Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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102 Surgery and Healing in the Developing World
Operating Room Schedule
The surgical team leader, clinical coordinator, anesthesia team leader, and medical
records coordinator will meet after screening is completed to plan the OR schedule
for all five days of the scheduled mission week. This allows all screened patients
to find out if and when they are scheduled so they will have time for personal training.
There are several basic rules for Operating Room scheduling.
1. Schedule an ASA I patient as the first case for each table on the first operating
day. This is done so that any unresolved problems with the operating
room table or anesthesia set up can be resolved with the least possible impact
on the patient or the mission.
2. Schedule the youngest children as first cases each morning.
3. After the first morning, schedule complicated or long cases in the morning
rather than the afternoon.
4. Consider not scheduling children less than one year of age unless an experienced
pediatric anesthesiologist is available.
Preoperative
A. NPO guidelines
No solids, milk or food after midnight
Clear liquids are allowed three hours prior to surgery (individual variations
to be determined by the anesthesiologist)
B. Quality resource management and personnel
1. Proper management of anesthesia personnel is critical to mission success.
Determine the expertise of all of the team members as early as possible. first
by asking questions about training and current expertise, and then by observation
during the mission.
2. Assign the most difficult cases to the most capable practioners.
3. Delegate one extra anesthesiologist for every five operating tables to serve
as the “floater” (n+1). This person should be one of the most experienced
members of the team. The “floater” person will serve as: second team member
for the inductions, trouble shooter, PACU supervisor, emergency assistant,
break giver, and operating room manager (along with the clinical coordinator).
If the number of operating room tables exceeds five, two free
anesthesiologists are necessary (n+2).
4. Consult with the pediatric anesthesiologist for all emergencies involving
children and consider this person the final authority on critical anesthesia
decisions, regardless of who is serving as team leader.
5. Discourage independent operators. All missions are team efforts. We often
operate in a difficult environment with unfamiliar colleagues and equipment.
We must make a collaborative effort to ensure the highest-level safety.
To this end, the following methods should be employed for each anesthetic
delivered:
• Use of a precordial stetoscope is required.
• A pulse oximeter is required for all pediatric cases.
• The pulse oximeter must be placed on the patient prior to induction.
• Two anesthesia providers must be present on the patient for each induction
for children.