Intraoperative care is the physical and psychological care given to the patient in the anaesthetic room and operating theatre, prior to their transfer to the post‐anaesthetic care unit. General anaesthesia is usually described as a triad of components that include hypnosis (sleep), analgesia and muscle relaxation.

In the anaesthetic room, patients are admitted and checked into the operating suite. The patient is normally transferred (already anaesthetized) into the theatre on a trolley and moved across to the operating table. For some life‐threatening emergency surgery (e.g. ruptured abdominal aortic aneurysm repair), it may be preferable to induce anaesthesia inside the operating theatre with the patient already positioned on the operating table (Leonard and Thompson [98]). A crucial role of the anaesthetic nurse is to support the patient, who is often frightened or anxious due to the unfamiliar, often intimidating environment and apprehensive about both the anaesthesia and the impending surgery (Turunen et al. [205]).

The patient should be carefully checked by the anaesthetist and an anaesthetic practitioner with reference to the ‘Sign In’ portion of the WHO Surgical Safety Checklist (WHO [225]). The patient should be comfortably positioned on a trolley or an operating table with the relevant monitoring devices attached (i.e. ECG leads, blood pressure cuff and pulse oximeter) (AAGBI [5]).

The patient may undergo surgery under general anaesthesia, regional anaesthesia or sedation; they may also have both general and regional anaesthesia. Depending on the nature of the surgery and the patient's co‐morbidities, the anaesthetist may require additional invasive monitoring, such as large‐bore intravenous cannula, arterial line or central venous catheter. After induction of general anaesthesia or performance of regional anaesthesia, and with the patient's cardiorespiratory stability ensured, the patient is carefully transferred to the operating table.

Depending on the nature of the surgery, the patient's position may need to be altered (e.g. moved into the prone or lateral position). Meticulous care of the patient's eyes, skin, joints and nerves must be taken during this positioning and throughout the surgery to avoid complications associated with prolonged immobility. The ‘Time Out’ portion of the WHO Surgical Safety Checklist (WHO [225]) is then completed before commencing the surgical procedure. Nursing activities during the intraoperative period are focused on patient safety, ensuring surgical swab counts are managed safely in accordance with the recommended safety practice, facilitating the procedure and adherence to infection control recommendations. It is then mandatory to complete the ‘Sign Out’ portion of the WHO Surgical Safety Checklist (WHO [225]) to confirm that all surgical counts are correct and to ensure any specific post‐operative concerns from the surgical and anaesthetic team are relayed to the post‐operative nursing care team.

The WHO Surgical Safety Checklist (WHO [225]) is a structured aid used to enhance communication and improve safety within surgery. It was first implemented in 2008 and is mandated in many countries, including the UK. The aim of the checklist is to decrease the numbers of errors and adverse events, and increase teamwork and communication in surgery. The checklist comprises three parts: before induction of anaesthesia (‘Sign In’), before skin incision (‘Time Out’) and before the patient leaves the operating room (‘Sign Out’) (Figure 16.14).