Knee arthroscopy is one of the most common orthopedic surgical techniques. Knee arthroscopy is a minimally invasive surgical technique that enables physicians to examine a patient by making a small incision through the skin. Physicians perform knee arthroscopies to facilitate the diagnosis and treatment of various knee pathologies, including torn meniscus, torn anterior cruciate ligament, swollen synovial tissue, injured articular cartilage, loose bone fragments or cartilage, kneecap problems, and knee sepsis infection. The procedure is mostly conducted as an outpatient procedure on healthy patients (Moran et al., 2020, p. 393). Physicians performing this procedure normally utilize various anesthetic techniques, including general anesthesia, neuraxial block, and local anesthesia, to manage patients safely. This paper discusses the pre-operative and operative steps undertaken to enhance patient care and ensure the safety of patients during a right knee arthroscopy procedure. The paper also discusses the significance of effective communication and documentation during and after surgery, the importance of considering individual patient needs during and after surgery, the importance of adhering to the World Health Organization’s five steps of care, the multi-disciplinary nature of the perioperative department, including the role of the Operating Department Practitioner in ensuring patient safety.
Right Knee Arthroscopy Procedure
Physicians utilize arthroscopic surgery to evaluate a patient’s joints and determine the cause or extent of joint damage. The procedure is normally carried out when physicians are unable to identify the cause of the joint problem and entails. Knee arthroscopies can be employed to facilitate several procedures, including making a diagnosis, completing meniscal repairs, debridement, loose body amputation, and tendon reconstruction (Hill et al., 2020, p.327). Given that it is a minimally invasive procedure, a knee arthroscopy is normally performed as an outpatient procedure. Before the surgery, the anesthesiologist and the surgical team ensure that all the operating equipment is sterile and in the right place. In addition, the patient’s knee is cleaned and sterilized before the operation to prevent infections. After the patient’s knee leg is effectively cleaned and placed in a supine position, the surgeon commences the operation, which encompasses the placement of two or more incisions adjacent to the patellar tendon in the anteromedial, anterolateral or super-medial facets of the knee joint (Moran et al., 2020, p.394). The surgeon then inserts an arthroscope into the knee joint through the incisions and utilizes the images produced by the camera on the monitor to investigate the issue. In addition, the images produced by the arthroscope guide miniature surgical instruments.
Furthermore, during the procedure, healthcare administrators continuously administer irrigating fluid through the incisions to enhance the visualization of the knee joints and wash away blood and debris. After the surgery, the surgeon drains the saline from the patient’s knee joints and places an ace bandage or stitches on the knee. If no complications or pre-existing conditions are recorded, most patients are discharged on the same day they undergo the surgery. Notably, the surgical instruments utilized in this procedure, including the arthroscope, are thin. As such, the surgeon creates very small incisions, rather than the bigger incisions created during open surgery (Kaya and Şimşek, 2021, p. 98). As a result, patients experience less pain and experience a quicker recovery. However, the procedure requires the usage of a thigh tourniquet to reduce bleeding, which may contribute to intraoperative pain, nerve damage, and hypertension.
A right knee arthroscopy is generally a painful procedure. As such, patients undergoing this procedure are placed under anesthesia to block out the pain. Before undergoing the procedure, the patient is placed under different types of anesthesia, including local and spinal anesthesia, depending on the damage that the surgeon expects to find (Zhang et al., 2022, p.3). Notably, when placed under local anesthesia, the patients remain awake. However, their knee is numbed with pain medicine. In addition, they are given medicines to help them relax. On the other hand, during a spinal anesthesia, physicians inject the pain medicine into the patient’s spine, numbing their waists and legs (Neuman et al., 2022, p.953). Thus, although they are awake, they cannot feel anything below their waists. However, patients placed under general anesthesia are totally asleep and pain-free. Additionally, physicians also utilize the regional nerve block during knee arthroscopy. When administering this type of anesthesia, the pain drugs are injected around the nerves in the patient’s legs or groin to block out the pain from the procedure. As such, the patient requires less general anesthesia.
Pre-Operation Preparation Before and During the Procedure
The pre-operation preparation for a right knee arthroscopy necessitates effective cooperation and communication between the healthcare providers, patients and the operating department practitioner to ensure patient comfort and safety. Before the scheduled operation, the patients are examined to assess their individual needs and identify if they have any underlying conditions. Surgeons liaise with doctors and nurses or the operating department practitioner to analyze the patient’s pre-operative history and conduct a thorough routine physical examination, which involves an evaluation of the airway, assessing the patient’s nil per os status, pre-existing medical conditions, and checking whether the patient is under any medications (Sbaraglia et al., 2024, p.4). Conducting a thorough pre-operation examination is essential as it enables the surgeon to identify the most appropriate procedure for the patient. In addition, it enables the anesthesiologist to select the most appropriate anesthesia for the patient based on their individual needs. For instance, patients with existing neurological illnesses, lumbar disease, severe gastroesophageal reflux, or austere arthritis may not be suitable candidates for regional anesthesia and sedation.
Additionally, the examination period provides an opportunity for the healthcare provider to educate the patient on the surgery procedure and its risks and obtain signed consent from them. Before the surgery, the patient should be made aware of the surgery’s procedure, as well as its benefits and disadvantages, to enable them to make an informed decision (Zacher et al., 2023, p.2). This stage necessitates effective teamwork and communication to ensure that the patient is adequately informed, consent is obtained, and the patient’s request are noted and communicated to the right individuals. In addition, effective teamwork and communication are essential as they facilitate the selection of the appropriate anesthetic techniques that best suit the patient’s needs. The anesthetic technique should be selected after the patient has been presented with the surgery’s risks and benefits and a signed consent form has been obtained. The anesthesiologist should select an anesthetic technic that considers the patient’s feedback and preferences and the surgeon’s recommendations. For instance, the patient could prefer to be awake or asleep during the operation. Several of the patients undergoing knee arthroscopies are relatively young and healthy individuals. As such, they normally do not require laboratory tests unless indicated by age or a medical condition expected to alter these tests.
In addition to ensuring that the patient is adequately informed, the operating department practitioner participates in other activities, including ascertaining the patient’s records to facilitate a smooth surgery. On the day of the procedure, the patient is normally called to the theatre by the nurse or anesthetist in charge. The operating department practitioner communicates with the patient and other healthcare providers to ensure that the patient’s records accompany them to the theatre. In addition, these practitioners facilitate a smooth transition as the patient is passed over from the ward to the theatre staff (King and Duffy, 2022, p.675). The operating department practitioner checks to confirm the patient’s identity and ascertain their operation procedure. Additionally, they ascertain that the patient has fasted for at least six hours, and if required, their blood results are available. The practitioner also reviews the patient’s observations, including their blood pressure, pulse, temperature and respiratory rate before operation. This helps in monitoring any changes and ensuring that the patient is in the right condition to undergo the surgery.
Furthermore, upon reaching the theatre room, the operating department practitioner ensures that the patient is shown and supported onto the operating table where they wait for anesthesia. In addition, the practitioner helps ensure that all the anesthetic and intravenous machines are in good condition. Most patients undergoing a right knee surgery are placed under a spinal anesthetic unless this is contraindicated (Kongur et al., 2021, p.70). However, sometimes, the procedure can convert to general anesthesia during the surgery if it takes longer than expected or if the spinal anesthesia starts to wear off before the surgery is completed. As such, the operating department practitioner needs to ensure that the anesthesiologist is adequately prepared for such incidences. Moreover, during the operation, the operating department practitioner ensures the patient’s comfort and safety by monitoring their vitals, offering reassurance, ensuring that they are not in pain, and monitoring their breathing patterns. In addition, they coordinate with nurses to ensure that the patient’s vitals, including their blood pressure, pulse, and oxygen saturation, are regularly recorded on the anesthetic sheet, and any changes in the vitals are promptly reported to the anesthetist and surgeon. Additionally, the operating department practitioner can also act as a runner during the surgery. Notably, a runner refers to an individual who is always ready to get the items required during surgery, including sutures and gauzes. This facilitates a smooth surgery and ensures the comfort and safety of the patient.
Perioperative Surgery Requirement and Measures Undertaken to Ensure the Patient’s Safety
To ensure the patient’s safety and a smooth procedure, the operating department practitioner collaborates with other healthcare providers, including nurses and physicians, to ensure that the patient has been thoroughly examined and has the proper documentation. In addition, depending on the type of anesthesia, patients undergoing a right knee arthroscopy are required to have fasted for certain periods before the surgery. For instance, for procedures that are performed under general anesthesia, the patients are required to have fasted for more than six hours prior to the surgery (El-Sharkawy et al., 2021, p.1406). According to the American Society of Anesthesiologists, low-risk patients are required to abstain from solid food for six to eight hours prior to surgery. However, the patients are allowed to consume clear liquids up to two hours before surgery.
The fasting period allows foods to clear the patient’s body. This is necessary because the anesthetic injected during the surgery temporarily stops the patient’s body reflexes. As such, if there is food in the patient’s stomach, they risk vomiting during the surgery. In addition, the food my come up to their throat, thus suffocating them. If such an event occurs, the food could get into the patient’s lungs and affect their breathing, thereby damaging their lungs. Thus, fasting before undergoing the surgery is essential as it ensures the patient’s by preventing nausea and preventing food items from going into their lungs (Cheng et al., 2021, p.995). Notably, the professional department practitioner collaborates with nurses and other healthcare providers to ensure that the patient is adequately informed of the fasting requirement and the reasons for such requirements before the surgery. This necessitates effective communication and fosters collaboration from the patients. Notably, patients with adequate information are more likely to adhere to the procedure’s requirement more than inadequately informed patients. Furthermore, the professional department practitioner verifies the patient’s compliance with the fasting requirement before the surgery is performed to facilitate a smooth surgery and ensure the patient’s safety.
Five Steps to Safe Surgery
Additionally, during the right knee arthroscopy, the patient’s safety is enhanced by adhering to the five steps to safe surgery recommended by the World Health Organization. The five steps to safe surgery is an operating safety checklist that entails briefing, sign-in, timeout, sign-out and debriefing. The checklist is endorsed by the National Patient Safety Agency (NPSA) for all patients in England and Wales undergoing surgical procedures and its usage has been demonstrated to reduce surgical death rates from “1.5% to 0.8% and serious complications from 11% to 7%” (De Jager et al., 2019, p.796). Notably, briefing is carried out before the patient and is aimed at confirming the operating list order, delegating tasks, and ensuring that all individuals are aware of their roles. briefing should be undertaken in a manner that supports open communication to enable the staff to make inquiries, and raise any concerns they might have before the surgery.
On the other hand, the sign in procedure is undertaken to ensure that all the necessary surgery preparations have been completed and that it is safe to put the patient under anesthesia. After the sign in procedure, the time out process is undertaken to ensure that the surgical team is undertaking the right procedure on the right patient, and that all the right procedures are in place to prevent harm (Tagar et al., 2019, p.145). After the surgery and before the staff leave the operating room, they undertake a sign out process which is meant to ensure that the surgical process has been completely finalized and documented. This step also certifies the patient’s ongoing safety beyond the theatre. At the end of the list, the surgical team carries out a debrief which enables them to analyze their performance, identify accomplishments and improvement areas. Following these steps enables the surgical team to avid errors and enhance patient safety during and after the knee arthroscopy.
Conclusion
Knee arthroscopies are significantly utilized in orthopedic surgeries to treat patients suffering from common knee disorders as they are minimally invasive and have a quicker recover time. Notably, arthroscopic surgeries have a shorter recovery period that traditional knee surgery, which require a long period of recovery and rehabilitation. Arthroscopic procedures are generally employed to treat arthritis, meniscus tears, and ligament damage. Similar to other surgeries, the procedure necessitates an interdisciplinary approach that entails collaboration between various healthcare providers to ensure the patient’s safety. In addition, the patient’s safety can be enhanced by conducting a thorough assessment before the surgery and adhering to the World Health Organization’s safety checklist. Ultimately, although the arthroscopic surgery is minimally invasive, it causes a variable degree of postoperative pain, normally triggered by an anterior fat pad, or a joint capsule. As such, it is important for patients to undertake postoperative pain control to facilitate faster rehabilitation.
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