Chapter 19: Intraoperative Nursing Care

The operating room functions as a meticulously controlled environment organized into unrestricted, semirestricted, and restricted zones, utilizing positive-pressure ventilation systems, temperature regulation, and rigorous sterilization protocols to prevent healthcare-associated infections. The perioperative nursing team includes circulating nurses who maintain environmental safety and documentation, scrub nurses who preserve sterile field integrity, and registered nurse first assistants who provide direct surgical support including hemostasis and tissue manipulation. Anesthesia care providers encompass anesthesiologists, certified registered nurse anesthetists, and anesthesiologist assistants who manage patient consciousness, airway protection, hemodynamic stability, and pain control through various modalities including general anesthesia with intravenous induction agents and inhalational anesthetics, regional techniques such as spinal and epidural blocks, monitored anesthesia care, and moderate sedation protocols. Critical nursing interventions include systematic room preparation with instrument counting, safe patient positioning to prevent nerve compression and circulatory compromise, adherence to surgical scrubbing and gowning procedures, implementation of surgical site preparation with antimicrobial solutions, and application of electrosurgery safety measures. The chapter emphasizes recognition and management of life-threatening intraoperative emergencies including malignant hyperthermia triggered by volatile anesthetics or succinylcholine requiring immediate dantrolene administration, anaphylactic reactions necessitating epinephrine and fluid resuscitation, and positioning-related injuries. Quality improvement initiatives include Surgical Care Improvement Project protocols for antibiotic prophylaxis and venous thromboembolism prevention, World Health Organization surgical safety checklists with mandatory time-out procedures, and structured communication using SBAR methodology to ensure accurate information transfer and minimize adverse events throughout the perioperative continuum.