SU10.1-4 | Perioperative Management — Glossary

Suture material broken down by the body over time (e.g. polyglactin/Vicryl), used for deep, buried layers.

A vasoconstrictor added to local anaesthetic to slow absorption, prolong action and raise the safe dose; avoided in end-arterial sites (fingers, toes, nose, ears, penis).

A decision made by a patient with capacity about future treatment, to apply if they later lose capacity.

A classification (I–VI, with E for emergency) grading a patient's systemic disease and fitness — not the operation's difficulty and not the airway.

The ethical principle of respecting a patient's right to make decisions about their own body and treatment; the foundation of consent.

The tort and crime of touching or treating a person without their valid consent, regardless of how skilfully it was done.

The standard for deciding for a patient who lacks capacity, weighing their known wishes, advance decisions and the views of those close to them.

A long-acting amide local anaesthetic; maximum safe dose 2 mg/kg and the most cardiotoxic agent — never given intravenously.

The ability to make a particular decision at a particular time — to understand, retain, weigh and communicate it; presumed in adults.

A non-sterile theatre nurse who fetches supplies, connects equipment and documents, without touching the sterile field.

A gloving technique keeping the hands inside the gown cuff until gloved so skin never touches the glove's outer surface.

Communication in which an instruction is stated, acknowledged and confirmed when completed, reducing error in theatre.

Applying opposing tension to tissue so a dissection plane opens up for the surgeon.

Removal of devitalised (dead) tissue and foreign material from a wound to reduce infection and promote healing.

Closure of a contaminated or late but viable wound a few days after cleaning and debridement, once it is clean and uninfected.

Firm sustained pressure over a bleeding wound, the first-line method to control external haemorrhage before a tourniquet is considered.

Giving the patient the material information needed to decide — nature of the procedure, material risks, benefits and reasonable alternatives.

The legal basis for treating a patient who cannot consent in an emergency — only what is immediately needed to save life or prevent serious harm, in their best interests.

An aggregated score from routine observations (e.g. NEWS) that flags clinical deterioration before collapse.

Enhanced Recovery After Surgery — a multimodal perioperative protocol (minimal fasting, opioid-sparing analgesia, early feeding and mobilisation) that shortens stay and reduces complications.

Consent given explicitly, in words (spoken or written), as for an operation or invasive procedure.

Immediate care given to an injured or ill person before definitive treatment, to preserve life, prevent deterioration and promote recovery.

Assessing capacity by whether the patient can understand, retain, weigh/use, and communicate the relevant decision.

Consent inferred from a patient's conduct, such as rolling up a sleeve for a blood test; not sufficient for invasive procedures.

A minor procedure to drain an abscess through an incision over the fluctuant point, leaving the cavity to heal by secondary intention.

The voluntary agreement of a person with capacity, given after disclosure of the material information needed to make the decision.

Care while the patient is in theatre — anchored by the WHO Surgical Safety Checklist, asepsis and continuous monitoring.

An amide local anaesthetic; maximum safe dose 3 mg/kg plain and 7 mg/kg with adrenaline.

Toxicity from excess or intravascular local anaesthetic — perioral tingling and agitation progressing to seizures and cardiac arrest; treated with 20% intralipid.

A risk a reasonable patient in this patient's position would want to know about; the patient-centred standard of disclosure (Montgomery).

A person under the age of majority (18 years in India under the Indian Majority Act), for whom a parent or legal guardian generally consents.

A single-strand suture with less tissue drag and lower infection risk, preferred for skin and contaminated wounds.

A designated, announced area for passing sharps so they are never hand-to-hand, reducing sharps injury.

Suture material that persists (e.g. nylon, polypropylene/silk), used for skin to be removed later or for securing structures.

Theatre members who do not touch the sterile field — the circulating (runner) nurse and the anaesthetist.

Coordinated care of a surgical patient across the preoperative, intraoperative and postoperative phases to prevent harm and speed recovery.

A timing aide-memoire for postoperative pyrexia: Wind (chest), Water (urine), Wound, Walking (DVT) and Wonder-drugs.

Care from recovery until discharge — analgesia, fluids, early feeding and mobilisation, wound care and complication surveillance.

Fasting to reduce aspiration: clear fluids 2 h, breast milk 4 h, formula/light meal 6 h, fatty/fried solids 8 h before surgery.

Correcting controllable conditions (diabetes, hypertension, anaemia, cardiac/respiratory disease, drugs) before surgery to reduce risk.

Care from the decision to operate until the patient enters theatre — clerking, risk stratification, optimisation, consent, fasting and prophylaxis.

Healing of a clean, recent wound whose edges are sutured together immediately, giving a fine scar.

The ordered initial assessment of an injured patient — Airway (with C-spine), Breathing, Circulation, Disability, Exposure.

Holding tissues or retractors to expose the operative field at the angle and tension the surgeon needs, without obscuring the view.

The scrubbed practitioner who manages the instruments and the sterile field and passes instruments to the surgeon.

Healing of an open wound (tissue loss, contamination, infection or abscess cavity) by granulation, contraction and epithelialisation.

The WHO checklist pause before induction of anaesthesia — confirms identity, consent, site marking, allergies and airway/aspiration risk.

The WHO checklist pause before the patient leaves theatre — confirms the procedure, instrument/swab/needle counts, specimens and recovery concerns.

A basic skin closure of individual stitches with perpendicular entry, equal everted bites and a flat instrument-tied knot.

Keeping continuous attention on the operative field and the room so as to anticipate needs and notice breaches of sterility or safety.

The operating-theatre members who are scrubbed, gowned and gloved and may touch the sterile field — the surgeon, assistant(s) and scrub nurse.

The defined microbe-free zone of sterile drapes and the sterile parts of gowns and gloves around the operative site.

The only sterile parts of a gowned person — the front from chest to waist and the sleeves to just above the elbow.

Soaking of a sterile drape or gown by fluid, which breaches sterility by providing a path for microorganisms.

Keeping the operative field clear of blood and fluid — suction for pooled fluid and dabbing (not wiping) with swabs.

A single antibiotic dose given within 60 minutes before incision for appropriate operations to reduce surgical site infection.

A timed antiseptic scrub or alcohol-based hand rub, with hands kept above the elbows, performed before gowning and gloving.

Asking the patient to explain the plan in their own words to confirm genuine understanding before consent is taken.

A contaminated, devitalised, puncture, or more than six-hour-old wound requiring risk-based tetanus toxoid with or without immunoglobulin.

The WHO checklist pause after induction but immediately before incision — the team confirms patient, procedure, site, antibiotics given and critical events.

A constricting band used to stop catastrophic limb haemorrhage that direct pressure cannot control; not the first response to bleeding.

Prevention of deep-vein thrombosis and pulmonary embolism by mechanical measures (compression stockings/IPC) plus pharmacological prophylaxis (LMWH) where indicated.

The requirement that a consent decision be the patient's own, free from coercion, undue influence or manipulation.

A standardised team checklist with three pause-points — Sign In, Time Out and Sign Out — that reduces surgical death and complications.

The team pause immediately before incision confirming patient, procedure, site, antibiotics and critical events.

A patient's right to revoke consent at any time, including after a form is signed and up to and during a procedure where feasible.

Cleaning a wound by irrigation and removal of dirt, debris and devitalised tissue under aseptic technique before any closure.