1. What are the safety precautions to be considered with placement of
patient return electrode?
Electrosurgery is a surgical procedure that uses electrical current of various voltages to generate heat in the skin. It is used to minimize the bleeding during surgery and to remove abnormal growths on the skin. It requires a power supply, a hand piece with two or more electrodes, and a switch on the handpiece or a footswitch to control the equipment. Electricity causes tissue destruction by desiccation, coagulation, fulguration, and vaporization. In the case of desiccation, the cells are shrunken by the loss of water and extensive coagulation of proteins. It is produced by a low current of higher voltage applied over broad surface area. Coagulation occurs in higher current densities leading to higher tissue temperatures. The tissue fluids are boiled and the proteins are denatured resulting in the formation of a white coagulum. The cellular definition is lost and tissue structures form a homogenized mass. Fulguration is caused by electrical arcs striking the tissue from divergent locations. The tissue destruction is superficial and large amounts of carbonization take place. The layer of carbon and the desiccated tissue beneath acts as an insulating barrier preventing the subsequent arc strikes in the same location. Vaporization of the cells leads to cutting of the tissue. This is done by heating the tissues to more than 100 degrees Celcius. The steam which is generated during the process helps in cutting the tissue. The spread of thermal energy is limited when the active electrode is placed just above the target and is maintained in constant motion.
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