Surgical room design and setup are not often top of mind for veterinary technicians focused on monitoring anesthesia. More commonly, we operate within existing parameters, including spaces shaped by outdated practices, legacy equipment, or limited resources. However, as veterinary technicians, our responsibility to advocate for our patients does not end at the anesthetic circuit. It flows into the environment where patients are being cared for during vulnerable times. Patient safety must remain at the forefront of any well-designed surgical suite. Every aspect of the OR should be centered around minimizing risk and supporting positive surgical outcomes. This includes environmental controls, layout, and equipment placement. Technicians bring first-hand knowledge of patient flow, surgical preparation, and intraoperative challenges. Our insights can—and should—inform the design of surgical spaces that are not only functional but also safe and efficient. Including veterinary technicians in surgical suite design helps improve workflow, efficiency, and safety for both patients and staff. GETTYIMAGES/VM Environmental factors Environmental factors may not be fully controlled when retrofitting a surgical space. However, if the technician can provide insight when designing a new suite, temperature, humidity, ventilation and air exchange, lighting, noise level, and cleanliness must be considered. Temperature and humidity Room temperature and humidity play a key role in staff comfort and patient safety. In the surgery suite, high temperatures can elevate the core body temperature of staff members, leading to discomfort and reduced concentration. On the other hand, patients under anesthesia are at risk of hypothermia due to exposure to cool environments and impaired thermoregulation. To balance both needs, it is recommended that the surgical suite be maintained at 63–66 F with a humidity level between 35–45 percent.1 However, the temperature in the recovery area should be set higher to help prevent further heat loss and support patient rewarming postoperatively. Ventilation and air exchange Minimizing microbial contamination in the sterile surgical environment requires proper ventilation and effective air exchange. It is recommended to use positive pressure ventilation equipped with a HEPA filter, along with 12–24 air changes per hour, or more for specialty procedures.2 Positive pressure ensures that when the surgery room door is opened, air flows outward rather than inward, reducing the risk of microorganisms entering the sterile field. To further protect the surgical environment, traffic in and out of the room should be limited, and the surgery room door should remain closed during procedures. In addition to controlling airborne pathogens, proper air exchange also helps reduce the concentration of waste anesthetic gases. The picture demonstrates a room equipped with positive pressure ventilation. PHOTO COURTESY ANDREW DUARTE, VCA DAVIS ANIMAL HOSPITAL IN STAMFORD, CONN Lighting A variety of surgical lighting options are available, each with different advantages. Ceiling-mounted lights are generally preferred, as they promote efficient workflow and minimize clutter in the surgical area. Additional factors to consider when selecting surgical lighting include the type of LED used, brightness levels, and shadow reduction capabilities.3 Noise level Many technicians do not realize that noise can have a significant impact. A 2018 study concluded that the average noise level in the operating room was at or above World Health Organization (WHO) recommendations.4 Technicians should advocate for a low-noise environment. This may require not playing music and reducing the number of people in the surgery room. Cleanliness One of the most impactful factors affecting patient safety is the cleanliness of the surgery room. Unfortunately, this is an area that may be rushed or overlooked by veterinary technicians, potentially compromising patient outcomes. Do not overlook parts of the surgery room, such as the surgical lights, as accumulated dust can fall into the sterile field.5 Similarly, patient preparation should occur in the designated prep area, not the surgery suite, to maintain sterility.6 When multiple surgeries are scheduled, technicians should spot-clean between procedures to minimize contamination. The surgery room should be equipped with nonporous cabinets and countertops to allow for effective disinfection at the end of the day. Thorough cleaning should include all surfaces, such as walls, cabinet handles, the base and legs of the surgery table, foot pedals, and other frequently touched or overlooked areas. Cleaning should be performed from top to bottom to prevent dust and debris from falling onto already-cleaned surfaces. Technicians must also understand the correct cleaning solutions to use, including proper dilution ratios and manufacturer-recommended contact times. Following these guidelines is essential to avoid inactivating disinfectants and to ensure maximum asepsis. A clutter-free surgical suite allows veterinary technicians to move efficiently and safely, with essential equipment strategically placed for easy access during procedures. Photo courtesy VCA DAVIS, STAMFORD CT Overall space The surgical suite should be kept free of clutter, with countertops cleared of unnecessary items. Only essential equipment should be present in the room, and the space should not be used for storing non-surgical machines. Adequate room must be available for the veterinary technician to move freely around the patient to ensure efficient monitoring and intervention. Equipment should be strategically positioned; it should be readily accessible in an emergency but placed to avoid interference with workflow. Additionally, the layout should accommodate extra personnel when needed for critical situations, such as CPR. Ensure there is minimal equipment and clutter in the surgery suite to provide adequate space and facilitate ease of movement. PHOTO COURTESY ANDREW DUARTE, VCA DAVIS ANIMAL HOSPITAL IN STAMFORD, CONN Monitoring equipment The surgical suite should be designed to allow for the proper placement and utilization of monitoring equipment and support equipment, ensuring a smooth workflow. Veterinary technicians must be able to move efficiently around the patient and within the room without obstructions, especially during critical moments. Strategic equipment positioning reduces clutter, improves response time, and minimizes the risk of errors. In this space, veterinary clinics must invest in high-quality monitoring equipment that allows veterinary nurses to continuously track all vital patient parameters during surgery. This includes heart rate and rhythm, respiratory rate, blood pressure, oxygen saturation, temperature, and end-tidal CO₂. Essential monitoring instruments that should be standard in every surgical suite include pulse oximeters, blood pressure monitors, capnography units, electrocardiography (ECG) machines, and temperature monitors. In most veterinary hospitals, a multi-parameter monitor tracks all vital signs in a single unit, eliminating the need for multiple individual machines. This not only reduces clutter in the operating room but also simplifies the technician’s workflow and enhances efficiency during surgical procedures. Pulse oximetry Pulse oximetry monitors a patient’s oxygen saturation as well as pulse. This is a noninvasive device that uses either red light or infrared light to estimate the amount of oxygen binding to hemoglobin. The higher the oxygen concentration the less light the machine will absorb, and a higher percentage will display on the machine. The oxygen saturation should never fall below 95 percent.6 Blood pressure Noninvasive blood pressure machines are most used for patients under anesthesia. Blood pressure devices measure tissue perfusion. Proper blood pressure cuff measurement and cuff placement are crucial in obtaining appropriate values. The values for systolic are 90-160 mm Hg, diastolic are 50-90 mm Hg, and mean arterial pressure (MAP) are 70-99 mm Hg.6 Capnography Capnograph machines serve a dual function. Not only do they monitor respiration rate, but they also monitor the amount of carbon dioxide expired by the patient. As the patient exhales, the machine will create a tracing that should have a steady incline, plateau, and then, as the patient inhales, there will be a steady decline. The value read arises from the plateau at peak exhalation. Generally, the range is between 35-45 mm Hg.6 Electrocardiography Electrocardiography (ECG) allows the veterinary nurse to monitor the electrical activity of the heart. Detecting arrhythmias or other heart issues under anesthesia is key for patient survival. Temperature Hypothermia is a common risk for patients if their temperature is not monitored at least every 15 minutes. Options include using a standard rectal thermometer or, if part of a multiparameter machine, an esophageal probe. Preventing hypothermia is key to successful patient outcomes. Body temperature should not fall below 97.6 F.6 Conversely, monitoring for hyperthermia is also crucial for patient safety. Support equipment While basic monitoring devices are critical for patient safety, additional support equipment should also be available in the surgery suite. These tools provide an extra layer of safety and support during surgical procedures. Cautery Hemostasis is critical for positive surgical outcomes. Cautery allows the use of electricity to cut or coagulate vessels.1 It can be integrated into a sterile procedure to provide a quick method of controlling bleeding. Suction A mechanical suction machine can manage excessive fluid or dust buildup in a patient’s body. Further, if procedures require abdominal lavage, suction can help remove the fluid. The procedure will depend on the attachments needed. Heating devices Improving patient recovery begins with proactive monitoring and management of body temperature, particularly through the appropriate use of warming devices. Hypothermia and thermal burns are two of the most significant perioperative and postoperative concerns. A patient’s body temperature can drop markedly within the first 20 minutes of a procedure, making continuous temperature monitoring essential. Maintaining normothermia often requires the use of warming devices; however, improper use can lead to thermal injuries. Patients under anesthesia cannot move away from excessive heat, making them especially vulnerable. Common culprits of thermal burns include electric heating pads, warmed fluid bags, and heating disks when used without proper safeguards. Fluid pump Fluid therapy is essential for maintaining patient safety during anesthesia. Patients are often mildly dehydrated due to preoperative fasting or may experience fluid loss from hemorrhaging during surgery. This can affect critical organs, including the heart and kidneys. Administering fluid therapy supports tissue perfusion and helps stabilize blood pressure. Using a fluid pump enables the veterinary technician to deliver fluids at a precise rate or to administer boluses in emergency situations Crash cart Prompt response to anesthetic-related emergencies is paramount to patient safety and successful recovery. The veterinary technician should take responsibility for verifying that the crash cart is fully stocked with the necessary drugs and equipment. This includes replacing used equipment and drugs and checking drug expiration dates. Summary Veterinary technicians often work in surgical suites designed without their input, despite their critical role in patient safety during anesthesia. Allowing technicians to provide input on layout and design can maximize workplace efficiency, flow, and increase employee satisfaction. Key environmental and functional factors should be considered. By contributing their expertise, technicians can help shape surgical environments that are not only functional but truly centered on the safety and comfort of both patients and staff. Valerie J. Ramos, LVT, MBA, is a licensed veterinary technician and educator with more than 15 years of experience in the veterinary technology field. She currently serves as a professor at Appalachian State University, where she focuses on clinical instruction, large animal care, and exotic animal medicine. In addition to her academic role, Montanez remains active in general practice with a strong passion for surgery. She is dedicated to advancing the profession through student mentorship, curriculum development, and a commitment to excellence in patient care. References Kessler, Martin. (2014). Maintaining a sterile operating environment. VIN. https://www.vin.com/apputil/content/defaultadv1.aspx?pId=12886&catId=57123&id=7054771&ind=479&objTypeID=17 Dornbusch, Josephine, Boston, Sarah, Colee, James. (2018, July). Noise levels in veterinary operating rooms and factors that contribute to their variations. Veterinary surgery : VS. https://pubmed.ncbi.nlm.nih.gov/30129066/ Namek, Ramzi, P. (2020, April 27). Handling heat and humidity. DVM 360. https://www.dvm360.com/view/handling-heat-and-humidity Tear, M. (2022).Small Animal Surgical Nursing (4th ed.).Mosby. Campbell, Dr. C. (2023, September 26). A clean operating room is a happy operating room. Vet Candy. https://www.myvetcandy.com/clinicalupdblog/2020/5/23/a-clean-operating-room-is-a-happy-operating-room Lewis, Heather E. (2024, April 20). What your next surgery suite could look like. DVM 360. https://www.dvm360.com/view/what-your-next-surgery-suite-could-look# Powell, T. (2025, March 23). Optimize your veterinary surgical suite with proper lighting. NVE. https://newvetequipment.com/blog/veterinary-surgical-lighting-considerations?srsltid=AfmBOopOIMYnY4Y4uCEppouKA8iNv3APwP5sLUem28C80PvQFyrcqWHI
