j. Procedure During and After Surgery.
(1) Preparation of the litter. As soon as a patient has been transferred from
the litter to the operating table and while the patient is still in the OR, the litter is to be
stripped, cleaned as necessary, and "dressed" to await further use. These procedures
may be carried out by the circulating specialist or by another person assigned by the
OR Supervisor or NCOIC. The person who dresses the litter should also see that hand
towels and an emesis basin are at hand to accompany the patient to his post-operative
destination. Some postoperative patients become nauseated and vomit during transit.
The emesis basin and towels are used to keep the patient clean and comfortable.
(2) Delivery of the patient. Upon the completion of surgery, the patient is
lifted onto the litter and positioned. The safety straps are fastened, and he is
transported to either the recovery room or the nursing unit. Both his position and his
destination depend upon the type of anesthetic and the kind of surgery the patient has
(a) The patient who has been given a general anesthetic should be
placed in a lateral recumbent (side-lying) position unless this position is contraindicated
by the surgery performed. In which case the patient should be placed either supine (on
his back) or prone (on his abdomen), with his head turned to one side. Turning the
head to one side facilitates the normal drainage of secretions and helps prevent the
aspiration of secretions and vomitus. The endotracheal tube, if one has been inserted,
should be left in place and kept free from obstruction until the patient's gag reflex
returns. Usually, the anesthesiologist or anesthetist accompanies the patient to the
recovery room, and there is assisted by either the circulator or the specialist who
assisted with anesthesia during surgery. The patient who has had a spinal anesthetic
should be transported to the recovery room in either a dorsal recumbent (supine)
position or prone position.
(b) When brought into the recovery room, the patient may be
transferred to recovery room equipment or remain on the wheeled litter for care by
recovery personnel. (In either case, the specialist should put side rails in place to
ensure that the patient will not fall off the bed.) A patient expected to remain in the
recovery room for only a short time may afterwards be wheeled to the nursing unit on
the same litter on which he was brought to the recovery room. If a lengthy stay in the
recovery room is anticipated, the patient is often placed in a recovery room bed
immediately after surgery. An arrangement that provides for a minimum number of
transfers of the postoperative patient protects the patient who has had spinal or general
anesthesia from sudden and dangerous drops in blood pressure.