Role of anesthesia nurse in operation theatre

ROLE OF ANESTHESIA NURSE IN OPERATION THEATRE, Anesthesia Technician, Anesthesia, Preop, Postop, What to keep ready
PPT for Nurses

1. ROLE OF ANESTHESIA NURSE IN OPERATION THEATRE

2. Anaesthesia is a state of temporary induced loss of sensation or awareness. It may include analgesia (relief from or prevention of pain), paralysis (muscle relaxation), amnesia (loss of memory), or unconsciousness . In preparing for a medical procedure, the Anesthetist giving anesthesia chooses and determines the doses of one or more drugs to achieve the types and degree of anesthesia characteristics appropriate for the type of procedure and the particular patient. 

3. Where do they work?

4. Roles & Responsibilities must be clear, Otherwise……

5. Duties Duties include getting supplies and equipment ready for procedures They may be called upon to explain the procedures to patients in an effort to secure cooperation and increase confidence in the procedure. They assist in monitoring the patient's vital signs and communicate the information to the physicians The nurse must also be able to prepare medications appropriately and recognize their actions and untoward reactions . Current cardiopulmonary resuscitation (CPR) certification is an essential requirement

6. During preoperative assessment, the Anesthesia nurse reviews the patient’s chart and assessment data and assesses the patient’s readiness for surgery, plans for the patient’s intraoperative care, and identifies data pertinent to anesthesia such as comorbidities, history of asthma, previous surgeries, experiences related to anesthetics, and complications. Family history of adverse reactions with anesthetics such as malignant hyperthermia Drug allergies and information about the patient’s current medications, including herbal medications , is essential to prevent the use of anesthesia medications that might react unfavorably with current medications or cause an allergic reaction. Allergies to contrast dyes , iodine solutions, adhesive tape, food allergies , and sensitivity to latex are relevant.

7. H istory of smoking, drug and alcohol use can alter the effect of anesthesia medications . Patients who will be intubated should be assessed for cracked lips, lacerations in or around the mouth, and loose or chipped teeth . Dentures should be removed prior to general anesthesia, because they can become dislodged and interfere with intubation and anesthetic delivery. Avoiding smoking for as few as 12 hours prior to surgery has been shown to measurably reduce the negative effects of smoking. Smokers should be encouraged to stop smoking as early as possible prior to surgery . Smokers have also been documented to need increased anesthetic dosages and greater amounts of postoperative pain medication.

8. Check to ensure that any diagnostic tests ordered were actually performed and that the results are present in the chart. Ensure that all team members are aware of any abnormalities in the test results.

9. Key Concept Before giving any preoperative medications, make sure the client does not have any drug allergies and that the surgical permit has been signed, witnessed, and is on the client’s chart or electronic record. Check ID bands and if the client is wearing an allergy band Be sure the client passes urine immediately before he or she is taken to the operating suite. Any jewelry not removed shall be secured with tape and documented as such

10. Roles Assist to Conduct a pre- and post- anesthesia and pre- and post-analgesia visit and assessment with appropriate documentation; Assist to develop a general plan of anesthesia care with the physician S elect the method for administration of anesthesia or analgesia; Help to administer appropriate medications and anesthetic agents during the peri -anesthetic or peri -analgesic period; support life functions during the peri -anesthetic or peri -analgesic period; recognize and take appropriate action with respect to patient responses during the peri -anesthetic or peri -analgesic period; manage the patient’s emergence from anesthesia or analgesia; and participate in the life support of the patient.

11. The Anesthesia Nurse and the circulating nurse both document relevant times related to the procedure (e.g., time in the room, time of induction, time of incision). It is essential that the documentation of these times be consistent in all of the various patient records. As much as possible, the room should be ready and preparations for surgery completed before the patient is brought into the operating-room suite and transferred to the operating bed. Once the patient is in the room, the Anesthesia Nurse must focus attention on providing emotional support, ensuring patient dignity, instituting safety measures, and assisting the anesthesia provider.

12. Confirm that the safety strap, electrocardiographic leads, blood pressure cuff, pulse oximeter probe and intravenous line are in place. Induction covers the time from administration of the first anesthetic drug until the patient is stabilized at the desired level of anesthesia . Prior to anesthesia induction, there should be a working suction with catheter in place within easy reach of the anesthesia provider. The Anesthesia nurse must be present and available to assist the anesthesia provider and , if necessary, to restrain the patient (particularly children). Just prior to induction, patients often become anxious. Remain at the patient’s side, speak calmly, explain the process, and answer any questions; be reassuring. Nonverbal support, such as making eye contact and holding the patient’s hand, can be the most supportive interventions in preparation for induction.

13. The Anesthesia nurse might assist with intubation by pulling gently on the corner of the patient’s mouth to increase visualization of the vocal cords and facilitate placement of the endotracheal tube . The Anesthesia nurse might also pass the endotracheal tube to the anesthesia provider so he or she does not have to look up to pick up the tube. Following the induction of anesthesia and positioning for the surgical procedure, the perioperative nurse should scan the patient from head to foot to ensure that the body alignment is maintained and padding is adequate to prevent pressure damage. This is a critical review—once the patient is draped, it’s difficult to assess and adjust the patient’s position. Before positioning or repositioning the patient , the Anesthesia nurse should confer with the anesthesia provider to determine that the patient can be moved without compromise to the airway or ventilation, and that he or she is ready to assist in repositioning by guiding and securing the patient’s head to prevent accidental extubation or disconnection from the ventilator. During the surgical procedure, the Anesthesia nurse helps the anesthesia provider assess fluid balance by monitoring fluid output and replacement, blood loss, blood and blood product replacement, and the amount of irrigating solution used

14. Even where the Anesthesia nurse’s responsibilities do not include postanesthesia care , he or she must demonstrate competence in the use of monitoring equipment and in the interpretation of the data. The perioperative nurse must also be familiar with anesthetic agents and techniques to anticipate patient events , implement nursing interventions quickly, and assist the anesthesia provider.

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16. Nursing Interventions Common to all Surgical Procedures Providing emotional support *previous surgeries may alter his/her response to surgery Preparing client physically for surgery Ensuring legal matters are carried out Ensuring preoperative tests completed Teaching Providing routine preoperative and postoperative care

17. During Pre-op Briefing Anesthesia safety checklist Confirm anesthesia equipment safety check has been completed Difficult Airway/Anesthesia Risk? Confirm airway equipment is available; and Confirm if difficult airway anticipated or likelihood of pulmonary aspiration of gastric contents. Risk of > 500ml of blood loss? May include PT/PTT/INR concerns; Medications or morbidities that may lead to complications and any intention to transfuse blood products; and Confirm if blood products are required and if they are available. Postoperative destination Confirm postoperative destination and any potential for changes.

18. Time-Out

19. Time-out At a minimum, requires surgeon, anesthesiologist, and nurse(s) to be present. Performed after induction, prepping/draping immediately prior to surgical incision. Completed in accordance with Policy “Correct site, correct procedure and correct patient for surgical procedures (identification of) Team members are identified Team members are identified by name and role. Team verbally confirms: Correct Patient; Correct Procedure; and Correct Site.

20. Antibiotic prophylaxis given within the appropriate time frame. Confirm antibiotic prophylaxis has been given within 60minutes (2 hours for Vancomycin and Fluoroquinolones) and when next dose will be given; If not given, give before incision; If administered, when is next dose due; and Consider duration of tourniquet time. Essential imaging displayed? Confirm essential imaging has been displayed and is displayed correctly. Team communicates anticipated complications. STOP! Does everyone agree we are ready to go?

21. AT THIS POINT THE TIME OUT IS COMPLETED AND THE TEAM MAY PROCEED WITH THE SURGERY

22. General Anesthesia …what to keep ready!

23. Endotracheal tubes What to keep ready!

24. Laryngeal mask airway What to keep ready!

25. Igel …simple to use!

26. Emergence from anesthesia, particularly during extubation, is a critical period when the Anesthesia nurse must be at the patient’s side and immediately available to assist the anesthesia provider . Extubation can initiate bronchospasm or laryngospasm reflex. The airway may become obstructed, and vomiting can occur. Airway management and adequate ventilation are priorities. Prior to extubation, the Anesthesia nurse should confirm that a suction catheter is within reach of the anesthesia provider and that suction is turned on and working.

27. Positioning for Spinal Anesthesia

28. Regional anesthesia Nursing responsibilities vary according to the type of regional anesthesia being administered. Patients scheduled for regional anesthesia may be apprehensive about being awake during surgery , believing that they will experience pain. Provide reassurance, answer questions , and remain close to the patient to alleviate their anxiety. Even patients who are sedated should be aware that the nurse is close by and is available to provide support. Nursing interventions for all patients who receive regional anesthesia should include preparation for toxic systemic reactions of the central nervous system and cardiovascular collapse Resuscitation equipment must be immediately available , and the Anesthesia nurse monitoring the patient must be able to use it competently.

29. Post-anesthesia Care Unit (PACU ) Articles that may be needed for care are located near the client’s unit in the PACU Breathing aids Circulatory aids Drugs Narcotics Sedatives Drugs for emergency situations

30. Nursing Alert--- Post op Leave no client alone until he or she has fully regained consciousness. Check the physician’s orders and carry them out immediately.

31. Immediate Postoperative Complications Observe the client postoperatively for immediate complications, for example Hemorrhage Shock Hypoxia hypothermia

32. Anesthesiologist review with the entire team Summary of important intra-operative events Confirm blood/fluid loss Recovery plans including concerns/issues related to postoperative care Confirm normothermia Is there anything we could have done better? Must be asked for each procedure Team members must respond with either a negative or a specific answer to the question Consider three (3) questions when answering: What did we do well? What did we learn? What could we do better/do differently? Debriefing

33. The most common of the scoring systems used to assess a patient’s recovery from general anesthesia is the Aldrete system. Evaluation criteria include patient activity, respiration, circulation, and oxygen saturation. Discharge from the post-anesthesia care unit (PACU) depends upon the score the patient achieves on each criterion The “passing” score varies with facility policy and where the patient will go when discharged from PACU. A patient going to a unit with continued nursing care might not require as high a score as a patient who will be going home.

34. If someone listens, or stretches out a hand, or whispers a kind word of encouragement, or attempts to understand a lonely person, extraordinary things begin to happen Loretta Gizarlis (1920) American writer and educator An ideal Anesthesia Nurse

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