Basic Principles of Surgery Dr Hani Al Sheikh
Basic Principles of Surgery Dr. Hani Al Sheikh Radhi
• Painless Surgery • Asepsis. • Minimal Damage. • Adequate access. • Arrest of Hemorrhage. • Debridement • Control and prevention of wound infection. • Patient support.
1) Painless Surgery Achieved by • Local Anesthesia. • General Anesthesia.
Hot tooth management (tooth with infection) • PDL injections • Intra-osseous injections.
Intra-osseous Injections
General Anesthesia • Acute infections cannot be treated with regional block. • Surgery involves many quadrants of the jaw, length and alarming nature. • Young children and uncooperative patients.
2) Asepsis “Exclusion of Micro-organisms from the operative field and prevent the organisms from accessing the surgical site” • Impossible for oral cavity. • Sterilization of Instrument • Antiseptic approach.
• The three methods generally available for instrument sterilization are dry heat, moist heat, and ethylene oxide gas.
• Sterilization is defined as the process by which an article, surface or medium is freed of all microorganisms either in the vegetative or spore state. ? • Disinfection means destruction of all pathogenic organisms, or organisms capable of giving rise to infection. Not necessarily kill all the organisms (especially bacterial spore) [usually used on nonliving objects] • Antisepsis The term antiseptic is used to indicate the prevention of infection, usually by inhibiting the growth of bacteria.
• Robert Koch • Heat sterilization 1 hr. and 30 mins 100 c° would destroy all vegetative Bacteria. Except Anthrax bacilli required 3 hrs. 140 c° • Kock noticed that moist heat can reduce time required to eliminate bacteria. • Dry heat required more time due to time for protein oxidation and destruction.
• The sterilization efficiency is measured by its ability to destroy bacteria when they are in spore form. • Spores are the most resistance phase of bacteria. • Hospitals and dental schools test the sterilization efficacy by using bacillus stearothermophilus bacteria spores strips. These spores are highly effective to heat.
Dry heat (Oven) • thermostatically controlled oven and a timer. (Simple) • The success of sterilization depends not only on attaining a certain temperature but also on maintaining the temperature for a sufficient time. Three factors must be considered • (1) warmup time for the oven and the materials to be sterilized. • (2) heat conductivity of the materials. • (3) air flow throughout the oven and through the objects being sterilized.
Moist heat “more efficient than dry heat for sterilization because it is effective at much lower temperatures and requires less time”. Several physical principles. 1. Water at 100 c° kill more organism than dry heat at the same temp. 2. Water require high temp. to change into steam; the steam condenses and almost instantly releases that stored heat energy, which quickly denatures vital cell proteins. Saturated steam placed under pressure (autoclaving) is even more efficient than non-pressurized. This is because increasing pressure in a container of steam increases the boiling point of water so that the new steam entering a closed container gradually becomes hotter. Temperatures attainable by steam under pressure include 109°C at 5 psi, 115°C at 10 psi, 121°C at 15 psi, and 126°C at 20 psi.
Gaz (ethylene oxide) Destroy cell membrane
3) Minimal Damage • Pay attention to the tissue with the same importance to the condition you are treating (teeth, cyst, bone, soft tissue. . etc…) • Well designed surgical site • Gentle tissue handling during the operation by the surgeon and the assistant.
- Slides: 19