Principles of Aseptic Technique in an Operating Room

Surgical asepsis, or aseptic technique, is designed to get rid of pathogenic microorganisms from
areas or objects. It is also used to keep areas and objects free of microorganisms. Surgical
asepsis demands more precautions than medical asepsis. Aseptic technique is commonly used
in surgery, labor and delivery, in procedures that involve puncturing the skin, when the skin's
layers are penetrated by surgical incisions or burns, and during procedures that involve putting
objects into normally sterile body cavities. There are nine principles that must be followed to
prevent microorganisms from infecting a wound during surgery.

Sterile Fields
The first principle of surgical asepsis states that all materials in a sterile field must
be sterile. All objects added to your sterile field must also be sterile. If you put your
hands into the sterile field, they must be covered using sterile gloving technique and
the gloves should also begin in sterile packaging.

The second principle states that a sterile barrier that has been compromised by
punctures, tears or moisture has to be considered contaminated. If a sterile field has
been set up and it is accidentally torn, the openings can allow microorganisms to
invade and contaminate.

Sterile Borders
The third principle states that once a package is opened, a 2.5 cm (1 inch) border
around the edge is considered unsterile. For example, many procedures contain
setup of sterile packaging that is opened before sterile gloves are applied. During
this time the 1 inch unsterile border is the only section that can be touched.

The fourth principle states that tables draped as part of a sterile field are considered
sterile only at the table level. Therefore the table legs, underside of the table, or any
shelves below the table level are to be considered unsterile.

Sterility Questions
The fifth principle examines questions or doubts. It states that if there are any
questions or doubts about an object's sterility, the object should be considered
unsterile.

The sixth principle states that sterile people and objects should only come into
contact with sterile fields, and unsterile people and objects should only come into
contact with unsterile areas, such as the 2.5 cm border.

Movement and Range of Vision

The seventh principle states that movement around or in the sterile field must not
compromise or contaminate the sterile field. While performing procedures requiring
 a sterile field, it is important to remember that correct sterile technique must always
be followed.

The eighth principle says that anything out of your range of vision or below waist
level is considered contaminated and unsterile. For instance, if an object is dropped
below the waist, it is no longer sterile. The backside of the body, which is out of your
range of vision, is also considered unsterile. Therefore, you should never turn your
back on your sterile field and bring all tables needed in procedures up to your waist
level.

Air Exposure
The ninth and last principle of surgical asepsis states that a sterile object or field can
become contaminated by lingering exposure to air. While performing a sterile
procedure, one should stay organized and finish the procedure as quickly as
possible.

Preoperative care
Definition

Preoperative care is the preparation and management of a patient prior to surgery. It

includes both physical and psychological preparation.

Purpose

Patients who are physically and psychologically prepared for surgery tend to have better
surgical outcomes. Preoperative teaching meets the patient's need for information
regarding the surgical experience, which in turn may alleviate most of his or her fears.
Patients who are more knowledgeable about what to expect after surgery, and who have
an opportunity to express their goals and opinions, often cope better with postoperative
pain and decreased mobility. Preoperative care is extremely important prior to any
invasive procedure, regardless of whether the procedure is minimally invasive or a form
of major surgery.

Preoperative teaching must be individualized for each patient. Some people want as
much information as possible, while others prefer only minimal information because too
much knowledge may increase their anxiety. Patients have different abilities to
comprehend medical procedures; some prefer printed information, while others learn
more from oral presentations. It is important for the patient to ask questions during
preoperative teaching sessions.

Description
Preoperative care involves many components, and may be done the day before surgery
in the hospital, or during the weeks before surgery on an outpatient basis. Many surgical
procedures are now performed in a day surgery setting, and the patient is never
admitted to the hospital.

Physical preparation

Physical preparation may consist of a complete medical history and physical exam,
including the patient's surgical and anesthesia background. The patient should inform
the physician and hospital staff if he or she has ever had an adverse reaction to
anesthesia (such as anaphylactic shock), or if there is a family history of malignant
hyperthermia. Laboratory tests may include complete blood count , electrolytes,
prothrombin time, activated partial thromboplastin time, and urinalysis . The patient
will most likely have an electrocardiogram (EKG) if he or she has a history of cardiac
disease, or is over 50 years of age. A chest x ray is done if the patient has a history of
respiratory disease. Part of the preparation includes assessment for risk factors that
might impair healing, such as nutritional deficiencies, steroid use, radiation or
chemotherapy, drug or alcohol abuse, or metabolic diseases such as diabetes. The
patient should also provide a list of all medications, vitamins, and herbal or food
supplements that he or she uses. Supplements are often overlooked, but may cause
adverse effects when used with general anesthetics (e.g., St. John's wort, valerian root).
Some supplements can prolong bleeding time (e.g., garlic, gingko biloba).

Latex allergy has become a public health concern. Latex is found in most sterile surgical
gloves, and is a common component in other medical supplies including general
anesthesia masks, tubing, and multi-dose medication vials. It is estimated that 1–6% of
the general population and 8–17% of health care workers have this allergy. Children
with disabilities are particularly susceptible. This includes children with spina bifida,
congenital urological abnormalities, cerebral palsy, and Dandy-Walker syndrome. At
least 50% of children with spina bifida are latex-sensitive as a result of early, frequent
surgical exposure. There is currently no cure available for latex allergy, and research has
found that the allergy accounts for up to 19% of all anaphylactic reactions during
surgery. The best treatment is prevention, but immediate symptomatic treatment is
required if the allergic response occurs. Every patient should be assessed for a potential
latex reaction. Patients with latex sensitivity should have their chart flagged with a
caution label. Latex-free gloves and supplies must be used for anyone with a
documented latex allergy.

Bowel clearance may be ordered if the patient is having surgery of the lower
gastrointestinal tract. The patient should start the bowel preparation early the evening
before surgery to prevent interrupted sleep during the night. Some patients may benefit
from a sleeping pill the night before surgery.

The night before surgery, skin preparation is often ordered, which can take the form of
scrubbing with a special soap (i.e., Hibiclens), or possibly hair removal from the surgical
area. Shaving hair is no longer recommended because studies show that this practice
may increase the chance of infection. Instead, adhesive barrier drapes can contain hair
growth on the skin around the incision.

Psychological preparation

Patients are often fearful or anxious about having surgery. It is often helpful for them to
express their concerns to health care workers. This can be especially beneficial for
patients who are critically ill, or who are having a high-risk procedure. The family needs
to be included in psychological preoperative care. Pastoral care is usually offered in the
hospital. If the patient has a fear of dying during surgery, this concern should be
expressed, and the surgeon notified. In some cases, the procedure may be postponed
until the patient feels more secure.

Children may be especially fearful. They should be allowed to have a parent with them
as much as possible, as long as the parent is not demonstrably fearful and contributing
to the child's apprehension. Children should be encouraged to bring a favorite toy or
blanket to the hospital on the day of surgery.

Patients and families who are prepared psychologically tend to cope better with the
patient's postoperative course. Preparation leads to superior outcomes since the goals of
recovery are known ahead of time, and the patient is able to manage postoperative pain
more effectively.

Informed consent

The patient's or guardian's written consent for the surgery is a vital portion of
preoperative care. By law, the physician who will perform the procedure must explain
the risks and benefits of the surgery, along with other treatment options. However, the
nurse is often the person who actually witnesses the patient's signature on the consent
form. It is important that the patient understands everything he or she has been told.
Sometimes, patients are asked to explain what they were told so that the health care
professional can determine how much is understood.

Patients who are mentally impaired, heavily sedated, or critically ill are not considered
legally able to give consent. In this situation, the next of kin (spouse, adult child, adult
sibling, or person with medical power of attorney ) may act as a surrogate and sign
the consent form. Children under age 18 must have a parent or guardian sign.
Preoperative teaching

Preoperative teaching includes instruction about the preoperative period, the surgery
itself, and the postoperative period.

Instruction about the preoperative period deals primarily with the arrival time, where
the patient should go on the day of surgery, and how to prepare for surgery. For
example, patients should be told how long they should be NPO (nothing by mouth),
which medications to take prior to surgery, and the medications that should be brought
with them (such as inhalers for patients with asthma).

Instruction about the surgery itself includes informing the patient about what will be
done during the surgery, and how long the procedure is expected to take. The patient
should be told where the incision will be. Children having surgery should be allowed to
"practice" on a doll or stuffed animal. It may be helpful to demonstrate procedures on
the doll prior to performing them on the child. It is also important for family members
(or other concerned parties) to know where to wait during surgery, when they can
expect progress information, and how long it will be before they can see the patient.

Knowledge about what to expect during the postoperative period is one of the best ways
to improve the patient's outcome. Instruction about expected activities can also increase
compliance and help prevent complications. This includes the opportunity for the
patient to practice coughing and deep breathing exercises, use an incentive spirometer,
and practice splinting the incision. Additionally, the patient should be informed about
early ambulation (getting out of bed). The patient should also be taught that the
respiratory interventions decrease the occurrence of pneumonia, and that early leg
exercises and ambulation decrease the risk of blood clots.

Patients hospitalized postoperatively should be informed about the tubes and

equipment that they will have. These may include multiple intravenous lines, drainage
tubes, dressings, and monitoring devices. In addition, they may have sequential
compression stockings on their legs to prevent blood clots until they start ambulating.

Pain management is the primary concern for many patients having surgery.
Preoperative instruction should include information about the pain management
method that they will utilize postoperatively. Patients should be encouraged to ask for or
take pain medication before the pain becomes unbearable, and should be taught how to
rate their discomfort on a pain scale. This instruction allows the patients, and others
who may be assessing them, to evaluate the pain consistently. If they will be using a
patient-controlled analgesia pump, instruction should take place during the
preoperative period. Use of alternative methods of pain control (distraction, imagery,
positioning, mindfulness meditation, music therapy) may also be presented.

Finally, the patient should understand long-term goals such as when he or she will be
able to eat solid food, go home, drive a car, and return to work.

Preparation
It is important to allow adequate time for preparation prior to surgery. The patient
should understand that he or she has the right to add or strike out items on the generic
consent form that do not pertain to the specific surgery. For example, a patient who is
about to undergo a tonsillectomy might choose to strike out (and initial) an item that
indicates sterility might be a complication of the operation.

Normal results
The anticipated outcome of preoperative care is a patient who is informed about the
surgical course, and copes with it successfully. The goal is to decrease complications and
promote recovery.

Intraoperative Care
Definition
The term "intraoperative" refers to the time during surgery. Intraoperative care is patient care
during an operation and ancillary to that operation.
Activities such as monitoring the patient's vital signs, blood oxygenation levels, fluid therapy,
medication transfusion, anesthesia, radiography, and retrieving samples for laboratory tests, are
examples of intraoperative care. Intraoperative care is provided by nurses, anesthesiologists,
nurse anesthetists, surgical technicians, surgeons, and residents, all working as a team.

Purpose
The purpose of intraoperative care is to maintain patient safety and comfort during surgical
procedures. Some of the goals of intraoperative care include maintaining homeostasis during the
procedure, maintaining strict sterile techniques to decrease the chance of cross-infection,
ensuring that the patient is secure on the operating table, and taking measures to prevent
hematomas from safety strips or from positioning.

Precautions
Patients undergoing surgery most often are given some type of anesthesia. The administration of
general anesthesia has a relaxing effect on the patient's body, which can suppress cardiovascular
function or heighten cardiovascular irritability. It may also result in respiratory depression, loss
of consciousness, paralysis, and lack of sensation. These effects, some of which are intentional
for the period of the surgery, mean the patient is in a very vulnerable position. It is the
responsibility of the health care team in the operating room to maintain the patient's safety and
yet facilitate surgery.
In 1992 the American Association of Nurse Anesthetists (AANA) established guidelines for
monitoring patients undergoing general anesthesia. The guidelines call for continuous
observation of the patient by the nurse assigned to the patient. Ventilation should be assessed by
continuous auscultation of breath sounds, and oxygenation should be monitored by continuous
pulse oximetry. Continuos electrocardiograph (ECG) showing the patient's cardiac function
should be in place, and the patient's heart rate and blood pressure should be monitored at least
every five minutes. A means to monitor the patient's temperature must be available immediately
for use. In case of an emergency backup personnel who are experts in airway management,
emergency intubation, and advanced cardiac life support (ACLS) must be available. An
emergency cart containing the necessary supplies and equipment must be immediately
accessible. The ACLS equipment should be checked daily to ensure proper function.
Total analgesia is a goal of general anesthesia in order to facilitate surgery. This means that the
patient does not have the normal "pain" sensations that warn of potential injury. The health care
team must keep this in mind when they are positioning the patient for a surgical procedure.
Although it may be necessary for a patient to be positioned in an unusual way for access to a
particular area during surgery, care must be taken to ensure that the patient's body is in proper
alignment and that joints and muscles are not in such an unnatural position that they will be
damaged if they remain in that position for a lengthy procedure. Areas of the operating table that
come into contact with the patient's bony prominences must be padded to prevent skin trauma
and hematomas.
During a surgical procedure many instruments, drapes, and sponges are used. Also, a multitude
of care providers may be working in the operative field performing different tasks. These factors,
combined with the complexity and length of some surgical procedures, may provide extensive
opportunity for patient trauma from equipment malfunction or the failure of the surgical team to
avoid using full weight on the sedated patient. Additionally, it is the responsibility of the nurses
working in the operating room to maintain an accurate count of all sponges, instruments, and
sharps that may become foreign bodies upon incision closure. Nurses who fail to make accurate
counts can be held legally liable.
Most surgical procedures are invasive and compromise a patient's skin integrity. This increases
the risk of infection. To decrease the risk, strict asepsis (sterile technique) must be followed at
all times. It is recommended that the ventilation system in an operative area provide a minimum
of fifteen exchanges of filtered air per hour. The temperature in the intraoperative area should be
maintained at 68–73°F (20–23°C), and the relative humidity should be maintained at 30%–60%.
Health care personnel who work in the operating room must not be permitted to work if they
have open lesions on the hands or arms, eye infections, diarrhea, or respiratory infections. Scrub
attire must be worn by all personnel entering the operating room. Fresh scrub attire must be
donned daily and, if heavily soiled during one case, should be changed before the next case.
Most facilities provide personnel with scrub attire that is professionally laundered. Shoe covers
are required and should be changed often. Head and facial hair must be completely contained in
a lint-free cap or hood. Properly fitting disposable surgical masks must be worn at all times and
discarded immediately after use. Sterile gloves and sterile gowns must be worn by those working
in, and in proximity to, the sterile field. Careful skin preparation with appropriate antiseptic
solutions is preformed on the patient's arrival to the operating area.
Patients who have a known or suspected allergy to latex should be scheduled for surgery as the
first case of the day whenever possible to avoid contact with airborne latex particles (often
attached to powder granules from the gloves) that may be in the room from a previous surgery.
These patients should also be identified (some facilities use special colored identification bands
and colored tapes on the patient's medical record) so that all health care personnel can recognize
them. Special care must be taken to limit the uses of equipment containing latex that will contact
the patient's skin. This includes anesthesia masks, adhesive tape and dressings, injections drawn
from multidose vials with rubber stoppers, adhesive ground plates for electrocautery or
diathermy, and pad coverings on the operating table and arm extensions.

Description
Intraoperative care includes the activities performed by the health care team during surgery that
ensure the patient's safety and comfort, implement the surgical procedure, monitor and maintain
vital functions, and document care given. The intraoperative time period can vary greatly from
less than one hour to 12 hours or more, depending on the complexity of the surgery being
performed.

Preparation
Prior to surgery the patient or legal guardian must have the surgical procedure explained to them
in great detail, including the expected outcomes and all possible complications, in order to give
informed consent. The explanation should be given to the patient at a time when he or she is
relaxed, but when judgment is not clouded by the use of any pain medication or anesthesia,
which would invalidate the consent. A consent form must be signed by the patient or guardian
and witnessed by a staff member as well as the surgeon performing the procedure. It is the duty
of the RN admitting the patient to the surgical suite to check the patient's ID band and ensure that
all records are intact and accounted for.
After consent is given the patient may be taken to a holding area where a large-bore intravenous
catheter is inserted into the patient's arm for use in fluid replacement and to infuse medications
during the procedure. The area of the body where the incision will be made is meticulously
prepared using drapes, and a skin preparation that is antiseptic and may include the use of
alcohol solutions and iodophor. Monitoring devices such as continuous ECG nodes, pulse
oximetry probes, and a blood pressure cuff are usually applied prior to skin preparation.
Anesthesia, also, is begun before skin prep. Surgery is then ready to begin.

Postoperative Care
The time after surgery is referred to as the postoperative period and includes the recovery and
convalescence phases. The recovery phase is the time immediately after surgery when the effects
of anesthesia are wearing off and the patient is waking up. The convalescence phase is spent
either in the hospital, in an interim care facility, or at home—depending on the procedure and the
preferences of the physician and patient.

Complications
Intraoperative complications are surgery related, anesthesia related, or position related. One
complication occurring during the intraoperative period that is not common but can be life
threatening is an anaphylactic (allergic) reaction to anesthesia. The intraoperative staff is trained
extensively in the treatment of such a reaction, and emergency equipment should always be
available in the event it is needed for this purpose. Another anesthesia-related complication is
called "awareness under anesthesia." This occurs when the patient receives sufficient muscle
relaxant (paralytic agent) to prohibit voluntary motor function but insufficient sedation and
analgesia to block pain and the sense of hearing. Patients are aware of being "awake" because
they hear the sounds and conversation in the room and, in some cases, can feel the pain
associated with the skin incision and surgery. However, they cannot respond to these sensations
in a way—not even with so small a motion as blinking the eyelid—that will tell someone what
they are sensing. This condition creates an exaggerated fear response that can affect
hemodynamics and vital signs. Another complicating reaction may be that of malignant
hyperthermia. This is a chain reaction triggered in susceptible people by commonly used general
anesthetics. Signs include greatly increased body metabolism, muscle rigidity, and eventual
hyperthermia which may exceed 110°F(43.3°C). Death may be caused by cardiac arrest, brain
damage, internal hemorrhage, or failure of other body systems.
Complications of surgery include, but are not limited to, hypovolemic shock (due to blood loss
during surgery), injuries from poor positioning during surgery, infection of the surgical wound,
fluid and electrolyte imbalances, aspiration pneumonia, blood clots, and paralytic ileus
(paralysis of the intestines, causing distention).

Results
The results of a surgical procedure depend greatly on the procedure preformed, the skill of the
surgeon, the general health of the patient preoperatively, and the ability of the patient's body to
recover from the procedure. Some surgeries cure a condition (e.g., an appendectomy for an
inflamed appendix). Others are only one step in a long process to cure a disease or repair an
injury (e.g., discectomy for a patient suffering from back pain). Still others are performed as
palliative measures rather than as a cure. An example of palliative surgery would be the removal
of a metastatic abdominal tumor to relieve abdominal pressure. In this example removing the
abdominal tumor is not going to cure the cancer that exists in other parts of the patient's body; it
is simply going to relieve the discomfort caused by the abdominal mass.

Health care team roles

Nurses may fill two different roles in the operating room. The scrub nurse is responsible for
providing the surgeon with instruments and supplies and maintaining the sterile field. This role
also may be assumed by a scrub or surgical technician. The second role nurses have in the
operating room is that of circulating nurse. The circulating nurse is first the patient's advocate,
with primary concern and responsibility for the patient's safety and welfare. In addition, the
circulating nurse is responsible for anything related to the patient that is not directly contingent
to the sterile field. That means all activities necessary to prepare the patient and the operative site
for surgery, and assistance required by anesthesia personnel. Of crucial import is that the
circulating nurse must be certified to give intravenous medication to the patient in case of an
emergency. Finally, nurses must document and process tissue specimens for pathology.
KEY TERMS
Anaphylactic reaction (anaphylaxis)—A hyper-sensitive reaction to an antigen resulting in
life-threatening, progressive symptoms.
Anesthesia—A classification of medications that are intended to cause the loss of normal
sensation.
Aseptic technique—Strict sterile procedures instilled to decrease the risk of contamination of a
surgical site or open wound.
ECG—Abbreviation for electrocardiograph. Electro-cardiograph is a tracing of the electrical
activity of the heart obtained through electrodes placed on a person's skin in certain areas where
electrical activity can be easily be detected.
Hypovolemic shock—A state of shock caused by the sudden loss of large amounts of blood.
Informed consent—Written or oral permission given by a patient or guardian for medical or
surgical treatment after a complete explanation is given and any questions the patient has are
answered. If consent is given orally, documentation must have two witnesses.
Intraoperative care—Care provided to a patient during surgery that is ancillary to the surgery.
Malignant hyperthermia—A chain reaction triggered in susceptible people by commonly used
general anesthetics. Signs include greatly increased body metabolism, muscle rigidity, and
eventual hyperthermia which may exceed 110°F(43.3°C). Death may be caused by cardiac arrest,
brain damage, internal hemorrhage, or failure of other body systems.
Pulmonary function tests—Tests used to determine ventilation and perfusion capabilities of the
lungs.
Pulse oximetry—A method of measuring a patient's blood oxygenation status. A measure of
100% is optimal.

Anesthesia - Types of Anesthesia

Anesthesia involves the use of medicines to block pain sensations (analgesia) during surgery and other
medical procedures. Anesthesia also reduces many of your body's normal stress reactions to surgery.

The type of anesthesia used for your surgery depends on:

1. Your medical history, including other surgeries you have had and any conditions you have (such
 as diabetes). You will also be asked whether you have had any allergic reactions to any
anesthetics or medicines or whether any family members have had reactions to anesthetics.

2. The results of your physical exam. A physical exam will be done to evaluate your current health
and identify any potential risks or complications that may affect your anesthesia care.

3. Tests such as blood tests or an electrocardiogram (EKG, ECG), if needed.

4. The type of surgery that you are having.

a. You need to be able to lie still and remain calm during surgery done with local or regional
anesthesia.

b. Young children usually cannot stay still during surgery and need general anesthesia.

c. Adults who are extremely anxious, in pain, or have muscle disorders also may have
difficulty remaining relaxed and cooperative.

d. Some surgical procedures require specific positions that may be uncomfortable for long
periods if you are awake.

e. Some procedures require the use of medicines that cause muscle relaxation and affect
your ability to breathe on your own. In such cases, your breathing can best be supported
if general anesthesia is used.

5. Based on your medical condition, your anesthesia specialist may prefer one type of anesthesia
over another for your surgery. When the risks and benefits of different anesthesia options are
equal, your anesthesia specialist may let you choose the type of anesthesia.

Anesthesia methods

There are several ways that anesthesia can be given.

1. Local anesthesia involves injection of a local anesthetic (numbing agent) directly into the surgical
area to block pain sensations. It is used only for minor procedures on a limited part of the body.
You may remain awake, though you will likely receive medicine to help you relax or sleep during
the surgery.

2. Regional anesthesia involves injection of a local anesthetic (numbing agent) around major nerves
or the spinal cord to block pain from a larger but still limited part of the body. You will likely
receive medicine to help you relax or sleep during surgery. Major types of regional anesthesia
include:

3. Peripheral nerve blocks. A local anesthetic is injected near a specific nerve or group of nerves to
block pain from the area of the body supplied by the nerve. Nerve blocks are most commonly
used for procedures on the hands, arms, feet, legs, or face.

4. Epidural and spinal anesthesia. A local anesthetic is injected near the spinal cord and nerves that
connect to the spinal cord to block pain from an entire region of the body, such as the belly, hips,
or legs.

5. General anesthesia is given into a vein (intravenously) or is inhaled. It affects the brain as well as
the entire body. You are completely unaware and do not feel pain during the surgery. Also,
general anesthesia often causes forgetfulness (amnesia) right after surgery (postoperative
period).

For some minor procedures, a qualified health professional who is not an anesthesia specialist may give
some limited types of anesthesia, such as procedural sedation. Procedural sedation combines the use of
local anesthesia with small doses of sedative or analgesic agents (painkillers) to relax you.

Medicines used for anesthesia

A wide variety of medicines are used to provide anesthesia. Their effects can be complex. And they can
interact with other medicines to cause different effects than when they are used alone. Anyone receiving
anesthesia-even procedural sedation-must be monitored continuously to protect and maintain vital body
functions. The complex task of managing the delivery of anesthesia medicines as well as monitoring your
vital functions is done by anesthesia specialists.

Medicines used for anesthesia help you relax, help relieve pain, induce sleepiness or forgetfulness, or
make you unconscious. Anesthesia medicines include:

1. Local anesthetics, such as bupivacaine or lidocaine, that are injected directly into the body area
involved in the surgery.

2. Intravenous (IV) anesthetics, such as fentanyl, propofol, or sodium thiopental, that are given
through a vein.

3. Inhalation anesthetics, such as isoflurane and nitrous oxide, that you breathe through a mask.
4. Other medicines that are often used during anesthesia include:

5. Muscle relaxants, which block transmission of nerve impulses to the muscles. They are used
during anesthesia to temporarily relax muscle tone as needed.

6. Reversal agents, which are given to counteract or reverse the effects of other medicines such as
muscle relaxants or sedatives given during anesthesia. Reversal agents may be used to reduce
the time it takes to recover from anesthesia.