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Preparation of the Patient. - Special Surgical Procedures - MD09280045

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(3)  The lighting of the room is provided for in accordance with the desire of
the surgeon. The circulator is to carefully check all details of lighting.
(4)  Tonsil snare wires must be prepared correctly. The loop in the snare
wire must be large enough to pass over the handle of the tenaculum, but it must not be
so large that its size prevents cutting through the pedicle of the tonsil. The scrub is to
prepare the snares in accordance with local policy.
(5)  The mouth gag used must be of a correct size (not too large) to avoid
inflicting injury to the patient's gums and lips and to avoid the danger of dislodging or
breaking any teeth.
(6)  Special straight or curved needles with a security stop are used for the
injection of the local anesthetic agent.
(7)
Sponges are normally handed on a curved hemostat.
(8)
Suction cautery is used for control of bleeding.
c. Preparation of the Patient.
(1)  If a general anesthetic is to be administered, the patient is anesthetized
first, then placed in a slight Trendelenburg position. The neck is hyperextended by
placing a roll under the shoulders. If a local anesthetic is to be administered, the patient
is placed in a sitting position.
(2)  The patient's face may be cleaned with a germicide. The patient is
draped as follows:
(a)  An opened sheet and two opened towels are placed under the
head of the patient.
(b) The uppermost towel is wrapped around the head and secured by
forceps, and the free ends of the towel are tucked under the head.
(c)
A second sheet is placed over the patient.
d. Operative Procedure.
(1)  When a general anesthetic is used, the mouth is retracted open with a
self-retaining retractor, the tongue depressed with a blade retractor, and an anesthesia
tube placed in the corner of the mouth. An efficient suction apparatus is most important.
The tonsil suction tube is introduced gently and passed along the floor of the mouth,
over the base of the tongue, and into the pharynx. During the procedure, the suctioning
ensures adequate exposure of the operative site and prevents blood reaching the lungs.
MD0928
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