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A ventilation and surgical drape elevator device
A ventilation and surgical drape elevator device William Lipsky, M.D. Houston, Texas
Many patients experience a feeling of suffocation and anxiety when placed beneath semipermeable, plastic surgical drapes. To alleviate this feeling, which can be particularly bothersome during prolonged surgeries, numerous drape elevators have been designed. 1,2,3 For three years, I have been using a ventilation and surgical drape elevator that I designed. It is sturdy, portable, and can be easily assembled. The drape elevator (Figure 1) is made of O.5-inch outside diameter rigid-wall copper tubing. The base is joined to the upright to allow rotation of the base around the vertical axis. A rotatable central bar is attached between the bases to allow adjustment of the drape's height. The central bar has numerous holes drilled in it through which compressed air and/or oxygen can be blown over the patient's face. A simple, flexible,plastic suction catheter, routinely found in the operating room, is connected to the drape elevator and allowed to lie in the hollow formed by the patient's neck. Copper tubing, connected to the operating room
Fig. 1.
vacuum system by plastic tubing, evacuates carbon dioxide from beneath the drape (Figure 2). The combination of air or oxygen flow from the drape's central bar elevator and carbon dioxide evacuation through the operating room's vacuum system ensures constant air exchange. The air flow can be controlled by the surgeon. The air chamber beneath the drape· is determined by the height of the crossbar (Figure 3). The drape only contacts the side of the face being operated on 'at the bridge of the nose and the cheek. The openness around the nose and mouth helps to alleviate the patient's feeling of claustrophobia (Figure 4).
Fig. 2. (Lipsky) Detail of oxygen and suction connections. A = union joining upright bar to base. B = plastic suction tubing that will be placed in the hollow of the patient's neck. C = copper tubing that is connected to operatingroom wall suction by plastic tubing. D = oxygen inlet tubing connection.
(Lipsky) The drape elevator. A = union joining base to upright. B= central rotatable bar; adjustment of this bar determines height of the drape about the patient's nose. C = upright bar support. Fig. 3.
Reprint requests to William Lipsky, M.D. , 1060 Hercules Avenue, Houston , Texas 77058 .
(Lipsky) Assembled device about the patient's head. All connections have been made and draping is about to begin . Note the placement of the suction tube in the hollow of the patient's neck.
AM INTRA-OCULAR IMPLANT SOC J-VOL 10, WINTER 1984
83
The surgical astigmatic ruler L. L. Hyde, M.D. Kansas City, Missouri
Fig. 4.
(Lipsky) Draping is complete. Note how device elevates drape above patient.
With most drape elevators, the surgeon is unable to approach the patient from the side because the upright supports cannot be offset. With this device, the left and right sides can be offset to allow more room. Because the device is rigid, it can serve as an armrest. In addition, paper drapes, which tend to slide, can be clipped directly to the drape elevator and clamps, forceps, and retaining sutures can be safely attached to them. Because the device will instantly adjust to the standard parallel-side operating-room tables as well as the newer tapered-head designs, no adaptations of operating-room tables are necessary. I have even used this device on stretchers. The base of the device is placed under the operating-table pad and the patient's weight thus maintains stability. The device is simple, requires less than one minute to assemble, and is small enough to be dismantled at the end of surgery and easily transported in a small attache case to another room or hospital.
REFERENCES 1. Machemer R, Parel JM, Hickingbotham D: Support and air supply tube for vitreous surgery. Arch OphthalmoI98:154, 1980 2. Wesley RE, Halpin M: Use of Venturi entrainment mask for high flow ventilation of patients submitting to ophthalmic surgery under local anesthesia. Ophthalmic Surg 12(2):85-88, 1981 3. King J Jr: A new drape ventilator. Trans Am Acad Ophthalmol Otolaryngol 79:421, 1975
ABSTRACT A simple device for evaluating the corneal astigmatism present at the conclusion of ocular surgery is described. Directing the coaxial light from the operating microscope through the ruler's round aperture will create an elliptical reflex from the cornea that indicates the presence of astigmatism. Successive apertures in the ruler present known elliptical light reflexes to the cornea, and the surgeon can select the aperture that converts the corneal reflex to a circular appearance. The dioptric marking of the aperture indicates the approximate value of the astigmatism on the cornea. Key Words: corneal astigmatism, elliptical corneal reflex, keratometry, surgical astigmatic ruler
To add a certain measure of sophistication to simple qualitative surgical keratometry, I devised a surgical astigmatic ruler that should allow the surgeon to adjust a cataract incision closure within a tolerance of two diopters (D) or less. Most keratometers measure corneal astigmatism by reflecting a ring of light onto the cornea and analyzing the elliptical image with prisms. 1 The measured difference in curvature, expressed in diopters, between the flat and steep corneal meridians represents the corneal astigmatism. For practical surgical use, a simple ring, such as the eye of a safety pin, will provide useful information. If the image reflected from the ring onto the cornea appears round, there is probably less than ±2 D of astigmatism; if it appears distinctly oval, there is somewhat more than 2 D.2 Estimating a numerical value, however, proves difficult for most surgeons. Presented at the U.S. Intraocular Lens Symposium, New Orleans, Louisiana, March 1983. Reprint requests to L. L. Hyde, M.D., 2900 Baltimore Avenue, #650, Kansas City, Missouri 64108.
84
AM INTRA-OCULAR IMPLANT SOC J-VOL 10, WINTER 1984
Many patients experience a feeling of suffocation and anxiety when placed beneath semipermeable, plastic surgical drapes. To alleviate this feeling, which can be particularly bothersome during prolonged surgeries, numerous drape elevators have been designed. 1,2,3 For three years, I have been using a ventilation and surgical drape elevator that I designed. It is sturdy, portable, and can be easily assembled. The drape elevator (Figure 1) is made of O.5-inch outside diameter rigid-wall copper tubing. The base is joined to the upright to allow rotation of the base around the vertical axis. A rotatable central bar is attached between the bases to allow adjustment of the drape's height. The central bar has numerous holes drilled in it through which compressed air and/or oxygen can be blown over the patient's face. A simple, flexible,plastic suction catheter, routinely found in the operating room, is connected to the drape elevator and allowed to lie in the hollow formed by the patient's neck. Copper tubing, connected to the operating room
Fig. 1.
vacuum system by plastic tubing, evacuates carbon dioxide from beneath the drape (Figure 2). The combination of air or oxygen flow from the drape's central bar elevator and carbon dioxide evacuation through the operating room's vacuum system ensures constant air exchange. The air flow can be controlled by the surgeon. The air chamber beneath the drape· is determined by the height of the crossbar (Figure 3). The drape only contacts the side of the face being operated on 'at the bridge of the nose and the cheek. The openness around the nose and mouth helps to alleviate the patient's feeling of claustrophobia (Figure 4).
Fig. 2. (Lipsky) Detail of oxygen and suction connections. A = union joining upright bar to base. B = plastic suction tubing that will be placed in the hollow of the patient's neck. C = copper tubing that is connected to operatingroom wall suction by plastic tubing. D = oxygen inlet tubing connection.
(Lipsky) The drape elevator. A = union joining base to upright. B= central rotatable bar; adjustment of this bar determines height of the drape about the patient's nose. C = upright bar support. Fig. 3.
Reprint requests to William Lipsky, M.D. , 1060 Hercules Avenue, Houston , Texas 77058 .
(Lipsky) Assembled device about the patient's head. All connections have been made and draping is about to begin . Note the placement of the suction tube in the hollow of the patient's neck.
AM INTRA-OCULAR IMPLANT SOC J-VOL 10, WINTER 1984
83
The surgical astigmatic ruler L. L. Hyde, M.D. Kansas City, Missouri
Fig. 4.
(Lipsky) Draping is complete. Note how device elevates drape above patient.
With most drape elevators, the surgeon is unable to approach the patient from the side because the upright supports cannot be offset. With this device, the left and right sides can be offset to allow more room. Because the device is rigid, it can serve as an armrest. In addition, paper drapes, which tend to slide, can be clipped directly to the drape elevator and clamps, forceps, and retaining sutures can be safely attached to them. Because the device will instantly adjust to the standard parallel-side operating-room tables as well as the newer tapered-head designs, no adaptations of operating-room tables are necessary. I have even used this device on stretchers. The base of the device is placed under the operating-table pad and the patient's weight thus maintains stability. The device is simple, requires less than one minute to assemble, and is small enough to be dismantled at the end of surgery and easily transported in a small attache case to another room or hospital.
REFERENCES 1. Machemer R, Parel JM, Hickingbotham D: Support and air supply tube for vitreous surgery. Arch OphthalmoI98:154, 1980 2. Wesley RE, Halpin M: Use of Venturi entrainment mask for high flow ventilation of patients submitting to ophthalmic surgery under local anesthesia. Ophthalmic Surg 12(2):85-88, 1981 3. King J Jr: A new drape ventilator. Trans Am Acad Ophthalmol Otolaryngol 79:421, 1975
ABSTRACT A simple device for evaluating the corneal astigmatism present at the conclusion of ocular surgery is described. Directing the coaxial light from the operating microscope through the ruler's round aperture will create an elliptical reflex from the cornea that indicates the presence of astigmatism. Successive apertures in the ruler present known elliptical light reflexes to the cornea, and the surgeon can select the aperture that converts the corneal reflex to a circular appearance. The dioptric marking of the aperture indicates the approximate value of the astigmatism on the cornea. Key Words: corneal astigmatism, elliptical corneal reflex, keratometry, surgical astigmatic ruler
To add a certain measure of sophistication to simple qualitative surgical keratometry, I devised a surgical astigmatic ruler that should allow the surgeon to adjust a cataract incision closure within a tolerance of two diopters (D) or less. Most keratometers measure corneal astigmatism by reflecting a ring of light onto the cornea and analyzing the elliptical image with prisms. 1 The measured difference in curvature, expressed in diopters, between the flat and steep corneal meridians represents the corneal astigmatism. For practical surgical use, a simple ring, such as the eye of a safety pin, will provide useful information. If the image reflected from the ring onto the cornea appears round, there is probably less than ±2 D of astigmatism; if it appears distinctly oval, there is somewhat more than 2 D.2 Estimating a numerical value, however, proves difficult for most surgeons. Presented at the U.S. Intraocular Lens Symposium, New Orleans, Louisiana, March 1983. Reprint requests to L. L. Hyde, M.D., 2900 Baltimore Avenue, #650, Kansas City, Missouri 64108.
84
AM INTRA-OCULAR IMPLANT SOC J-VOL 10, WINTER 1984