Case No.

: Circulating 2
Name of Student: Mary Edella Acob
Year/ Section & RLE Group: 3NUR1 / RLE 1
Name of Patient: S. L. O. Sex: M Age: 71 Civil status: Married
Date of Admission: 10/05/19 Time Started/Ended: 1:04 PM– 4:45 PM
Date of Surgery: 10/08/19
Bed #: 3111 Hospital #: 19-120000237109 Admission #: 19500165

Surgeon: Dr. Delos Angeles, MD

Assistant Surgeon/s: Dr. Manahan/Dra. San Antonio
Anesthesiologist: Dr Doctor, MD
Scrub nurse: Darylle Joyce S. Romero, RN
Circulating Nurse: Aldrin B. Basaysay, RN

Chief Complaint: Hematochezia

Rationale/Definition: The passage of fresh blood per anus, usually in or with stools
Post-Operative Diagnosis: Rectal Adenocarcinoma Stage III B
Rationale/Definition: The cancer has grown through the bowel wall or surrounding organs and into 1 to
3 lymph nodes or to a nodule of tumor in tissues around the colon or rectum that do not appear to be lymph
nodes. It has not spread to other parts of the body

Complete Surgical Procedure: Anterior Resection with End to End Anastomosis

Definition: Anastomosis of two sections of colon, such as with partial colectomy or when an ileostomy
is closed; anterior resection classically refers to removal of the sigmoid colon and upper rectum
Indication: Malignant lesions in the rectosigmoid or low sigmoid area; in order to re-establish bowel
continuity

Type of Anesthesia: General (GETA) and Spinal

Specific Technique: Inhalation and Regional (injected)
Skin Preparation: Cleaned the lumbar area with antiseptic solution. Swab radially outwards from the
proposed injection site for the regional.
Items Used to administer Anesthesia: ET Tube and mask; sterile spinal needle, syringe and anesthesia
catheter connector
Main Anesthetic Agent: D2 + Sevoflurane
Mechanism of Action: These work by reducing the activity of the body's central nervous system
temporarily. It is a clear colorless liquid, that becomes a gas when put into a special anesthetic machine
(vaporizer); causes a dose-dependent vasodilation of cerebral vasculature, thereby increasing cerebral
blood flow and intracranial pressure. Sevoflurane reduces the cerebral metabolic rate
Other medications used: Fentanyl, Propofol and Rocuronium
Mechanism of Action:
Propofol – An intravenous general anesthetic and sedation drug for use in the induction and
maintenance of anesthesia or sedation. It produces its sedative/anesthetic effects by the positive
modulation of the inhibitory function of the neurotransmitter GABA through the ligand-gated GABAA
receptors.
Fentanyl - a strong, synthetic narcotic that is similar to morphine. stimulates receptors on nerves
in the brain to increase the threshold to pain (the amount of stimulation it takes to feel pain) and reduce
the perception of pain.
 Rocuronium - nondepolarizing neuromuscular blocking agent with a rapid to intermediate onset
of action, depending on dose, and with an intermediate duration of action. It produces neuromuscular
blockade by competing with acetylcholine for cholinergic receptors at the motor end plate.

Position: Supine
Equipment Used for Positioning: pillow and safety strap
Incision: Midline
Skin Preparation: upper and lower abdominal
Disinfectant Used: Cutaseft
Draping: Lap sheet and towel (4)
Surgical Safety Checklist:
Sign In
 Patient’s identity, site,
procedure, and consent
was confirmed
 Surgical site marked
 Anesthesia machine and
medication chart checked
 Pulse oximeter attached
and working
 Antibiotic prophylaxis
within the 60 minutes
 With glycemic control
Time Out Sign Out
 1:00 PM, our patient is  Nurse verbally confirms
S.L.O, scheduled for the name of the procedure
Anterior Resection with to be recorded, and
End to End Anastomosis instruments, sponges,
 Surgeon: Dr. Delos sharps, and needle counts
Angeles, MD are complete
 Assistant Surgeon/s:  Specimen has been
 Dr. Manahan/Dra. San labeled correctly,
Antonio including patient’s name
 Anesthesiologist: Dr.  Specimen: Rectosigmoid
Doctor, MD Mass
 Undertaken Venous  Pathologist: Dr. Lopez
Thromboembolism  All team members
prophylaxis introduced themselves
 Initial count done and and their roles
recorded  Patient’s identity,
procedure to be done and
site of operation
confirmed by surgeon,
anesthesiologist, and
nurse
 To surgeon: Anticipated
critical events: bleeding