NURS 4200 Chapter_019 Medium

Anesthesia Overview

• Anesthetic techniques and agents are collaboratively chosen by the Anesthesia Care Provider (ACP), surgeon, and patient.
• Factors influencing this choice include the patient's physical and mental status, age, allergies, pain history, and specifics of the procedure.

ASA Physical Status Classification

• The American Society of Anesthesiologists (ASA) classifies patients from ASA1 (healthy) to ASA6 (brain-dead).
• This classification represents the patient's status immediately before surgery.

Anesthesia Types

• Moderate to Deep Sedation

  • Used for procedures outside the operating room (OR).
  • ACP presence not mandatory; can be administered by an RN under physician supervision.

• Monitored Anesthesia Care (MAC)

  • For diagnostic or therapeutic procedures in or outside the OR.
  • Administered by an ACP, includes various sedation and analgesia levels, with critical assessment of physiological problems.

• General Anesthesia

  • Involves total intravenous anesthesia (TIVA) and newer inhalation agents.
  • Indications include long procedures, need for muscle relaxation, uncomfortable positions, and controlled ventilation.

Induction and Agents

• Induction Agent

  • Initial agents for routine general anesthesia induce sleep rapidly, lasting a few minutes, enough for airway management.

• Inhalation Agents

  • Volatile liquids/gases administered through alveoli, allowing easy administration and rapid excretion, with side effects like coughing and laryngospasm.

Adjuncts to General Anesthesia

• Opioids

  • Used for sedation, analgesia, and pain management, but may cause respiratory depression.

• Benzodiazepines

  • Provide premedication for amnesia, anesthesia induction, and monitored anesthesia care.

• Neuromuscular Blocking Agents

  • Facilitate intubation and muscle relaxation by interrupting nerve signal transmission; effects may persist beyond the procedure.

Anesthesia Administration Methods

• Local Anesthesia

  • Loss of sensation without consciousness; can be topical, ophthalmic, nebulized, or injectable.

• Regional Anesthesia

  • Involves injecting anesthetic into central nerves, providing analgesia during preoperative and postoperative phases.

• Spinal and Epidural Anesthesia

  • Spinal: Injection into cerebrospinal fluid (CSF) for complete blockade.
  • Epidural: Injection into epidural space preserving motor function.

Gerontologic Considerations

• Anesthetic drugs must be carefully titrated in older adults, who may experience postoperative delirium and communication difficulties.
• Increased risk of injury from medical devices and hypothermia.

Perioperative Crisis Events

• Anaphylaxis

  • Allergic reactions to anesthetic agents, antibiotics, or latex, requiring vigilance and rapid intervention, with symptoms such as hypotension and tachycardia.

• Malignant Hyperthermia (MH)

  • A rare genetic disorder leading to severe complications during anesthesia, characterized by muscle rigidity and hyperthermia triggered primarily by succinylcholine or volatile agents.
  • Symptoms include tachycardia, hypercarbia, and potential cardiac arrest; treatment involves Dantrolene and supportive care.

Monitoring and Response

• Continuous monitoring for signs of anesthetic complications is crucial, especially in distinguishing between normal reactions and severe crises during surgeries.### Patient Diagnosis
• Patient diagnosed with osteoarthritis in the left knee and has a history of hypertension.

Physical Environment of the Operating Room

• Operating room characterized as a restricted zone, geographically and aseptically controlled.
• Ideal location adjacent to Post Anesthesia Care Unit (PACU) and surgical ICU for quick patient transport post-surgery.
• Equipped with advanced features:
  • Filters and controlled airflow
  • Positive air pressure management
  • Temperature and humidity controls
  • UV lighting
  • Strict cleaning protocols and maintenance checks.

Operating Room Furniture and Equipment

• Furniture should be adjustable, easy to clean, and portable.
• Equipment undergoes regular checks for operational efficiency and electrical safety.
• Specialized lighting enhances visibility of the surgical site.
• Effective communication systems in place among the surgical team.

Surgical Team Roles

• Perioperative Nurse:
  • Registered Nurse involved in preoperative, intraoperative, and postoperative care phases.
  • Advocates for the patient during surgery.
• Scrub Nurse:
  • Maintains sterile environment, follows antiseptic protocols, and prepares surgical instruments.
• Circulating Nurse:
  • Operates within unsterile field, facilitating procedural progress and managing documentation.
• LPN/VN/Surgical Technologist:
  • Can assume circulating or scrub role under RN supervision.
• Surgeon:
  • Responsible for all surgical actions including patient consent, pre-op assessment, and postoperative management.
• Surgeon's Assistant:
  • May be physician or other trained professionals assisting with various surgical tasks.

Nursing Management Before Surgery

• Admittance Process:
  • Involves patient reassessment, confirming last food/fluid intake, and verifying preoperative medications.
  • Covers patient’s physical preparation, including hair covering.
• Nursing Care:
  • Addresses both complementary and alternative therapies to alleviate anxiety and pain.
  • Circulating nurse ensures implementation of the intraoperative care plan, including ongoing assessments.

Preparation of Operating Room

• Ensure privacy and infection control, especially for obese patients needing special equipment.
• Confirm compliance with surgical attire and functionality of electrical/mechanical equipment.
• Employ aseptic techniques in handling instruments and maintain correct item counts.

Patient Transfer and Positioning

• Safely transfer the patient post-assessment with locked wheels and adequate staff support.
• Monitor vital signs and apply necessary medical devices before surgery begins.
• Position the patient carefully to maintain access, proper alignment, and avoid any physical trauma during surgery.

Assistance During Anesthesia

• Circulating nurse assists anesthesia provider by applying monitors and ensuring patient safety.
• Clear communication is crucial for effective anesthesia management.

Postoperative Care

• After surgery, anesthesiologist is responsible for maintaining patient stability and medication management during recovery.
• During hand-off to PACU, thorough communication regarding patient status and procedural details is essential.

Safety and Infection Control

• Key safety considerations include preventing infection, physical trauma, and managing physiological effects of surgery.
• Clear communication protocols outline expectations in surgical team interactions (SBAR: Situation, Background, Assessment, Recommendations).

Holding Area Protocols

• Implementation of Surgical Care Improvement Project measures, ensuring preoperative safety checks.
• Verification processes mandated by National Patient Safety Goals, including documentation checks and marking the surgical site.

Case Study Overview

• Example of patient M.C. includes surgical preparations: IV infusion, antiembolic stocking application, and medication orders before knee surgery.
• Post-surgery notes indicate a drain present in the left knee and an elastic bandage from ankle to thigh.

Anesthesia Overview

• Anesthetic techniques and agents are collaboratively chosen by the Anesthesia Care Provider (ACP), surgeon, and patient.
• Factors influencing this choice include the patient's physical and mental status, age, allergies, pain history, and specifics of the procedure.

ASA Physical Status Classification

• The American Society of Anesthesiologists (ASA) classifies patients from ASA1 (healthy) to ASA6 (brain-dead).
• This classification represents the patient's status immediately before surgery.

Anesthesia Types

• Moderate to Deep Sedation

  • Used for procedures outside the operating room (OR).
  • ACP presence not mandatory; can be administered by an RN under physician supervision.

• Monitored Anesthesia Care (MAC)

  • For diagnostic or therapeutic procedures in or outside the OR.
  • Administered by an ACP, includes various sedation and analgesia levels, with critical assessment of physiological problems.

• General Anesthesia

  • Involves total intravenous anesthesia (TIVA) and newer inhalation agents.
  • Indications include long procedures, need for muscle relaxation, uncomfortable positions, and controlled ventilation.

Induction and Agents

• Induction Agent

  • Initial agents for routine general anesthesia induce sleep rapidly, lasting a few minutes, enough for airway management.

• Inhalation Agents

  • Volatile liquids/gases administered through alveoli, allowing easy administration and rapid excretion, with side effects like coughing and laryngospasm.

Adjuncts to General Anesthesia

• Opioids

  • Used for sedation, analgesia, and pain management, but may cause respiratory depression.

• Benzodiazepines

  • Provide premedication for amnesia, anesthesia induction, and monitored anesthesia care.

• Neuromuscular Blocking Agents

  • Facilitate intubation and muscle relaxation by interrupting nerve signal transmission; effects may persist beyond the procedure.

Anesthesia Administration Methods

• Local Anesthesia

  • Loss of sensation without consciousness; can be topical, ophthalmic, nebulized, or injectable.

• Regional Anesthesia

  • Involves injecting anesthetic into central nerves, providing analgesia during preoperative and postoperative phases.

• Spinal and Epidural Anesthesia

  • Spinal: Injection into cerebrospinal fluid (CSF) for complete blockade.
  • Epidural: Injection into epidural space preserving motor function.

Gerontologic Considerations

• Anesthetic drugs must be carefully titrated in older adults, who may experience postoperative delirium and communication difficulties.
• Increased risk of injury from medical devices and hypothermia.

Perioperative Crisis Events

• Anaphylaxis

  • Allergic reactions to anesthetic agents, antibiotics, or latex, requiring vigilance and rapid intervention, with symptoms such as hypotension and tachycardia.

• Malignant Hyperthermia (MH)

  • A rare genetic disorder leading to severe complications during anesthesia, characterized by muscle rigidity and hyperthermia triggered primarily by succinylcholine or volatile agents.
  • Symptoms include tachycardia, hypercarbia, and potential cardiac arrest; treatment involves Dantrolene and supportive care.

Monitoring and Response

• Continuous monitoring for signs of anesthetic complications is crucial, especially in distinguishing between normal reactions and severe crises during surgeries.### Intraoperative Care
• Historically performed in operating rooms; now often in outpatient settings.
• Growth in minimally invasive surgery (MIS) utilizing endoscopes, robotics, and advanced technologies.
• MIS results in reduced blood loss, smaller incisions, less pain, shorter recovery times, and decreased hospital stays.

Physical Environment

• Surgical departments designed to minimize pathogen spread and ensure smooth patient, staff, and equipment flow.
• Unrestricted Zone: Allows interaction between street clothes and scrub attire; includes patient intake areas and staff facilities.
• Semirestricted Zone: Access restricted to authorized personnel in clean surgical attire, including scrubs and appropriate PPE.
• Restricted Zone: Encompasses the surgical suite where adherence to sterile protocols is critical; masks worn and traffic minimized.

Preoperative Holding Area

• Functions as an unrestricted zone for patient identification and assessment prior to surgery.
• Admission, observation, and discharge (AOD) area facilitates early morning admissions for outpatient and same-day surgeries.

Nursing Management

• Critical components include patient admitting phase: reassessment, addressing questions, and confirming preoperative medication.
• Use of complementary therapies can alleviate anxiety and enhance relaxation.
• Circulating nurse manages the intraoperative care plan, performing ongoing assessments and adjusting as necessary.

Room Preparation

• Ensures safety, privacy, and infection prevention with adequate staff and equipment, especially for obese patients.
• All personnel entering the OR must wear surgical attire, and equipment is checked for functionality.
• Aseptic technique practiced when opening instruments; items counted to ensure accuracy.

Patient Transfer and Preparation

• Patients transported with safety precautions, including locked wheels and adequate monitoring devices.
• Scrubbing, gowning, and gloving follow strict protocols to maintain sterility, including wet scrubbing and using alcohol-based agents.

Positioning and Surgical Site Preparation

• Proper positioning facilitates surgical access and monitoring of anesthetic agents while ensuring musculoskeletal alignment and preventing pressure injuries.
• Surgical site is cleansed with antimicrobial agents, scrubbed from clean to dirty areas, and draped appropriately.

Safety Considerations

• Key focus areas include infection control, physio-trauma risks, and effective communication among the surgical team.
• Protocols for patient care during the procedure emphasize clarity in communication, including situation, background, assessment, and recommendations.

Holding Area Protocols

• Compliance with Surgical Care Improvement Project (SCIP) measures includes timely antibiotic administration, warming blankets, and IPC devices.
• Pre-procedure verification process mandates checking documentation, diagnostic study results, and marking procedure sites.

Postoperative Care

• Anesthesia care provider ensures minimal effects at the end of surgery, overseeing patient transfer to the Post Anesthesia Care Unit (PACU).
• Important hand-off includes sharing the patient's status and details of the procedure performed.

Anesthesia Overview

• Anesthetic techniques and agents are collaboratively chosen by the Anesthesia Care Provider (ACP), surgeon, and patient.
• Factors influencing this choice include the patient's physical and mental status, age, allergies, pain history, and specifics of the procedure.

ASA Physical Status Classification

• The American Society of Anesthesiologists (ASA) classifies patients from ASA1 (healthy) to ASA6 (brain-dead).
• This classification represents the patient's status immediately before surgery.

Anesthesia Types

• Moderate to Deep Sedation

  • Used for procedures outside the operating room (OR).
  • ACP presence not mandatory; can be administered by an RN under physician supervision.

• Monitored Anesthesia Care (MAC)

  • For diagnostic or therapeutic procedures in or outside the OR.
  • Administered by an ACP, includes various sedation and analgesia levels, with critical assessment of physiological problems.

• General Anesthesia

  • Involves total intravenous anesthesia (TIVA) and newer inhalation agents.
  • Indications include long procedures, need for muscle relaxation, uncomfortable positions, and controlled ventilation.

Induction and Agents

• Induction Agent

  • Initial agents for routine general anesthesia induce sleep rapidly, lasting a few minutes, enough for airway management.

• Inhalation Agents

  • Volatile liquids/gases administered through alveoli, allowing easy administration and rapid excretion, with side effects like coughing and laryngospasm.

Adjuncts to General Anesthesia

• Opioids

  • Used for sedation, analgesia, and pain management, but may cause respiratory depression.

• Benzodiazepines

  • Provide premedication for amnesia, anesthesia induction, and monitored anesthesia care.

• Neuromuscular Blocking Agents

  • Facilitate intubation and muscle relaxation by interrupting nerve signal transmission; effects may persist beyond the procedure.

Anesthesia Administration Methods

• Local Anesthesia

  • Loss of sensation without consciousness; can be topical, ophthalmic, nebulized, or injectable.

• Regional Anesthesia

  • Involves injecting anesthetic into central nerves, providing analgesia during preoperative and postoperative phases.

• Spinal and Epidural Anesthesia

  • Spinal: Injection into cerebrospinal fluid (CSF) for complete blockade.
  • Epidural: Injection into epidural space preserving motor function.

Gerontologic Considerations

• Anesthetic drugs must be carefully titrated in older adults, who may experience postoperative delirium and communication difficulties.
• Increased risk of injury from medical devices and hypothermia.

Perioperative Crisis Events

• Anaphylaxis

  • Allergic reactions to anesthetic agents, antibiotics, or latex, requiring vigilance and rapid intervention, with symptoms such as hypotension and tachycardia.

• Malignant Hyperthermia (MH)

  • A rare genetic disorder leading to severe complications during anesthesia, characterized by muscle rigidity and hyperthermia triggered primarily by succinylcholine or volatile agents.
  • Symptoms include tachycardia, hypercarbia, and potential cardiac arrest; treatment involves Dantrolene and supportive care.

Monitoring and Response

• Continuous monitoring for signs of anesthetic complications is crucial, especially in distinguishing between normal reactions and severe crises during surgeries.### Patient Diagnosis
• Patient diagnosed with osteoarthritis in the left knee and has a history of hypertension.

Physical Environment of the Operating Room

• Operating room characterized as a restricted zone, geographically and aseptically controlled.
• Ideal location adjacent to Post Anesthesia Care Unit (PACU) and surgical ICU for quick patient transport post-surgery.
• Equipped with advanced features:
  • Filters and controlled airflow
  • Positive air pressure management
  • Temperature and humidity controls
  • UV lighting
  • Strict cleaning protocols and maintenance checks.

Operating Room Furniture and Equipment

• Furniture should be adjustable, easy to clean, and portable.
• Equipment undergoes regular checks for operational efficiency and electrical safety.
• Specialized lighting enhances visibility of the surgical site.
• Effective communication systems in place among the surgical team.

Surgical Team Roles

• Perioperative Nurse:
  • Registered Nurse involved in preoperative, intraoperative, and postoperative care phases.
  • Advocates for the patient during surgery.
• Scrub Nurse:
  • Maintains sterile environment, follows antiseptic protocols, and prepares surgical instruments.
• Circulating Nurse:
  • Operates within unsterile field, facilitating procedural progress and managing documentation.
• LPN/VN/Surgical Technologist:
  • Can assume circulating or scrub role under RN supervision.
• Surgeon:
  • Responsible for all surgical actions including patient consent, pre-op assessment, and postoperative management.
• Surgeon's Assistant:
  • May be physician or other trained professionals assisting with various surgical tasks.

Nursing Management Before Surgery

• Admittance Process:
  • Involves patient reassessment, confirming last food/fluid intake, and verifying preoperative medications.
  • Covers patient’s physical preparation, including hair covering.
• Nursing Care:
  • Addresses both complementary and alternative therapies to alleviate anxiety and pain.
  • Circulating nurse ensures implementation of the intraoperative care plan, including ongoing assessments.

Preparation of Operating Room

• Ensure privacy and infection control, especially for obese patients needing special equipment.
• Confirm compliance with surgical attire and functionality of electrical/mechanical equipment.
• Employ aseptic techniques in handling instruments and maintain correct item counts.

Patient Transfer and Positioning

• Safely transfer the patient post-assessment with locked wheels and adequate staff support.
• Monitor vital signs and apply necessary medical devices before surgery begins.
• Position the patient carefully to maintain access, proper alignment, and avoid any physical trauma during surgery.

Assistance During Anesthesia

• Circulating nurse assists anesthesia provider by applying monitors and ensuring patient safety.
• Clear communication is crucial for effective anesthesia management.

Postoperative Care

• After surgery, anesthesiologist is responsible for maintaining patient stability and medication management during recovery.
• During hand-off to PACU, thorough communication regarding patient status and procedural details is essential.

Safety and Infection Control

• Key safety considerations include preventing infection, physical trauma, and managing physiological effects of surgery.
• Clear communication protocols outline expectations in surgical team interactions (SBAR: Situation, Background, Assessment, Recommendations).

Holding Area Protocols

• Implementation of Surgical Care Improvement Project measures, ensuring preoperative safety checks.
• Verification processes mandated by National Patient Safety Goals, including documentation checks and marking the surgical site.

Case Study Overview

• Example of patient M.C. includes surgical preparations: IV infusion, antiembolic stocking application, and medication orders before knee surgery.
• Post-surgery notes indicate a drain present in the left knee and an elastic bandage from ankle to thigh.

This quiz explores the anesthetic techniques and agents selected by the Anesthesia Care Provider (ACP) in collaboration with both the surgeon and patient. Key factors such as the patient's physical and mental status, age, allergies, and pain history are discussed in relation to the choice of anesthesia. Test your knowledge on this critical aspect of surgical care.