Operating Room22

Dimitrije E. Panfilov

The operating room is the "heart" of any surgical clinic. As we deal with physically healthy patients, the possible risks should be reduced to a minimum. Nosocomial infections should be avoided and such clinics should in the optimal situation only be used for plastic surgery and aesthetic-cosmetic operations. Surgical specialities which deal with inflammatory and septical indications, like abdominal surgery and proctology, do not match the extreme need for aseptic work we require.

The operating room should be spacious, at least 25 m2, bright, allowing direct optical impression of outward climate and natural light sources. This is important for the members of the operating team and their positive motivation, which is not so high if they work in artificially illuminated spaces. Air conditioning is necessary, especially if implantations and transplantations are to be performed. Reducing microbiological contamination is also the aim of air conditioning, with especially high standards required in some countries. Special glass should hinder any observer from outside from looking into the operating theatre. The average temperature inside should range between 18 and 22 °C.

There should be separated and isolated space for disinfection of hands for surgeons and assistants, liquid soap, and a disinfector container should be activated with the elbow and water flow should be started automatically through hand movement or with a lever arm or foot pedal. The entrance door into the theatre should have a bull's-eye window and should be hermetically closed and activated with an electric switch. There should be three separated areas adjoining the operating area: changing and dressing room for staff, entrance separated from the exit for patients, and the third area for instruments ending in the sterilization room (if possible with two sterilizers: a quicker, smaller one and a bigger one with digitalized data). Each of those three areas should not cross each other.

The walls and floor should be tiled. In some countries it is allowed for there to be a silicon sheet covering to enable easy and complete cleaning and disinfection. Plugs have to be at least 120 cm above the floor. If possible, one wall might have an image of a smooth water surface or some scenery of water life with fish and plants but without too much colourful accentuation. It has been found that electroencepha-

Fig. 22.1. How should we do a facelift operation - standing or sitting? We prefer the sitting position, which allows comfortable operative action
Fig. 22.2. The operating room should have facilities for teaching workshops with video and audio transmission to the audience, or just to record surgeries for video archives

lographs show the lowest waves if human beings look at water, because all life, ontogenetically and philoge-netically, comes out of the water. Such images will additionally calm down our patients, which is psychologically very important.

Does music have its place in the operating theatre? Many surgeons of the older generation will answer negatively. This is certainly a justifiable point of view in the case of unusual operations or emergency surgery, or when undesired complications might be expected. When the patient is struggling between life and death or when the anaesthetist needs to assess the function of lung and heart with a stethoscope, music is out of place.

When scheduled operations are being performed for which the entire surgical staff is well adjusted to working together and all the phases of the operation are well mastered by all the members of the operating team, then carefully chosen and correctly dosed music can most certainly help in the quest for perfection.

Music is nowadays used for the treatment of various disorders. Books are available on the market containing CDs such as The Musical Medicine Cupboard, Musical Psychotherapy, and Health Through Music.

Music by Bach, Vivaldi, Tchaikovsky, and Mozart has a particularly inspiring effect during aesthetic operations. Some pieces by Sarasate, Grieg, or de Falla are an excellent supplement to the atmosphere in the operating theatre. I also operate to the sounds of compositions by Chopin, to the Spanish guitar, or to the only and unique violin concerto in D major by Beethoven. It does not appear impossible that Chopin's nocturnes, Boccherini's minuet, Toselli's serenade, or Strauss's waltzes can penetrate into the fingertips of a plastic surgeon and help create a more beautiful and harmonious result.

Apart from classical music, the musical background is also excellently supplemented by instrumental music featuring the saxophone, clarinet, and piano - even the violinists Zacharias, Mantovani, or Grapelli. Heavy metal or hard rock would do more harm than it would be of use. It would be interesting to conduct research into which type of music patients would choose for their operations. In our private clinic Nefertiti in Bonn, Germany, we have asked in our questionnaire given to the patients preoperatively which of six kinds of music the patients would prefer to have played during their surgery. The top answers by far were classical and instrumental music.

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