I work in the Operating Theatre AMA

[StealingYourWiFi]

I work across anaesthetic, scrub and recovery. Currently in the private sector.

Ask away

Ahhh I’m sad my farting question wasn’t answered

I don't remember ever hearing a patient fart under anaesthetic. It's not impossible, but certainly not very common.

Not in my specialty anyway

How common are apnoic episodes as you go under? My baby had an operation as as the mask was put on her and she went under her breathing went really gasping. It was so frightening. She has to have another operation and i’m frightened of it happening again.

I can also try to answer a few questions, I’m a junior doctor in a surgical specialty, so I spend a lot of time in operating theatres.

Do patients die very often or is it a rare occurrence? In most branches of surgery this is rare, but there are some more high risk surgeries where it’ll happen more often. Personally I’ve never seen a patient die during an operation.

Re bruising, we use various stands/supports to hold body parts in the right place/out of the way, so my guess would be that those have caused bruising.

What happens if you reeeeeeeally need to pee? The longest I’ve been scrubbed in for is 7 hours, and obviously in that time I hadn’t drunk anything, so I didn’t need to pee. If you really needed to pee you could pause the operation, though I’ve never needed to do this.

l had a hip replacement two years ago. l've heard the surgery's pretty brutal. ls that right? Yes, hip and knee replacements are basically carpentry they can be pretty bloody too.

What does 'scrub' mean? Does that mean actually in the theatre during the surgery Yes as PP has said, if you are scrubbed in then you are sterile and stand at the operating table. In the theatre there will also be the anaesthetist and normally at least one ODP who aren’t scrubbed in.

How many people are usually in an operating theatre?

Would students, if present, be actively participating?

How many people are usually in an operating theatre?

Depends. Absolute minimum of 5 or 6. Can be loads. I've been known to start chucking people out when it gets silly (like 12+)

Would students, if present, be actively participating?

Depends on stage of training/type of surgery/ability of student/tolerance of qualified staff.

Does anyone comment when the gown is opened/removed on the operating table? No, and to be honest the patient will be covered pretty quickly with drapes. At this point everyone is focused on getting everything ready to start, no one is standing around gawping.

Do trainee surgeons always work on the right hand side of the body when working with another surgeon? As a general rule of thumb, the surgeon doing the operation will stand on the right, and the surgeon assisting will stand on the left, but sometimes the surgeon doing the operation will be the trainee, with the senior assisting. Also there are plenty of operations where this is not the case and you stand in different places.

I had an operation last year and apparently it was very difficult to put the tube in; I now have a card that I’m meant to give in if I ever need surgery again! Is this common? Is it normally difficult anaesthetising people? It sounds like it wasn’t the anaesthetising that went wrong, but the intubation once you were under. Intubation goes smoothly most of the time, but it can be tricky. This is a problem because once you are under anaesthetic you aren’t able to breath for yourself, so there’s a window of a few of minutes after administering the anaesthetic in which you need to be intubated or you will not be getting enough oxygen. It’s pretty rare to be unable to intubate someone, but it’s one of the most serious anaesthetic emergencies. If there’s a patient who’s likely to be tricky to intube, you need to know about this so senior staff members are on hand, and any equipment you might need is right there.

How many people are usually in an operating theatre? There’ll be several people. As a minimum an anaesthetist/OPD who monitors the patient during the operation, the surgeon, someone assisting the surgeon, and person who isn’t sterile circulating around the room. It can be a lot more, especially in cases where you need two teams (eg when doing a Caesarian it might be necessary to have paediatricians in the room, in addition to the normal obstetric team.)

Would students, if present, be actively participating? as above, it depends on the situation, the student, and the surgeons.

There’ll be several people. As a minimum an anaesthetist/OPD who monitors the patient during the operation, the surgeon, someone assisting the surgeon, and person who isn’t sterile circulating around the room. It can be a lot more, especially in cases where you need two teams (eg when doing a Caesarian it might be necessary to have paediatricians in the room, in addition to the normal obstetric team.)

Why do you have someone who isn't sterile - what's their purpose, and why don't they 'scrub'?

Really interesting thread!

Why do you have someone who isn't sterile - what's their purpose, and why don't they 'scrub'?

You need someone who isn’t sterile because during an operation there will be things that need doing that involve touching non-sterile things. Off the top of my head answering the phone/making phone calls, opening up packets with equipment in, adjusting the table/position of the patient. However the role is more complex than just that, as I’m sure the OPDs on this thread will tell you, those are just the things that spring to my mind.

I had an op recently under sedation rather than GA but was asleep throughout and not aware of anything. Afterwards the nurse asked me if I have sleep apnea as apparently I’d been gasping for breath whilst under. This has worried me and I’m not sure if it’s something I should get checked out with my gp or not. Is this (gasping for breath) something that happens sometimes during sedation?

Thanks to those that answered about my Mum. I'm always glad to know that she wouldn't have known a thing about it.

My daughter broke two bones in her wrist and was told by several different doctors that she would be having pins put in her arm as that is what she would need. I signed forms for this to happen. When she went for the operation they never put pins in her arm and said they had just manipulated it back into place. I was worried as they told me she needed pins. But anyway. Got sent home and a few days later the bones had moved so daughter had to go back and put back to sleep agen for her to have the pins put in. Why would several doctors tell me she's having pins .. then the operating doctors don't do it ? This caused a delay in the healing process and my daughter had a pot on for over two months. She had her pot changed several times.

@StealingYourWiFi are you coming back?

Hello! Sorry I will be back later I promise!

I’m on the treadmill whilst typing this on my phone so apologies for any mistakes!

IceLemonGin

How long does it take to clean theatre and prepare for the next patient?

Do you prefer it when patients are under rather than awake?

We clean at the beginning of the day and get all the equipment we need into theatre. After each patient we wipe everything down and mop floors. The end of the day is a deep clean. We use lots of disposable single use items so you won’t be lying directly on the table, you’ll be in your own use transfer sheets for example.

I like both! I enjoy having patients who’ve had a spinal or local because I like a chat

GeorgieTheGorgeousGoat
Depends what drugs we give you it’s not usually noticeable unless we are doing bottom end surgery.

junebirthdaygirl
Yes we do chat. If something’s tricky or complex then we don’t chat so much. We know the right and wrong times to talk and only do so when somethings going well. We chat about all sorts! The only time we would comment on a patients size is the beginning of the list when we are told the patients weight. If a patient weighs more than 100kg we have a special transfer mattress to use. We don’t really remark on tattoos, very occasionally if they are in a foreign language and someone who speaks that language notices it.

gottachangethename1 I like all my patients I like the confident and anxious ones. It would be boring if they were all the same!

Mayrhofen I’m an ODP!

gummygoddess thankfully I haven’t seen any patients die, even in my time in the NHS. I have only seen patients who are coming in to be organ donors.

Whatsnewwithyou this is all too common. We draw up emergency drugs every morning to use for this.

ISdads I’m a bit confused about this question? I trust my colleagues wouldn’t do this but there are cases of this happening of course.

Obsidian77 I would happily let my family members be operated on any of the surgeons I work with. However some I would pick over others purely because I have a closer working relationship with them.

With regards to bruising it’s most often from retracting tissues. When I’m scrubbed we sometimes have to lean on the patient to get a better retraction and view for the surgeon. Sadly it’s one of those things!

Why have someone who isn't sterile

Someone is needed to move the lights, check equipment, fetch more equipment, tie your gown, move trolleys around, label specimen jars and accept the specimen, open packages, write up how many swabs have been used and push your glasses back on for you!

DRE56322 not in the middle of surgery but I have seen them wake up towards the end. We are usually just putting a dressing on though. They never remember it!

redsummershoes luckily I don’t scrub for long cases now. The longest I scrub for these days is up to 6 hours. I go to the toilet before. It’s usually fine. I have seen some scrub staff ask someone to take over though if absolutely necessary.

SlightAggrandising yes all my colleagues and myself are registered under our practicing titles. We are still overseen by the CQC as the NHS is. We were recently visited and had a glowing report.

will answer page two when I’m home

Unobtainable

*Can anyone else answer:

1. Does anyone comment when the gown is opened/removed on the operating table?*

No...we position the patient, check consent then expose and proceed

2. What happens if the surgeon makes a mistake? Do you all keep shtum? no way! I've called stuff before as have my colleagues. We are always taught about surgical conscience and I could honestly say I'd never be afraid to challenge a surgeon. If I challenge and they dismiss me then I document it. I have NEVER seen mistakes, I am talking about things like "there's a little bleeder there/are you happy with this wound closure?"

3. Ever seen anyone’s teeth break when being intubated? no but I have seen someones veneers fly off when being extubated! They were clip on ones and hadn't been declared by the patient.

4. Why do I take so long to come round after a general compared to other people? Some people are lazier than others everyone is different.

TitsalinaBumSquash so sorry for your loss I haven't seen a death in theatre other than organ retrievals. I have been at many deaths when I worked in A+E however and we always ensured someone was with someone. Even after the retrieval team had finished with a patient we stayed with them until the team from the mortuary came to collect them. If your mum died under anaesthetic then the machine would've carried on, I imagine her death would've been fairly instant and they couldn't revive her. I actually find comfort in that people who die under anaesthetic would have a very peaceful death with no awareness.

Parsleyisntfood
Ds had some kind reaction when they put the tube down his throat. He needed adrenaline and chest compressions.
They said it was just one of those things. Is this likely to happen again? For ages after I was worried about him being in an accident and having to have emergency surgery and having a worse reaction.

These things can and do happen but are rare. I'm unsure if it's likely to happen again as sometimes it can be drug reactions or 'one of those things'. If he does require surgery again then he'd need to be seen at high risk clinic beforehand.

ItIsChristmasTime
I had a spinal anaesthetic and afterwards my back really hurt and did for days afterwards. The anaesthetist said it would have been a coincidence as spinals don’t cause back problems, but I don’t see how it was fine before and not after th injection. Can you give your view?

What surgery did you have? Sometimes positioning can cause aches and pains afterwards. It would be unlikely to be caused by the spinal. Sometimes the anaesthetists have struggle trying to locate the injection space and might prod your back very firmly before but it shouldn't cause too much discomfort.

Unobtainable
Do trainee surgeons always work on the right hand side of the body when working with another surgeon? I always seem to have great results on the left and shit results on the right. Would we be told if a trainee was working on us? I’m talking about being stitched up in particular. All the stirches on the right hand side of my body & face look like theyve been done by a child.
Usually in the NHS two surgeons will be there, the consultant and the junior doctor - some more experienced than others. Side preference is down to the consultant.

newestbridearound
*Thanks for the job you do OP, and to the others on the thread doing similar.

I had an operation last year and apparently it was very difficult to put the tube in; I now have a card that I’m meant to give in if I ever need surgery again! Is this common? Is it normally difficult anaesthetising people?

What made you pursue this line of work? How long did you train for?*

Thank you difficult intubation can and does happen for a number of reasons. I've been at a couple of difficult intubations and it is handy for us to know beforehand! It's not always difficult to anaesthetise but it does vary from person to person.

I used to work in A+E and theatres as a HCA before I went into this. I always loved theatres so I knew it was for me. I did 2 years at university but it's now 3 years.

youaremyrain JustBeenNosey sorry for the delay!

Beerflavourednipples scrub means we make ourselves sterile and work alongside the surgeon(s). Yes sometimes people go the toilet but very rarely. Sometimes we empty peoples bladders for them before we start depending on the procedure type.

Ollivander84 yes that can be usual, depending on the drugs given!

LovelyBranches
How common are apnoic episodes as you go under? Did your LO have a gas induction or an injection into the vein? This can be common with gas induction, rest assured she would've been well looked after. It's always worth a mention if you're concerned

ImNotKitten
*How many people are usually in an operating theatre?

Would students, if present, be actively participating?*

It depends on the hospital and type of surgery. The NHS has far more people in theatre than the private sector. NHS would have an consultant and junior anaesthetist, anaesthetic practitioner, consultant and junior surgeon, scrub nurse, circulating team (could be 2-4 people) plus students. There could be 4 students - anaesthetic, student nurses, medical students, midwives, paramedics. It can be a bit hectic! Private is consultant anaesthetist and surgeon, anaesthetic practitioner, scrub practitioner and also a scrub first assistant if required plus circulation staff (1-3 usually) occasionally students too.

It depends where students are in their training. I've intubated patients during my training and scrubbed for major cases. We all have to learn somewhere, everyone is overseen though.

buttercreamweeds gasps under sedation aren't massively alarming for us usually. We give you respiratory suppressing drugs so we expect a bit of snoring

It's very reassuring to know it's rare to die in surgery. I'm not planning on any, but have had I think 5 operations on my wrists when I've broken them and two on my eye. It always is the last thought that occurs to me.

When someone is being an organ donor, do they get sewn back up properly or just the outside since they're 'dead' anyway?

GummyGoddess closed properly including dressings. It is done as it would be on a patient going for routine surgery.

@StealingYourWiFi thanks for coming back!