This chapter explains the fundamental principles of respiratory physiology for the perioperative practitioner. First, it describes the relevant respiratory anatomy, its function, and how it applies to the anaesthetic context. Second, it describes the different lung volumes and their relevance and application during artificial ventilation. Finally, it explains the physiology of perfusion and its application to ventilation and how they can be affected by different patient positions during anaesthesia and surgery.

This chapter identifies and explains the fundamental role and responsibilities of the perioperative practitioner essential to the surgical scrub role; this includes surgical counts, sharps safety, specimen managements, and waste disposal. The scrub practitioner is a recognised member of the perioperative team, performing a crucial role in preparing the operating theatre environment for surgical procedures. They must ensure it is clean, ready, and safe to receive the surgical patient. The scrub practitioner should possess the requisite technical and non-technical skills, and theoretical underpinning knowledge of anatomy and physiology to optimally perform their role.

This chapter explains the fundamental aspects of decontamination and sterilisation. A working knowledge of the principles of sterilisation, disinfection, and infection control are essential for effective and safe perioperative practice. Decontamination is defined as the combination of methods—including cleaning, disinfection, and sterilisation—used to make a reusable item safe for further use on patients and for handling by staff. The term refers to the whole cycle, including processes such as cleaning, disinfection, and sterilisation. Aseptic techniques are fundamental to supporting a safe environment and to ensure patient and staff safety with regards to infection and its associated risks. It is essential that perioperative practitioners adhere to national and local standards and understand how the decontamination cycle can mitigate the risk of infection.

This chapter provides a detailed overview of the cardiovascular system in the context of perioperative care. The cardiovascular system is responsible for the delivery of oxygen around the body and the return of this blood to the heart. This blood is then pumped to the lungs and back to the heart. The systemic and pulmonary circulations have a number of important differences between them. The heart beats repeatedly in a process known as the cardiac cycle, which has two distinct phases, systole, and diastole. The conduction system of the heart allows for the chambers of the heart to contract in a well-coordinated manner. Problems with the cardiovascular system occur frequently under anaesthesia and can have numerous causes, some of which are explored in this chapter.

This chapter focuses on the perioperative care of the paediatric patient and aims to undermine the common misconception that children are just little adults. Providing safe and effective care for children requires a clear underpinning knowledge of their unique needs. Conscious consideration of age-dependent characteristics such as anatomical, physiological, psychological, and behavioural are essential in the delivery of paediatric patient care. The rationale for adaptations to the delivery of care is to ensure children receive anaesthesia and surgery in a safe and appropriate environment.

The provision and practice of healthcare is subject to a broad legal framework of accountability. Healthcare professionals must develop a sound understanding of their legal responsibilities and the underpinning ethical, professional and legal reasons for them. Ultimately, healthcare law is about people, their bodies, and those entrusted to care for them. Therefore, the aim of this chapter is to rationalise and offer insight into the link between legal accountability and quality of patient care. This chapter has been written to support all perioperative practitioners in developing their legal knowledge in the context of the operating theatre.

Anaesthetic breathing systems are used to deliver oxygen and anaesthetic gases to patients and remove carbon dioxide. A breathing system is most commonly attached to an anaesthetic machine, which is designed to deliver the fresh gas flow to the patient via a facemask, a supraglottic device or an endotracheal tube. The breathing system used can affect the composition of the gas and volatile anaesthetic mixture inhaled by the patient, and so it is important to understand the different breathing systems used in anaesthesia. This chapter describes the key components of the different breathing systems and explores the benefits and disadvantages of the circuits in the Mapleson classification.

This chapter explores some of the fundamental issues surrounding wound healing. It is important that perioperative practitioners understand the physiological process of wound healing as it plays a key role in the patient’s ability to maintain homeostasis and recover from surgery. A wound is any break in the continuity of the skin. Understanding the process of wound healing provides insight into understanding wound assessment and the choice of appropriate dressings and drains. The principles outlined in this chapter will apply equally to wounds caused by trauma, surgical incisions, intravenous cannulation, and invasive haemodynamic monitoring.

Surgery and general anaesthesia are invasive and inherently risky. A rarely discussed reality of perioperative care is that sometimes patients die during anaesthesia and surgery, and many perioperative practitioners are not suitably prepared to handle such an event and its aftermath. Despite the rarity of intraoperative deaths, the experiences of those involved show that there is the potential for a long-lasting impact on individuals and teams. This chapter summarises the incidence of intraoperative death, reviews the potential impact on perioperative practitioners, and explores the different approaches to navigate their aftermath.

The primary purpose of the anaesthetic machine is to deliver anaesthetic gases and volatile agents safely to the patient - helping to maintain a suitable level of consciousness and analgesia for surgery. It is vital that any clinician checking and using an anaesthetic machine is familiar with the type of machine they are intending to use and possess a detailed knowledge of how it operates. Machines must be rigorously checked and tested by a suitably trained person before use and a breathing circuit check should take place between each patient. This chapter is an introduction to the anaesthetic machine, highlighting the main components and features that are essential to maintaining user and patient safety.

The system of shoulder examination described in this chapter is as follows: Stand the patient and look, then feel, then move. Following this, examine the rotator cuff, perform impingement tests, then instability tests. In this chapter, examination of the acromioclavicular joint and examination of other muscles around the shoulder girdle such as pectoralis major are described. At the end of the chapter, in the ‘Advanced Corner’, other special tests are also described such as the bear-hug test for subscapularis tears and the upper cut test for biceps tendinitis.

Examination of the knee joint begins with standing the patient, then asking them to walk. Look for any lurch and observe the foot and patella progression angles. Next ask the patient to sit with their legs hanging over the couch. Observe the patella height and tracking. Then palpate for an effusion and for areas of tenderness. After this, examine the cruciate and collateral ligaments. Depending on the findings, so far further special tests would be a dial test for the posterolateral corner, meniscal stimulation tests or patellofemoral tests. Included in the chapter is clinical evaluation of the acutely injured knee in the child.

A system for examination of the peripheral nerves of the upper limb is described in this chapter. This includes the ulnar, median, radial, axillary and musculocutaneous nerves. The steps are inspection followed by a screen test to decide if the lesion is likely to be radial, median or ulnar. Then the nerve is examined in more detail by testing sensation and movement in relation to that nerve. Provocation tests are performed if necessary. This chapter also describes nerve compression as a result of thoracic outlet syndrome, as this may be a differential diagnosis. In the ‘Advanced corner’ Tinel’s sign and Valleix phenomenon as well as ‘double crush’ are described.

In this chapter. clinical examination of the spine in the child is described. The main pathology here is scoliosis and a simplified method of assessing a child with scoliosis is described. This method is similar to a lumbar spine examination, except that during the examination process a few specific points are noted: When inspecting, look for other stigmata associated with scoliosis such as café-au-lait spots. When palpating, remember to use a plumb line, which indicates whether the scoliosis is balanced. When asking the patient to move, look for the rib prominence (Adam’s test) indicating structural scoliosis. Finally, when performing a neurological assessment, remember to look at the abdominal reflexes.

This chapter also covers kyphosis and other conditions such as torticollis.