Intraoperative Care and Anesthesia

• Maintaining sterile technique requires keeping hands above waist level to prevent contamination during intraoperative care.
• Ensuring proper skeletal alignment and bony prominence protection prevents pressure injuries and nerve damage when positioning a patient for surgery.
• The intraoperative nurse is responsible for maintaining sterility, positioning the patient safely, and monitoring vital signs, not administering anesthesia or performing surgery.

Anesthesia & Patient Safety

• The primary role of the nurse during the induction phase of general anesthesia is monitoring the patient closely for complications like coughing, retching, or laryngospasm.
• Inhaled anesthetics, such as volatile liquids, act as bronchodilators.
• Local anesthetics block nerve conduction, affecting sensory and motor function.
• Benzodiazepines provide sedation, opioids manage pain, and neuromuscular blockers assist in muscle relaxation as adjuncts to general anesthesia.

Complications & Emergency Situations

• Tachycardia, tachypnea, and muscle rigidity indicates malignant hyperthermia, and dantrolene is required as an antidote.
• General anesthesia may cause airway obstruction (laryngospasm), circulatory instability (hypotension), and rare but life-threatening reactions (malignant hyperthermia, hypoxia).
• Suctioning prevents aspiration and reduces post-intubation complications like airway obstruction.

Universal Protocol & SCIP Guidelines

• The "time-out" verifies patient identity, procedure, and site to prevent wrong-site surgery.
• SCIP focuses on infection prevention, maintaining normothermia, and blood glucose control; razors increase infection risk.

Critical Thinking Questions

• Hypotension and bradycardia may indicate spinal anesthesia complications like autonomic blockade and requires immediate intervention.
• Malignant hyperthermia requires cessation of anesthetics, rapid cooling, and administration of dantrolene as interventions that should be implemented immediately.

Surgical Team & Patient Safety

• The scrub nurse directly assists the surgeon, maintains the sterile field, and handles sterile instruments.
• Warming IV fluids helps maintain core body temperature without causing excessive external heat exposure to prevent intraoperative hypothermia.
• Supine is the most common positioning, Trendelenburg can cause hypotension, prone requires padding, and lateral is used for thoracic/kidney surgeries.

Anesthesia Complications & Management

• Symptoms of nausea and dizziness indicate hypotension due to autonomic blockade after spinal anesthesia. Lowering the head and increasing IV fluids restores perfusion.

• Positive pressure ventilation helps open the airway, preventing hypoxia, during laryngospasm.

• Patients with COPD (increases respiratory complications), a history of malignant hyperthermia (genetic risk factor), and kidney disease (affects drug metabolism) are at higher risk for complications from general anesthesia.

• Hypotension and bradycardia suggest autonomic nervous system suppression after receiving an epidural anesthetic, requiring immediate intervention.

• Side-lying prevents aspiration, antiemetics manage symptoms, oxygen supports ventilation, and assessing for obstruction ensures safe medication use when experiencing post-anesthesia nausea and vomiting.

Malignant Hyperthermia & Emergency Responses

• Tachycardia and muscle rigidity are intraoperative signs concerning for malignant hyperthermia.
• Stopping the triggering agent (e.g., succinylcholine) is the first step in managing malignant hyperthermia.
• Treatment for malignant hyperthermia includes stopping anesthetics, dantrolene administration, cooling measures, and 100% oxygen support.

Surgical Safety & Postoperative Care

• The "time-out" ensures patient identity, procedure, site, and consent verification to prevent errors.
• Shaving with a razor increases microabrasions, leading to higher infection risk.
• Patients must learn wound care, infection signs, early ambulation benefits, and pain control strategies for surgical discharge.
• Early ambulation promotes circulation, reducing DVT risk postoperatively.
• Incentive spirometry, deep breathing, repositioning, and ambulation help prevent atelectasis and pneumonia.