Glossary of terms
Removal (to remove something).
Narcosis. Most surgical procedures cause pain and are stressful and traumatic experiences for the patient. In order to spare the patient from pain and stress, anesthesia professionals are needed to protect the patient from harm. Anesthesia entails removing the sensation of pain by administering anesthetic agents and pain medication in optimal combinations, often also producing sleep. Anesthesia providers also give medication to achieve a suitable degree of muscle relaxation, to ensure optimal surgical conditions.
The administration of the above substances often disables spontaneous breathing and necessitates assisted or mechanical ventilation. An anesthesia machine is used to help the anesthesia provider to induce and maintain adequate anesthesia and optimize the patient’s ventilation. The presence in blood of pharmacological substances which act on the central nervous system, as well as the need of mechanical ventilation, call for accurate control, monitoring and documentation of the anesthetic effect and of the patient’s vital functions. The anesthesia providers are responsible for the patient’s well being throughout the process, including the phases before and after the surgical procedure.
Open connection, for example, between blood vessels (may be natural or created surgically).
Artificial blood vessel implants.
Care of morbidly obese patients.
Technology that improves blood circulation in a patients’ coronary artery in the heart by forcing blood into the coronary artery with the help of a balloon pump placed in the aorta. The pump works in sync with the heart rhythm and increased blood circulation in the coronary artery supplies more oxygen to the heart muscle, which thus improves its ability to pump.
Pertaining or belonging to both heart and lung.
Pertaining or belonging to both heart and blood vessels.
Heart and blood vessel diseases.
Surgical treatment of cardiovascular diseases.
Critical care is a non-linear journey for a patient starting with an acute life-threatening disease process that can quickly go in one of many treatment directions. Patients are brought to critical care unit through many pathways: after major routine or emergency surgery or because of trauma, acute or chronic illness. While a patient’s journey continues, care providers continuously monitor and support the failing vital functions such as ventilation, circulation or central nervous system, as well as provide the body with nutrition. The variety of monitoring facilities range from the non-invasive heart rhythm and oxygen saturation to sophisticated invasive measurements like blood pressures inside the heart. With the help of sophisticated alarm systems, patient monitoring assists the care providers in managing abnormal physiological events. The patient’s vital functions may need to be supported by infused drugs, mechanical ventilation, dialysis or even extracorporeal oxygenation.
The patient’s journey requires that care providers call on the support of various disciplines such as laboratory, consultation of different specialties, diagnostic imaging or surgery. It is necessary to be able to integrate the disparate data from clinical evaluation, diagnostic measurements and patient monitoring into care information, which supports clinical decision making and therapy selection. The care providers are responsible for managing the patient’s daily activities as well as for documentation of all procedures and their outcomes. Critical care units are well-defined independent entities within the hospital, supported by space, manpower, professional skills, technical equipment and life support techniques. Some hospitals may have one unspecialized Intensive Care Unit (ICU) whereas the larger hospitals may have several specialized ICUs. The length of a patient’s journey may be a few precious moments, days or even weeks, but the ultimate goal is to restore the patient’s health and former quality of life.
Single-use or reusable devices intended for use with patient monitors and anesthesia machines, e.g. pulse oximetry probes, ECG electrodes and gas sampling tubes
Having a short and relatively severe course; urgent
Set of instructions for a computer to perform a function, for example
Anesthesia machine (Anesthesia delivery unit)
A combination of modules for the delivery of determined gas concentrations and volumes to a patient during general anesthesia
A patient monitor specifically designed for anesthesia
A record of an anesthetic, either manual or electronic
An anesthetic drug used to induce and maintain anesthesia
Radiographic visualization of blood vessels, following introduction of a contrast material
Abnormal rhythm in the beat of the heart or irregular electrical activity in the heart
High resolution screen and powerful computer with software to automatically identify type of abnormal heart activity
Pertaining to hearing
Auditory evoked potential
A change in the brain’s electrical activity as a response to auditor y stimuli
Pertaining to the heart
Doctor specialized in the study of the heart and its function
Data on the patient and the therapies which is integrated to help improve patient outcome and processes
Mobile X-ray device for real-time, continuous viewing (fluoroscopy) during surgical and interventional procedures
Monitoring of several patients simultaneously, by means of networked monitors
X-ray imaging to determine specific structures and landmarks as a basis for orthodontic therapy
Regular movement of blood through the heart, blood vessels and organs to transport oxygen, nutrients and metabolic products
Clinical information system
A software-based information system used to collate, process, print and archive clinical data
The area and processes in a hospital used to treat a patient whose life is at immediate risk
Critical care monitor
A patient monitor used to measure and display vital signs specific to critical or intensive care
Computed radiography (CR)
The creation of digital images by laser scanning of data on intermediate storage phosphor plates
Patient monitors with fixed capabilities
Pharmaceutical treatment for various types of cancer. Also known as cytotoxin.
A procedure to find the cause of an ailment
Imaging for clinical diagnostic purposes, e.g. X-ray
Ultrasound method commonly used to assess flows, such as in a blood vessel or the heart.
Application of com puting power to detect, document, s tore and anno tate arrhythmia from the 12-lead standard throughout a 24-hour period, for example
Electrocardiogram, a recording of the heart’s electrical activity, using 12 standard leads
Electroencephalography, recording of brain’s electrical activity
Electromyography, recording of skeletal muscle activity
Endoscopic vessel harvesting
Minimally invasive (see below) technique that removes part of a blood vessel (often in the leg) and uses this blood vessel to replace the diseased coronary artery.
Operation on the cardio and vascular system conducted without invasive surgery. Through small holes in the skin and selected blood vessels instruments are inserted into the vessel where the surgery takes place.
The measure of a degree of disorder
A subcategory of the medical speciality cardiology (cardio and vascular diseases), which involves active operations in addition to medication. May include cardiac assist (see above), for example.
Premarket approval issued by U.S. Food and Drug Administration
A device utilizing glass fibre, or other substrate, to transmit light
Full-field direct digital
In mammography, imaging of all breast tissue, converting X-rays to electrical signals
A process by which certain small molecules can be removed from the blood, necessary when the kidneys are not functioning
The ”sleep” component of an anesthesia
Hypoxic respiratory failure
Inability to breathe efficiently, due to lack of oxygen at tissue level
Intensive Care Unit
Apparatus for maintaining new born babies in an environment of controlled temperature, noise, humidity and oxygen concentration
Area close to the operating room where anesthetic is started
Intensive care unit
A hospital unit for treating critically ill patients, see critical care
Diagnostic imaging made during a procedure performed on a patient
Inside the mouth
A syndrome characterized by deposition of bile pigment on the skin, yellow appearance
The ability to both easily screen and effectively treat jaundice is crucial to newborn health. Recent medical focus on minimal stress therapies has led to the development of jaundice screening and therapeutic solutions that are non-invasive, simple-to-use, and highly effective.
Diagnostic imaging method used to screen for breast cancer
Pertaining to the upper jaw and face
Maintaining a patient’s ability to breathe through a ventilator (respirator).
Bacteria, viruses, fungus and similar organisms that can only be observed through a microscope.
Minimally invasive instruments
Various types of instruments that make it possible to conduct treatment and other measures through very small operations without the need for major surgery. The benefits of minimally invasive operations include less pain for the patient, shorter rehabilitation periods and lower costs.
A relaxed state of skeletal muscles that is produced to immobilize the area of surgical operation
Newborn, pertaining to the first few weeks of life
Neonatal Warming Therapy
From the beginning of the 20th century, the impact of a newborn's body temperature on its mortality is well known. New developments offers warming therapy solutions for the neonatal intensive care unit, labor and delivery, as well as neonatal transport.
Anesthesia for surgery on the nervous system
Neuromuscular transmission (NMT)
Degree of transmission of signal between nerve and skeletal muscle; a monitoring modality
NO, a vasodilator
Branch of surgery concerned with the skeletal system
The component in perfusion products (see below) that oxygenates the blood during cardio surgery.
The measurement of oxygen saturation of the blood
Degree to which the hemoglobin in the red blood cells is bound with oxygen
Treatment by additional oxygen
A wide view
A variable whose measure is indicative of a function which in itself cannot be measured
A device used to measure and display a patient’s vital signs
Pertaining to children
Artificial circulation of body fluids, such as blood
Products that handle blood circulation and oxygenation during cardio surgery, often referred to as heart-lung machines.
Pertaining to events before, during and after birth
Pertaining to medicinal drugs
Treatment with light
The place where a patient is and care actually takes place
Ulcers that arise as a result of blood flow to the skin being limited by external pressure. Most often affects patients with limited mobility
Pertaining to the lungs
A non-invasive device used to measure oxygen saturation of pulsating arterial blood.
A device which warms the patient by radiating heat
A physician specialized in x-rays and other radiation in the diagnosis and treatment of a disease
Ability to distinguish between
Problems with bacteria that have become resistant to penicillin or other antibiotics
Imaging of a small volume of (breast) tissue, of ten to guide a procedure, e.g. a biopsy
Technique of using coordinates in three planes to assist in accurately reaching structures deep in tissue
Patient care other than critical care
Aspiration of a gas or liquid by mechanical means
Generic disposable or reusable items used with patient monitors and anesthesia machines, e.g. airway filters and humidifiers and breathing tubes
To remove something surgically
Providing medical care from afar by real time video conference at a hospital or with external specialists
Remote monitoring of a patient using wireless transmitters/receivers
Tissue damage caused by an outside force
The component in an anesthesia machine that vaporizes a set concentration of an anesthetic agent into the fresh gas
Pertaining to the blood vessels
A substance capable of dilating constricted blood vessels
The process of exchange of air (or gas mixtures) between the lungs and the ambient air (or patient circuit); aside this, in case of apnea or impaired spontaneous respiration, supporting ventilation measures must be instituted
An adjustable positive pressure generator that maintains ventilation during anesthesia or respiratory depression
The signs of life of a person; e.g. blood pressures, heart functions, respiration, temperature
Electromagnetic vibration with very high energy.
Types of surgery
Many surgeries are categorized as general surgery, and are associated primarily with accidents, emergencies, and trauma care. Hospitals have general surgeons that staff their emergency rooms or trauma centers. As surgical technology and knowledge have advanced, other surgical specialties have developed for each function and organ of the body. They involve special surgical techniques and anesthesiology requirements, and sometimes require subspecialtists with in-depth knowledge of organ function, operative techniques, complex anesthesiology procedures, and specialized nursing care.
The basic surgical specialties include:
* General surgery—General surgeons manage a broad spectrum of surgical conditions that involve almost any part of the body. They confirm the diagnoses provided by primary care or emergency physicians and radiologists, and perform procedures necessary to correct or alleviate the problem.
* Cardiothoracic surgery—A major surgical specialty with very high demands. The cardiothoracic surgical team oversees the preoperative, operative, and critical care of patients with pathologic conditions within the chest, including the heart and its valves, cancers of the lung, esophagus, and chest wall, and chest vessels.
* Neurosurgery—Neurosurgical teams specialize in surgery of the nervous system, including the brain, spine, and peripheral nervous system, and their supporting structures.
* Oral and maxillofacial surgery—Head and neck surgical teams provide treatment for problems of the ears, sinuses, mouth, pharynx, jaw, and other structures of the head and neck.
* Reconstructive and plastic surgery—Reconstructive surgery is performed on abnormal structures of the body due to injury, birth defects, infection, tumors, or disease. Cosmetic surgery is performed to improve a patient's appearance.
* Transplantation—Transplant surgical teams specialize in specific organ transplant techniques, such as heart and heart-lung transplants, liver transplants, and kidney/pancreas transplants. These highly intricate surgeries require very advanced training and technological support.
* Urology and renal transplantation—Also known as gastrointestinal surgery. The team specializes in problems of the digestive tract (stomach, bowels, liver, and gallbladder) with intensive use of or coordination with transplant team members.
* Vascular surgery—Vascular surgery offers diagnosis and treatment of such arterial and venous disorders as aneurysms, lower extremity revascularization, and other problems.
* Pediatric surgery—Pediatric surgical teams are specially trained to treat a broad range of conditions affecting infants and children. They work closely with specially trained anesthesiologists, and are experts in childhood diseases of the head, neck, chest, and abdomen, with training in birth defects and injuries. Many pediatric surgeons work to increase the use of minimally invasive techniques with children.
Open surgeries requiring invasive procedures within the abdominal cavity, brain or extensive limb areas require a hospital stay overnight or up to two weeks. Hospitalization allows the clinical staff to monitor patient recovery (and provide medical attention in the case of a complication), while allowing patients to regain organ functions.
Surgery has been revolutionized by new technology. Ambulatory or outpatient surgeries account for an increasing percentage of surgeries in the United States. Imagery with miniature videoscopes that pass into the patient via tiny incisions is an example of how minimally invasive procedures are replacing open surgeries. Minimally invasive surgeries reduce recovery time and increase the speed of healing. Outpatient or ambulatory surgery environments often allow patients to recover and go home the same day. In such specialty surgery centers, as those designed for ophthalmology, surgery is performed as part of a physician's office practice. These centers contain their own operating rooms and recovery areas.
Minimally invasive procedures that involve the use of a video scope as an exploratory as well as viewing instrument, include the following:
* Arthroscopy—allows viewing of the interior of joints, especially the knee joint.
* Cystoscopy—used to examine the urethra and bladder.
* Endoscopy—much like the laparascope, the endoscope is used in gastrointestinal surgeries of the esophagus, stomach, and colon.
* Laparoscopy—an illuminated tube with a video camera inserted in small incisions in the abdomen.
* Sigmoidoscopy—used for examining the rectum and sigmoid colon.
Types of anesthesia
Surgical procedures and the surgical setting may be associated with different types of anesthesia:
* General anesthesia renders the patient unconscious during surgery. The anesthesia is either inhaled or given intravenously. A breathing tube may be inserted into the windpipe (trachea) to facilitate breathing. The patient is carefully monitored and wakes up in the recovery room.
* Regional anesthesia numbs the surgical section of the body. This is usually accomplished via injection through the spinal canal (spinal anesthesia) or through a catheter to the lower part of the back (epidural). Regional anesthetics numb the area of the nerves that provide feeling to the designated part of the body.
* Local anesthesia medicates only the direct operative site, and is administered through injection. The patient remains conscious during the operation.
The basic surgical team consists of experts in operative procedure, pain management , and overall or specific patient care. Team members include the surgeon, anesthesiologist, and operating room nurse. In teaching hospitals attached to medical schools, the team may be enlarged by those in training, such as interns, residents, and nursing students.
SURGEON. The surgeon performs the operation, and leads the surgical team. Surgeons have medical degrees, specialized surgical training of up to seven years, and in most cases have passed national board certification exams. Board certification means that the surgeon has passed written and oral examinations of academic competence. The American Board of Surgery, a professional organization that strives to improve the quality of care by surgeons, is the certifying board for surgeons. As a peer review organization, the College has advanced standards to certify surgical competence by allowing examined surgeons to become a fellow of the organization. Fellows of the American College of Surgeons (FACS) are the elite members of the profession. An FACS designation after a physician's name and degree denotes attainment of the profession's highest training and expertise. Surgeons' credentials may be explored through the Official American Board of Medical Specialties, available at libraries or online.
ANESTHESIOLOGIST. Anesthesiologists are physicians with at least four years of advanced training in anesthesia. They may attain further specialization in surgical procedures, such as neurosurgery or pediatric surgery . They are directly or indirectly involved in all three stages of surgery (preoperative, operative, and postoperative) due to their focus on pain management and patient safety.
CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). The certified nurse anesthetist supports the anesthesiologists, and in an increasing number of hospitals, takes full control of the anesthesia for the operation. Registered nurses must graduate from an approved nursing program and pass a licensing examination. They may be licensed in more than one state. While states determine the training and certification requirements of nurses, the work setting determines their daily responsibilities. Certified registered nurse anesthetists must have advance education and clinical practice experience in anesthesiology.
OPERATING NURSE. The general nursing staff is a critical feature of the surgical team. The nursing staff performs comprehensive care, assistance, and pain management during each surgical phase. He or she is usually the team member providing the most continuity between the stages of care. The operating nurse is the general assistant to the surgeon during the actual operation phase, and usually has advanced training.
The Type of Surgical Instruments Used by an Orthopedic Surgeon:
Orthopedic surgeons try to restore the function of the skeletal system. This can include a hip replacement or hand surgery to release tendons for Carpal Tunnel Syndrome. The range of skill and instrumentation is wide. It can mean that the surgeon can use power drills in one surgery and delicate micro-surgical instruments in another. Most of the instruments used in orthopedic surgery are specialized and are classified according to their function.
There are cutting instruments used to cut through or remove bone, such as a ball joint from the hip or a limb. Most of the cutting instruments are powered tools. There are some that are used by hand, such as a straight hand saw or one that is called a "gigli saw." The gigli saw is a long wire with teeth that attach to handles. It is used to cut through bones in the lower leg.
There are also bone cutting instruments that look like large wire cutters. In back surgery, instruments called a "rongeur" are used to bite-away at small bone.
Automatic drills are used to install pins, plates and screws. Hand tools consist of pliers, screwdrivers, mallets and curettes used for skimming bone off the surface.
Some instruments that are used in a general instrument tray can be used in orthopedic surgery such as clamps, scissors and retractors. The clamps are used to stop vessels from bleeding. Scissors are used to cut through tissue and wire. Retractors are used to hold back muscle tissue so the surgeon can work freely.
Orthopedic surgery probably uses prosthesis more than any other service. Joint replacement has become routine. During the replacement of a hip, large scale instruments are used. Power tools are used to cut through bone, reamers are used to clean out the leg bone, calipers are used to measure the head of joint, and chisels are used to smooth the bone. Glue is used inside the leg bone to hold the prosthesis in place. Knee and shoulder surgery involves the same type of instruments, but different prosthesis.
Skin grafts are used by taking a section from the patient with an instrument called a dermatome. This device slices a small section of surface skin. The graft is then placed in another device called a mesh graft. This instrument meshes the skin by placing small holes through it. The graft is then sutured to the surgical site in hopes that it will be accepted by the body, and generate new skin growth as well as covering and protecting the site.