beam used in surgery for cutting or cauterizing tissue, enabling minimally invasive procedures with greater precision and reduced blood loss

local anesthesia

numbing of a small, localized area through topical or injected anesthetic medications

malignant hyperthermia (MH)

a rare, life-threatening inherited, hypermetabolic disorder of skeletal muscles in reaction to certain anesthesia medications or a history of a muscular or neuromuscular disorder

medication reconciliation

a comprehensive review of the patient’s medication history: medications being taken at home, including ones that the patient should have been taking but may not be, and any medications administered in the preoperative area, OR, and PACU; this medication review should occur before discharge and is compared with any newly prescribed medications with a goal of identifying potential problems and resolving discrepancies

minimally invasive surgery (MIS)

a surgical technique using one or more small incisions or natural body openings

monitored anesthesia care (MAC)/moderate sedation

drug-induced state of depressed consciousness while maintaining reflexes

Multi-Angle Rear-Viewing Endoscopic tooL (MARVEL)

a flexible, robotic endoscope providing a panoramic view for surgeons of hidden anatomical structures, especially in confined spaces like the brain or spine

occupational anesthetic gas (OAG)

anesthetic gas and vapor that, while essential for surgery and pain management, pose health risks when personnel are exposed over time

operating room (OR)

a meticulously controlled environment designed to minimize patient risk (e.g., surgical site infections) during surgical procedures

patient-controlled analgesia (PCA)

a pain management system that allows the patient to self-administer small doses of IV pain medication within safe, preprogrammed limits, which are based on patient-specific factors like age and health

perioperative first assistant (also, registered nurse first assistant [RNFA], certified surgical first assistant [CSFA], surgical physician’s assistant [PA], perioperative nurse practitioner [NP])

scrub person with advanced education and training who helps the surgeon with tasks such as holding retractors and suturing

perioperative period

the entire surgical experience to include all stages of surgery

phase I recovery

the immediate postanesthetic period during which the PACU nurse ensures the patient’s full recovery from anesthesia and return of vital signs to near baseline

phase II recovery

preparing patients for discharge from the facility, which includes providing education regarding the postoperative instructions and prescribed discharge medications

polypharmacy

the use of multiple medications simultaneously to treat one or more medical disorders

postanesthesia care unit (PACU)

area where patients recover from anesthesia after surgery; previously known as the recovery room

preadmission testing

a range of examinations, laboratory or diagnostic tests, and procedures tailored to the specific patient and surgery to be performed that are completed before a procedure or surgery to evaluate a patient’s health status

preoperative assessment

conducting a comprehensive physical and psychosocial evaluation that includes reviewing past surgeries, medications, allergies, and any preexisting conditions and identifying potential risks

preoperative stage

a critical component of the perioperative experience that includes all the activities and preparations from the time surgery is decided on until the patient is transferred to the OR

regional anesthesia

numbing of a specific body region through spinal or epidural anesthesia

registered nurse first assistant (RNFA)

a perioperative RN with advanced education and training who helps the surgeon with tasks such as holding retractors and suturing

restricted zone

OR suite with actual OR rooms, the scrub sink areas, substerile rooms, central core, and steam sterilization areas; access restricted to personnel wearing surgical attire, hair covers, and masks

retained surgical items (RSIs)

surgical item unintentionally left inside a patient, which poses a severe risk to patient safety and causes an unacceptably poor patient outcome

RN circulator

a registered nurse who is not scrubbed in but whose primary responsibilities include managing the overall environment of the OR to ensure it remains safe, sterile, and efficient; the overarching roles of the RN circulator include being the primary patient advocate; orchestrating the environment and ensuring sterility; and collaborating with the anesthesia provider and scrub personnel

robotic-assisted surgery

a surgical procedure performed with a robotic system controlled by a surgeon

scrub person

the person (RN, technologist) who scrubs in during surgery to assemble and pass instruments and supplies to the surgeon and surgical team, label medications and fluids on the sterile field, count all required items, and manage specimens

semirestricted zone

includes the preoperative and postanesthesia care units and medication rooms; personnel are clothed in surgical attire

stage 1—immediate

the immediate stage of postoperative care is the period of time the patient is in the PACU, which may last a few hours or up to a day; stage 1 recovery is divided into phases I and II

stage 2—intermediate

the intermediate postoperative stage begins when the patient is transferred out of the PACU to a hospital room, to a convalescent facility, or to home; this stage can range from days to weeks depending on the surgery and healing progress

stage 3—convalescence

the convalescence stage begins when the patient is home and includes gradual rehabilitation and resumption of normal activities; this phase can take weeks or months, varying greatly based on the individual

sterile technique

a set of specific practices and procedures employed to maintain sterility of the sterile field (e.g., equipment, instruments, drapes)

sterility

state of being free from living microorganisms (e.g., germs, spores)

surgeon

a medical provider trained to perform surgical procedures who bears the ultimate responsibility for the surgery and members of the surgical team

surgical asepsis

the absence of all microorganisms in any type of invasive procedure, achieved through rigorous sterilization processes and meticulously maintained through sterile technique

surgical attire

personal protective equipment used to prevent personal and environmental contamination; determination of what to wear (e.g., scrubs, surgical gowns, gloves, masks, hair coverings, shoes, face shields) depends on the area of surgical suite and the risk of contamination

surgical conscience

a moral code of integrity that compels a person to speak up when an infraction has or is thought to have occurred, to prevent patient harm

surgical count

the process of counting all item that may possibly be retained in a patient during a surgical procedure to identify and prevent count discrepancies and the occurrence of retained surgical items

surgical site infection (SSI)

infection that occurs at or near a surgical incision within thirty days of the procedure or within one year in the case of organ or space infections with an implant

surgical smoke

contains potentially harmful particles that are produced by thermal destruction of tissue when using electrosurgical and radio-frequency devices, lasers, ultrasonic scalpels, power tools, and other heat-destructive devices in the operating room

surgical zone

segmented area in the surgical suite with distinct function and attire requirements; a zone may be unrestricted, semirestricted, or restricted

telesurgery

remotely performing surgical procedures from a distance using robotic systems and telecommunication technology

time-out

a specific verification process that occurs as a short pause just before induction of anesthesia, before the initial surgical incision, and before the patient leaves the OR to confirm that the team is about to perform (and has performed) the correct procedure on the correct body part of the correct patient

unrestricted zone

where nonsterile activities like patient admission and transport occur; includes the admissions area, offices, changing areas, break rooms, and supply receiving and storage; street clothing is allowed

urgent surgery

typically occurs within hours of the decision to operate for an acute situation, and if resuscitation was required, it has been performed and resolved; although urgent, time is available to allow for more efficient identification of a surgeon, anesthesia provider, perioperative personnel, and available operating room time