Operating+Room+Design+&+Set-Up

= = toc =OPERATING ROOM SET-UP AND DESIGN= Anesthesiologist spend more time in ORs than any other group of physicians. Anesthesiologists are often primarily responsible for the proper functioning of medical gases and many other environmental factors in the operating room.

Medical Gas Systems

 * Most commonly used gases in operating: oxygen, nitrous oxide, air, nitrogen
 * Design and standards are overseen by National Fire Protection Association in the United States

Oxygen

 * Medical grade oxygen manufactured by fractional distillation of liquefied air
 * Oxygen can be stored as compressed gas at room temperature //or//refrigerated as a liquid below its critical temperature of -119 C
 * Most hospitals store oxygen as liquid or in high-pressure cylinders (H-cylinders) connected by a manifold
 * E-cylinder of oxygen should be stored on anesthesia workstation in case of hospital gas-system failure
 * E-cylinder of oxygen stores 660 L, a pressure of 1900 psi indicates the tank is full



Nitrogen

 * Manufactured by heating (thermal decomposition) of ammonium nitrate
 * Stored in H-cylinders connected by manifold at most hospitals, E-cylinders for back-up on anesthesia workstations
 * Critical temperature of nitrous (36.5 C) is above room temperature, therefore kept liquefied without elaborate refrigeration system
 * If liquid nitrous oxide is kept at a constant temperature it will vaporize at the same rate at which it is consumes and will **maintain a constant pressure (745 psi) until the liquid is exhausted**
 * Only reliable way to determine residual volume of nitrous oxide is to weigh the cylinder (tare weight should be stamped on shoulder of cyclinder)

Air

 * Medical grade "air" is manufactured by blending oxygen and nitrogen, dehumidified
 * Critical temperature of air is -140.6 C so it is stored as air in cylinders
 * Pressures fall in proportion to content


 * ** Gas ** || ** E-Cylinder (L) ** || ** H-Cylinder (L) ** || ** Pressure (psi) ** || ** Form ** ||
 * O2 || 625-700 || 6000-8000 || 1800-2200 || Gas ||
 * Air || 625-700 || 6000-8000 || 1800-2200 || Gas ||
 * N2O || 1590 || 15,900 || 745 || Liquid ||
 * N2 || 625-700 || 6000-8000 || 1800-2200 || Gas ||

Delivery of Medical Gases

 * Medical gases delivered from central supply to operating room via piping network
 * Pipes are sized such that pressure drops across the system never exceed 5 psi
 * Pipes are generally constructed of seamless copper tubing
 * Color coded hoses, noninterchangeable diameter index safety systems
 * E-cylinders that attach directly to the anesthesia machine

Temperature

 * Room temperature should be around 24C or higher (especially for pediatric patients or patients with thermal burns)
 * Hypothermia associated with increased incidence of wound infection, intraoperative blood loss (secondary to impaired coagulation), prolonged hospitalization
 * Intraoperative hypothermia may offer some neuroprotection during intracranial or cardiopulmonary bypass surgeries

Humidity

 * Relative humidity of at least 50% recommended, compliance not as important with the use of modern anesthetics
 * Static discharge previously feared source of ignition in operating rooms that use flammable anesthetics

Ventilation

 * High rate of operating room airflow decreases contamination of surgical site
 * Flow rates achieved by blending recirculated air with fresh air
 * Separate anesthetic gas scavenging system must supplement operating room ventilation

Noise
http://www.jimprice.com/prosound/db.htm
 * operating room noise measured at 70-80 dB
 * increased noise associated with reduction in mental efficiency and short-term memory
 * **Sounds** || **dB SPL** ||
 * Rocket Launching || 180 ||
 * Jet Engine || 140 ||
 * Thunderclap, Air Raid Siren 1 Meter || 130 ||
 * Jet takeoff (200 ft) || 120 ||
 * Rock Concert, Discotheque || 110 ||
 * Firecrackers, Subway Train || 100 ||
 * Heavy Truck (15 Meter), City Traffic || 90 ||
 * <span style="font-family: Arial,Arial,Helvetica;">Alarm Clock (1 Meter), Hair Dryer || <span style="font-family: Arial,Arial,Helvetica;">80 ||
 * <span style="font-family: Arial,Arial,Helvetica;">Noisy Restaurant, Business Office || <span style="font-family: Arial,Arial,Helvetica;">70 ||
 * <span style="font-family: Arial,Arial,Helvetica;">Air Conditioning Unit, Conversational Speech || <span style="font-family: Arial,Arial,Helvetica;">60 ||
 * <span style="font-family: Arial,Arial,Helvetica;">Light Traffic (50 Meter), Average Home || <span style="font-family: Arial,Arial,Helvetica;">50 ||
 * <span style="font-family: Arial,Arial,Helvetica;">Living Room, Quiet Office || <span style="font-family: Arial,Arial,Helvetica;">40 ||
 * <span style="font-family: Arial,Arial,Helvetica;">Library, Soft Whisper (5 Meter) || <span style="font-family: Arial,Arial,Helvetica;">30 ||
 * <span style="font-family: Arial,Arial,Helvetica;">Broadcasting Studio, Rustling Leaves || <span style="font-family: Arial,Arial,Helvetica;">20 ||
 * <span style="font-family: Arial,Arial,Helvetica;">Hearing Threshold || <span style="font-family: Arial,Arial,Helvetica;">0 ||

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