A practical tip to eliminate the anesthesia screen

AORN Journal, March, 1999 by Vickie Fambrini, Ronald P. Gruber

Traditionally, the purpose of an anesthesia screen was to separate the anesthesia care provider from the surgeon performing abdominal or chest surgery on the patient. Since its introduction, using an anesthesia screen or a sterile drape to separate the patient's head from the surgical site during procedures helps avoid contamination from the patient's head. Screens and drape barriers prevent the surgeon from being distracted by the anesthesia care provider monitoring the patient's head and neck area and allow access to the patient's head and face without disrupting the procedure in progress. Anesthesia screens also have been shown to serve as supporting mechanisms to which light sources can be added. A lamp has been attached to the anesthesia screen crossbar to aid in evaluating patients' color.(1) In addition, surgical retractors have been attached to the anesthesia screen to reduce the need for extra OR staff members.(2)

As more surgical procedures are being performed on an outpatient basis using conscious sedation, however, surgeons and nurses are seeking alternatives to cumbersome anesthesia screens and drape barriers. One distinct disadvantage of either a screen or surgical drape separation is that it restricts the surgeon's mobility when performing surgery in the region of the shoulder, axilla, or upper chest. Surgeons operating near the patient's head often find themselves restricted by the screen or surgical drape barrier in an attempt to gain better access to the surgical wound. This typically is true for plastic surgeons performing transaxillary augmentation mammoplasties. In these types of procedures, surgeons have to insert a paddle from the axilla toward the inframammary fold. To gain access to the axilla, surgeons would stand on the opposite side of the anesthesia screen or surgical drape barrier to comfortably drive the paddle in an inferior direction, in which case, they risk contamination.

Another problem with using drapes or screens to separate the patient's head from the surgical site is the need for perioperative team members to be aware of the patient's behavior and vital signs as they are performing the surgery. The nurse or surgeon has to ask patients how they are doing and whether they feel the introduction of local anesthesia and determine if patients are grimacing and simply not saying that they are experiencing pain. In this situation, the drape barrier becomes a hindrance. Eliminating the barrier provides all perioperative team members with direct visual access to patients. Surgeons then are able to treat a patient's pain from local infiltration as soon as the patient begins to grimace, rather than waiting until the pain is so uncomfortable that the patient vocalizes it.

Plastic surgeons commonly use local anesthesia and would benefit from a technique whereby the drape barrier or screen could be eliminated, yet not have a problem with contamination from the patient's unprepped head. Other surgeons also could benefit from eliminating drape barriers (eg, general surgeons who do herniorrhaphy or breast biopsy using local anesthesia).

To solve these problems, we decided to cover patients' faces with a sterile, metal wire mesh colander during surgical procedures using conscious sedation (eg, augmentation mammoplasties). Before placing the colander on the patient's face, a split sheet is used to drape the patient's abdomen and upper chest. The upper part of the sheet is drawn beyond the patient's head and clipped at the top of the head. Using this manner of draping means only the patient's face is exposed (ie, from forehead to chin). The colander is laid on the patient's face and stabilized by attaching it to the surrounding drapes with towel clips. As all patients are well sedated, none have complained of claustrophobia. There are no other barriers that need to be overcome. Now, perioperative team members can keep an eye on patients to see if they are grimacing or in pain as the local anesthesia is infiltrated. Surgeons no longer bump their elbows against the anesthesia screen and can walk comfortably around the patient and work from the shoulder area. If a patient needs oxygen or if there is an emergency, the screen is easily removed and treatment is instituted. When emergency treatment no longer is necessary, perioperative team members reapply sterile drapes and a sterile colander. Although there is risk of contamination, it is easier to prevent with a less obtrusive barrier.

NOTES

(1.) R M Flowerdew, "A light for anaesthetists," Anaesthesia 31 (November 1976) 1257-1260.

(2.) H E Dorton, "New self-retaining retractor holder to facilitate surgical exposure," American Journal of Surgery 141 (February 1981) 306-308.

VICKIE FAMBRINI, RN, is an OR charge nurse at the East Bay Aesthetic Plastic Surgery Center, Oakland, Calif, and a recovery room RN in Walnut Creek, Calif.

RONALD P. GRUBER, MD, FACS, is president of East Bay Aesthetic Plastic Surgery Center, Oakland, Calif, and clinical assistant professor at Stanford University, Palo Alto, Calif.