Anaesthesia and Recovery Room Protocols

Procedure Monitoring

• Monitors breaches in surgical aseptic technique and initiates corrective actions.

Recovery Room Nurse Responsibilities

• Maintains patient’s airway, breathing, and circulation.
• Controls pain and alleviates nausea and vomiting.
• Assesses the wound site and manages fluid balance.
• Conducts thorough documentation of patient status.

General Anaesthesia (GA)

• Induces loss of sensation and consciousness; suppresses cough, swallow, and gag reflexes.
• Blocks awareness in the brain's reticular activating system (RAS), inducing amnesia, analgesia, and relaxation.
• Administered via intravenous injection, inhalation of gases, facemask, laryngeal mask (LMA), or endotracheal tube (ETT).
• Phases of GA include:
  • Induction: Administration of anaesthetic until ready for surgery.
  • Maintenance: Continuation until procedure completion.
  • Emergence: Begins when patient starts to regain consciousness.

Endotracheal Tube (ETT) Intubation

• Aimed at facilitating ventilation and preventing aspiration.
• Offers clear airway maintenance during surgeries of the head, neck, mouth, throat, and nose.
• Sizes available: 7.5mm for women, 8-8.5mm for men.

ETT Insertion Process

• Follows surgical and anaesthetic time-outs.
• Induction of anaesthetic and patient positioned in “sniffing” position.
• ETT passed through vocal cords, cuff inflated to prevent gas escape and aspiration risk.
• Confirm placement through breath sounds, end-tidal CO2 tracing, and oxygenation monitoring.

Rapid Sequence Induction (RSI)

• Reduces risk of pulmonary aspiration of acidic stomach contents.
• Indicated for emergency cases with unknown fasting time, pregnancy, bowel obstruction, and trauma.
• Cricoid pressure applied via Sellick's manoeuvre to compress the oesophagus, preventing regurgitation.

Airway Obstructions and Complications

• Obstructive Sleep Apnoea (OSA): Patients may need post-op CPAP devices in PACU.
• Aspiration: Gastric contents enter lungs leading to impaired function, pulmonary oedema, and hypoxia.
• Tracheostomy: Surgically created stoma to establish an airway, bypassing obstructions and facilitating prolonged ventilation.

Catastrophic Events in the Operating Theatre

• Anaphylactic Reactions: Symptoms may be masked by anaesthesia; rapid intervention needed. Indicators include hypotension, tachycardia, and bronchospasm.
• Malignant Hyperthermia: Muscle rigidity and elevated body temperature (over 41°C) can occur, leading to severe complications including cardiac arrest.

Importance of Situational Awareness (SA)

• Collecting and interpreting information enhances decision-making in healthcare, reducing errors and improving patient outcomes.
• Individual and contextual factors can influence one’s ability to maintain SA.

Patient Interaction and Intraoperative Care

• Patients can apply Emla cream for numbing; time consideration is crucial for efficacy.
• In holding bays, verify patient identity, surgical site, and consent; assess consciousness and integumentary system.
• During surgery, maintain sterile fields, ensure correct medication administration, and monitor vital signs.
• Post-surgery, stop inhaled anaesthetics and administer reversal agents as needed.