Preoperative Preparation and Patient Care
Verification and readiness
The first assistant's preoperative role is verification, not assumption. Confirm identity with two identifiers, check that the consent form is signed and matches the planned procedure, site, and surgeon, and verify the surgeon has marked the site. The surgeon-not the assistant-obtains informed consent. Review allergies, anticoagulants, diabetes medications, and baseline labs, and report abnormalities. Fasting follows ASA guidance: clear liquids 2 hours, breast milk 4 hours, light meal 6 hours, fatty meal 8 hours; “NPO after midnight” is outdated and a common distractor. Remove hair with clippers, not razors, immediately before surgery. Give prophylactic antibiotics within 60 minutes of incision (120 minutes for vancomycin or fluoroquinolones), apply warming measures, and confirm DVT prophylaxis and glucose plans.
Positioning and team communication
Positioning is a shared responsibility: protect pressure points, eyes, nerves, and dependent limbs; secure the patient before draping; and verify that extremities are neutral. The time-out is a final pause-team members state name and role, patient, procedure, site, allergies, antibiotic, counts, and imaging needs.
Trap: a question may imply the assistant can obtain consent or mark the site. Both are surgeon responsibilities. Another trap confuses “clear liquids” with “nothing by mouth”; black coffee is clear, coffee with cream is not.
Rule of thumb: use the 2-4-6-8 fasting rule and “if it isn't documented and verified, it isn't ready.”