Speed in Surgery Operating on High Risk Patients

Speed is essential in surgery for patients who are critically ill or injured. The trauma triad of death is defined in human medicine as hypothermia, acidosis, and coagulopathy. Hypothermia develops secondary to wet skin from prepping, cold air in the anesthetic circuits, use of room temperature fluids (especially boluses of cold fluid to patients that develop significant hypotension intraoperatively), and the presence of open body cavities or extensive tissue exposure to room temperature. To counteract this, warming circuits should be used on anesthetic machines, fluids should be warmed, surgery tables should be heated, and patients should be kept warm with warm water circulating blankets, forced warm air circuits, and warm lavage fluids. Operating rooms should be set up and ready to go. In extremely critical patients it may be appropriate to have the surgeon gowned prior even prior to induction of anesthesia to minimize the amount of time the patient spends anesthetized.

Time, trash, and trauma must be minimized. This means the surgeon must have a thorough knowledge of anatomy since surgery for the critically ill or injured can take you anywhere. Indwelling implants or foreign material such as drains and suture material should be minimized. Necrotic tissue must be removed. Surgical technique should be as precise as possible and tissue must be handled gently. […]