Perioperative Nursing Roles Overview

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Questions and Answers

What is one of the primary responsibilities of the scrub/scout role during surgery?

Performing the surgical procedure

Taking patient history

Administering anesthesia

Monitoring for complications (correct)

The scrub/scout is responsible for directly performing the surgical procedure.

False

What must be confirmed regarding specimens during surgery?

Specimen identification

The position where the patient's back is facing up is called _____ position.

supine Signup and view all the answers

Match the following surgical positions with their descriptions:

Supine = Patient lying on their back Prone = Patient lying on their stomach Fowlers = Patient seated with the upper body elevated Lithotomy = Patient lying on their back with legs in stirrups Signup and view all the answers

Which of the following is NOT a component of asepsis?

Performing calculations Signup and view all the answers

Documenting the count and maintaining item locations is part of the scrub/scout's duties.

True Signup and view all the answers

Name one type of safety consideration that the scrub/scout must be aware of during surgeries.

Electrical safety Signup and view all the answers

The _____ phase involves preparing dressings and drains post-surgery.

post-procedure Signup and view all the answers

Which of the following is a key aspect of coordinating patient movement?

Ensuring patient comfort during transfers Signup and view all the answers

What is one of the major concerns for anaesthetic nurses during surgery?

Malignant Hyperthermia Signup and view all the answers

Anaesthetic nurses do not need to prepare equipment prior to surgery.

False Signup and view all the answers

Name one role of the scrub nurse in the perioperative setting.

Maintaining asepsis during surgery Signup and view all the answers

The ______ score is used to assess the airway prior to anaesthesia.

Mallampati Signup and view all the answers

Match the following roles with their responsibilities:

Anaesthetic Nurse = Assist the anaesthetist Scrub Nurse = Maintain asepsis Scout Nurse = Circulate instruments Post-operative Nurse = Monitor recovery Signup and view all the answers

Which of the following is NOT a type of anaesthesia?

Sedative Anaesthesia Signup and view all the answers

Monitoring the patient's haemodynamic status is not essential during anaesthetic nursing.

False Signup and view all the answers

What is one key component of pre-operative assessment?

Patient medical history review Signup and view all the answers

An important aspect of anaesthetic nursing includes ______ patient safety.

advocating for Signup and view all the answers

Which of the following best describes the role of the scout nurse?

Circulating and managing instruments in the OR Signup and view all the answers

What area allows individuals in street clothes and includes preoperative holding areas?

Unrestricted area Signup and view all the answers

Masks and protective gear are mandatory in the unrestricted area.

False Signup and view all the answers

What should be confirmed by the perioperative nurse before the procedural preparation begins?

Patient identity and consent Signup and view all the answers

The _____ area includes sterile stock rooms and scrub areas.

restricted Signup and view all the answers

Match the perioperative areas with their descriptions:

Unrestricted area = Can include preoperative holding and reception areas Semi-restricted area = Includes support areas and corridors with mixed attire Restricted area = Requires PPE and includes surgical rooms Clean area = Houses sterile supplies and equipment Signup and view all the answers

What is a primary role of a perioperative nurse during surgery?

Assists the anaesthetist in monitoring Signup and view all the answers

The Nurse Practitioner (NP) can function independently without any collaboration.

False Signup and view all the answers

What role does a Perioperative Nurse Surgeon’s Assistant (PNSA) fulfill during surgery?

Works collaboratively with the surgeon to optimize surgical outcomes. Signup and view all the answers

A perioperative nurse must maintain an accurate count of _____ to prevent retained instruments.

sponges, needles, and instruments Signup and view all the answers

Match the following roles with their primary function:

Perioperative Nurse = Plans and coordinates intraoperative nursing care Nurse Practitioner = Assesses and manages patients autonomously Surgeon = Performs surgical procedures Perioperative Nurse Surgeon’s Assistant = Assists with tissue handling and haemostasis Signup and view all the answers

Which of the following is a key responsibility of a perioperative nurse?

Monitor the patient and surgical environment Signup and view all the answers

The perioperative nurse is responsible for ensuring the operating room is prepared and sterile.

True Signup and view all the answers

During a surgical procedure, the perioperative nurse must actively advocate for what?

Safe patient care Signup and view all the answers

The emergency procedure for newly retained instruments is known as _____ protocol.

count Signup and view all the answers

What is the primary purpose of the preoperative holding bay?

To perform minor clinical activities Signup and view all the answers

The operating room (OR) is designed to have unrestricted inflow of staff to minimize the risk of infection.

False Signup and view all the answers

What is one way to reduce patient anxiety during the preoperative period?

Allow a family member to accompany the patient in the waiting area. Signup and view all the answers

The recommended temperature range for the operating room is _____ degrees Celsius.

20-22 Signup and view all the answers

Match the following roles with their primary responsibilities:

Anaesthetic nurse = Manages anaesthesia care and emergency situations Circulating nurse = Supports the surgical team and ensures patient safety Instrument nurse = Handles surgical instruments and maintains sterile fields Post-anaesthesia care nurse = Cares for patients recovering from anaesthesia Signup and view all the answers

Which of the following factors is NOT considered in the design of operating rooms?

Color of the walls Signup and view all the answers

Bacteria from patients in the OR do not contribute to contamination risks.

False Signup and view all the answers

What is the role of an Enrolled Nurse (EN) in the perioperative environment?

To be supervised by an experienced Division 1 Registered Nurse. Signup and view all the answers

The anaesthetic nurse is the last member of the surgical team to greet the patient before surgery.

False Signup and view all the answers

What is one responsibility of the anaesthetic nurse during surgery?

Acts as the patient advocate. Signup and view all the answers

Before surgery, the anaesthetic nurse checks the _____ and anaesthetic equipment.

anaesthetic machine Signup and view all the answers

Match the following perioperative roles with their primary responsibilities:

Anaesthetic Nurse = Coordinates intraoperative activities Instrument Nurse = Maintains sterile field Circulating Nurse = Oversees the non-sterile aspects EN = Supports the RN under supervision Signup and view all the answers

During the preoperative assessment, which aspect is NOT typically evaluated?

Patient's preferred surgical procedure Signup and view all the answers

Postoperative care information and advice should only be given to patients, not their carers.

False Signup and view all the answers

What must be verified regarding the patient before surgery?

Patient's identity and planned procedure. Signup and view all the answers

During the surgical procedure, the nurse ensures the _____ of the sterile field.

integrity Signup and view all the answers

Which of the following actions is essential for maintaining an aseptic field?

Removing contaminated items immediately Signup and view all the answers

Microorganisms can travel through moist fabrics by capillary action.

True Signup and view all the answers

What must be done if an entire aseptic field is contaminated?

It should be set up again with all new materials. Signup and view all the answers

The only parts of a sterile gown considered sterile are from the chest to _____ level.

table Signup and view all the answers

Match the following aseptic principles with their descriptions:

Sterile items only = All items entering the field must be sterile Contamination removal = Immediate action for any contaminated item Field setup = All new materials needed if contamination occurs Aseptic attire = Surgical team must wear sterile gowns and gloves Signup and view all the answers

Which of the following statements is false regarding aseptic technique?

The edges of an opened sterile package are considered sterile. Signup and view all the answers

What is ASA 1 classification indicative of?

A normal healthy patient Signup and view all the answers

General anaesthesia involves a loss of consciousness.

True Signup and view all the answers

What are the two main types of general anaesthesia?

Spontaneous ventilation general anaesthesia (SVGA) and relaxant general anaesthesia (RGA) Signup and view all the answers

The classification system that assigns anaesthesia levels based on physiological status is the _____ classification system.

ASA Signup and view all the answers

Match the type of anaesthesia with its description:

General anaesthesia = Loss of sensation with loss of consciousness. Regional anaesthesia = Loss of sensation to a region of the body without loss of consciousness. Local anaesthesia = Loss of sensation without loss of consciousness, often applied topically. Procedural sedation = Patient is responsive but may require airway monitoring. Signup and view all the answers

Which of the following is a common application for procedural sedation?

Colonoscopies Signup and view all the answers

What is one key responsibility of the anaesthetic nurse during surgery?

Prepare the anaesthetic machine and monitor patient Signup and view all the answers

The PACE acronym stands for Probe, Alert, Challenge, Emergency.

True Signup and view all the answers

Name one safety consideration related to the use of electrosurgical units in surgery.

Proper grounding of the patient Signup and view all the answers

The anaesthetic nurse remains the patient’s advocate throughout the ______ phase of anesthesia.

intraoperative Signup and view all the answers

Match the following personal protective equipment (PPE) with their purpose:

Gloves = Prevent direct contact with bodily fluids Gowns = Protect clothing and skin from contamination Face shields = Protect the face and eyes from splashes Masks = Prevent inhalation of airborne pathogens Signup and view all the answers

Which of the following is NOT a critical juncture of the WHO Surgical Safety Checklist?

Patient review Signup and view all the answers

Human factors impacting patient safety only include technical skills.

False Signup and view all the answers

Monitoring equipment such as BP and ______ must be connected to the patient prior to anaesthesia induction.

ECG Signup and view all the answers

Which surgical position is most commonly used for surgeries involving the abdomen, chest, or face?

Supine Signup and view all the answers

Anaesthesia can provide a lack of sensation but does not block pain entirely.

False Signup and view all the answers

What is the primary goal of skin preparation before surgery?

To reduce the number of microorganisms present near the surgical wound. Signup and view all the answers

The position used for pelvic organ surgeries, such as vaginal hysterectomy, is called the _____ position.

lithotomy Signup and view all the answers

Match the following surgical positions with their primary use:

Supine = Surgery involving abdomen, chest, or face Prone = Back surgery Lateral = Renal surgery Beach chair = Shoulder surgery Signup and view all the answers

Which of the following is a risk factor for perioperative inadvertent hypothermia?

Combined general and regional anaesthesia Signup and view all the answers

Adequate padding and support during surgery are solely the responsibility of the anaesthetist.

False Signup and view all the answers

What needs to be monitored every 30 minutes during surgery to prevent hypothermia?

Patient's temperature. Signup and view all the answers

To prevent pooling of blood, the raising of the head of the OR bed may lead to increased blood volume in the _____ torso.

lower Signup and view all the answers

Match the type of anaesthesia with its description:

General anaesthesia = Induces unconsciousness and lack of sensation Local anaesthesia = Numbs a specific area without affecting consciousness Regional anaesthesia = Blocks sensation in a larger area of the body Sedation = Calms the patient while maintaining awareness Signup and view all the answers

What potential complication can occur due to excessive absorption of local anaesthetic agents?

Convulsions Signup and view all the answers

Older adults typically have a greater functional reserve compared to younger patients.

False Signup and view all the answers

What is the role of an anaesthetist during deep sedation?

To deliver procedural sedation Signup and view all the answers

The practice of _____ sedation allows patients to tolerate uncomfortable procedures.

procedural Signup and view all the answers

Match the anaesthetic complications with their descriptions:

Spinal headache = Headache following spinal anesthesia Failed spinal = Inability to achieve sufficient anesthesia Local anaesthetic toxicity = Adverse reactions from excessive local anesthetic Anaphylaxis = Severe allergic reaction Signup and view all the answers

Which patient factor is most important when titrating anaesthetic medications in older adults?

Patient's weight Signup and view all the answers

The risk of critical events decreases as the patient ages.

False Signup and view all the answers

Name one physiological change in aging that affects response to anaesthetic agents.

Altered pharmacokinetics Signup and view all the answers

An anaesthetic nurse must have ready access to an _____ to deliver deep sedation.

anaesthetist Signup and view all the answers

Match the anaesthesia complications with their management strategies:

Cardiac arrest = Immediate CPR and defibrillation Laryngospasm = Positive pressure ventilation Malignant hyperthermia = Immediate administration of dantrolene Respiratory arrest = Airway management and support Signup and view all the answers

At which levels of the spinal column is spinal anaesthesia most commonly administered?

L3–L4 Signup and view all the answers

Epidural anaesthesia involves the injection of local anaesthetic into the cerebrospinal fluid.

False Signup and view all the answers

What is a common complication associated with spinal and epidural anaesthesia?

Hypotension Signup and view all the answers

The injection of local anaesthetic into the _____ space is called epidural anaesthesia.

epidural Signup and view all the answers

Match the type of anaesthesia with its specific characteristics:

Spinal Anaesthesia = Injection into cerebrospinal fluid Epidural Anaesthesia = Injection into the epidural space Caudal Anaesthesia = Injection into the sacral portion General Anaesthesia = Loss of sensation and consciousness Signup and view all the answers

Which of the following statements is true regarding spinal anaesthesia?

It can lead to vasodilation and hypotension. Signup and view all the answers

Caudal anaesthesia can be used for surgical procedures above the umbilicus.

False Signup and view all the answers

Why is spinal anaesthesia referred to as a 'one-shot' administration?

Because it cannot be re-administered after the initial injection. Signup and view all the answers

Epidural anaesthesia is commonly used in _____ procedures involving the lower extremities.

vascular Signup and view all the answers

What does the term 'epidural' specifically refer to?

Outside the dura Signup and view all the answers

Study Notes

Perioperative Nursing Roles

Anaesthetic Nurse: Transfers the patient, assists the anaesthetist, prepares and checks equipment, monitors patient haemodynamic status, administers medications, supports airway, performs IV cannulation and manages fluids, and advocates for patient safety.
Scrub Nurse: Possesses knowledge of surgical procedures, instruments, and equipment, prepares instruments, assists with surgical scrub, performs gowning and gloving, maintains asepsis, assists with patient positioning, supports the surgeon, coordinates patient movement, confirms specimens, prepares dressings and drains, monitors for complications, assists with post-procedure cleanup, and conducts counts on items.
Scout (Circulating) Nurse: Possesses knowledge of surgical procedures, instruments, and equipment, confirms specimens, ensures patient safety and recognizes deterioration, prepares dressings and drains, monitors for complications, assists with post-procedure cleanup, conducts counts on items, assists with positioning, monitors safety (electrical, radiation, plume/gases, sharps), documents procedures, assists with patient movement, and assists with the surgical scrub.

Anaesthesia Nursing Assessment

Airway Assessment: Clear and patent airway, Mallampati Score, rise and fall of chest bilaterally equally, depth and rate of breathing.
Circulation Assessment: Pulses, ECG monitoring, heart rate, blood pressure, oxygen saturation.

Anaesthesia Nursing Major Concerns

Hypoxaemia
Hypotension
Hypothermia
Hypovolaemia
Malignant Hyperthermia: Rare, anaphylactic response.

Surgical Positioning

Lithotomy
Jackknife
Lateral
Prone
Supine
Fowlers

Surgical Scrub

Scrub
Skin Prep
Draping
Scout opening gowns and gloves

Perioperative Environment Layout

The perioperative environment is a controlled environment designed to minimize infection spread and ensure smooth patient flow.
It's divided into three zones: unrestricted, semi-restricted, and restricted.
The unrestricted zone is the main entrance, accessible to people in street clothes, and includes areas like the preoperative holding area and reception.
The semi-restricted zone includes support areas and corridors leading to restricted zones, where a mix of personnel wear perioperative attire and street clothes.
The restricted zone is accessed from a semi-restricted area, requiring masks and other PPE along with perioperative attire.
It includes operating rooms, scrub bays, and areas for sterile item processing and storage.
The physical layout promotes a clear flow of staff and supplies, moving from clean areas to sterile areas, and then to contaminated waste areas.

Waiting Areas

Nursing care starts before the patient enters the procedure room.
The perioperative nurse confirms patient identity, verifies consent, and assesses them.
Many hospitals have a preoperative holding bay for patient waiting, where minor clinical activities can be done.
The waiting area minimizes patient anxiety by allowing accompanying family members or guardians to wait with them.
It's standard practice to allow parents or guardians to accompany pediatric patients to the operating room.

Operating Room

The operating room is a dedicated space, controlled to minimize infection risk.
It's preferable for the OR to be located next to the PACU, ICU, or HDU for immediate post-operative transport.
OR lighting provides a range of intensity for surgical site visibility, and UV lighting may be used to reduce airborne microorganisms.
The Australian College of Perioperative Nurses (ACORN) sets standards for OR design, including temperature, humidity, ventilation, and airflow.
Maintaining a temperature of 20-22°C and humidity of 50-60% inhibits bacterial growth and minimizes static electricity risks.
Positive air pressure in the OR prevents outside air from entering, and HEPA filters provide air changes per hour to reduce airborne particles.
Surgical staff wear tight-fitting clothing to minimize the release of contaminants.
Floors, walls, and furniture are easy to clean, and equipment is routinely checked for safety and functionality.
The OR has a communication system for routine and emergency messages.

Surgical Team

The perioperative nurse can be a Registered Nurse (RN) or an Enrolled Nurse (EN) who implements patient care during the perioperative period.
Perioperative nursing is a specialized field requiring specific education and qualifications.
The instrument and circulating nurse both require knowledge of asepsis, surgical procedures, and complications.
The circulating (or scout) nurse supports the instrument nurse and surgical team, ensuring patient safety.
Perianaesthesia nursing involves anaesthetic and post-anaesthetic care nursing roles.
The anaesthetic nurse assists the anaesthetist with induction and maintenance of anaesthesia, monitoring, and life support procedures.
The post-anaesthesia care nurse manages patients postoperatively, addressing complications and understanding anaesthesia.
When ENs work in the perioperative environment, they must be supervised by an experienced RN and practice within their scope.

Perioperative Nurse Surgeon’s Assistant (PNSA)

The PNSA is an extended-practice role working at an advanced level in collaboration with a surgeon.
They need specific education, experience, and demonstrated competence to perform tasks like tissue handling, haemostasis, suturing, and patient transfer.

Nurse Practitioner (NP) Role

The NP is an advanced practice nurse (APN) with autonomous and collaborative functions.
NPs assess and manage patients, refer to other professionals, prescribe medications, and order investigations.
Their scope of practice is determined by their authorization and setting.
Perioperative NPs work in specialist teams or collaboratively with surgeons during surgery or in private practices.

Surgeon and Assistant

The surgeon is the medical practitioner performing the surgical procedure.
They are usually Fellows of the Royal Australasian College of Surgeons (RACS) or trainees in an RACS-approved program.

Surgeon Responsibilities

Determines if surgery is needed and which procedure
Takes pre-op medical history and does physical assessment
Evaluates and manages pre-op testing
Discusses risks and alternatives of surgery with the patient
Ensures informed consent
Provides direct patient care and management in the OR
Oversees postoperative care
The surgeon's assistant can be a medical officer or a first surgical assistant (specially trained RN or Nurse Practitioner)

Anaesthetist Responsibilities

Assesses the patient preoperatively and determines the safest anaesthetic for their needs and the anticipated surgical procedure
Prescribes pre-op and adjunctive medications
Monitors the patient's vital signs throughout the surgical procedure
Administers the anaesthetic during the operation and informs the surgeon if difficulties arise
Administers fluids, electrolytes, medications and blood products during the operation
Supervises the post-anaesthesia recovery of the patient in the PACU
Documents the patient's post-anaesthetic recovery.

The Role of Perioperative Nurses

Perioperative nurses need to be knowledgeable about the activities involved in transferring a patient to the operating suite to provide reassurance to the anxious patient.
They can answer general questions about surgery or anaesthesia, but specific questions should be referred to the surgeon or anaesthetist.
The perioperative nurse should conduct a cultural assessment to learn about the patient's spiritual and cultural habits and beliefs.
Always provide an interpreter for patients from culturally and linguistically diverse backgrounds.
Consider spiritual needs, attitudes towards pain, and health beliefs and practices when creating an individualized plan of care.
They are responsible for engendering trust and ensuring cultural practices are respected and identified.
A thorough perioperative history and physical assessment is crucial for the perioperative nurse to ensure patient safety and quality care.
Baseline vital signs, height, weight, age, allergies, skin condition, VTE risk factors, pre-existing pressure injuries, skeletal and muscle impairments, perceptual difficulties, level of consciousness, nil by mouth status, and sources of pain or discomfort should be recorded.

Documentation

Documentation may be in hard copy or electronic form.
Follow institutional policy, patient condition, and specific surgical procedure.
Fewer tests are generally required for day surgery facilities.
Preoperative assessment data includes history and physical examination, urinalysis, full blood count, serum electrolyte values, chest X-ray (if applicable), ECG (if applicable), other diagnostic tests (e.g. CT scan), pregnancy testing (if applicable), surgical and blood transfusion consent, allergies, blood type and cross-match (if applicable), implantable devices/contact lenses/metal implants, nail polish/jewellery, verification of consent, patient’s fasting status, VTE risk status and prophylaxis, and specific preoperative preparation (if applicable—e.g. bowel preparation for patients scheduled for colonoscopy).
This information is confirmed on admission to the operating suite by the admitting nurse using the preoperative checklist.

Asepsis in the Perioperative Environment

Asepsis is the absence of pathogenic microorganisms, preventing their transfer to surgical sites.
Practices in the perioperative environment to prevent infection, creating an aseptic field.
All items used in the aseptic field must be sterile, with immediate removal of contaminated items.
Surgical team members wear sterile gowns and gloves, with only the front of the gown and sleeves to 5 cm above the elbow being sterile.
Maintaining a wide margin of safety between sterile and unsterile fields, with tables only considered sterile at tabletop level.
Edges of a sterile package are considered contaminated once opened, requiring methods that preserve sterility.
Excessive air movement and currents can introduce microorganisms into the sterile field.
Microorganisms travel through moist fabrics via capillary action, causing contamination.
Individuals’ hair, skin, and respiratory tracts harbor microorganisms, requiring appropriate attire to confine them.

Anaesthetic Nurse Role

The anaesthetic nurse collaborates with the anaesthetist to plan care for anaesthesia, preparing necessary equipment.
This includes the anaesthetic machine, airway management requirements, fluid replacement therapy, invasive and non-invasive monitoring devices, and maintaining normothermia.
The anaesthetic machine is checked according to ANZCA Guideline PS31 at the start of each operating list, ensuring its proper functioning for patient safety.
The anaesthetic nurse ensures patient monitoring before anaesthesia induction, including BP, SaO2, ECG, temperature probe, BIS or entropy, neuromuscular transmitter (if relaxant anaesthesia is used), and other monitoring as needed (e.g., arterial lines, central venous lines).
The anaesthetic nurse acts as the patient's advocate throughout the intraoperative phase, assisting the anaesthetist during induction, airway management, maintenance, and emergence.
Communication with the anaesthetist is crucial when the nurse leaves the OR for any reason, allowing for prompt recall if needed.
During the surgical procedure, the nurse facilitates communication between the anaesthetist and other departments, such as the laboratory or blood bank.
Nursing documentation, including fluid balance, is maintained.
Anaesthetic nurses and perioperative team members need to understand the effects of anaesthetic agents and know the location of emergency medications and equipment.

Human Factors in Safety

Studies indicate adverse events can be attributed to a lack of skills among team members, leading to poor communication, teamwork, leadership, decision-making, and situational awareness.
The perioperative environment is complex and unique, being fast-paced, highly technological, and hierarchical.
Developed communication skills are crucial to keep patients safe, especially in their vulnerable state within the perioperative environment.
Skills like graded assertiveness using the acronym PACE (Probe, Alert, Challenge, Emergency) support team members in "speaking up" if they have concerns, advocating for patient safety.
Wrong patient, wrong site, or wrong procedure incidents are preventable events, highlighting the importance of the evidence-based Surgical Safety Checklist developed by the WHO.
This checklist is key in making surgery safer and has been modified for use in Australia and New Zealand, integrated into practice guidelines of key professional associations.
The checklist has three critical junctures: "sign in," "time-out," and "sign out."

Other Safety Considerations

Electrosurgical safety requires careful placement of the dispersive electrode pad to prevent burns or fire.
Smoke particles produced during laser procedures may contain trace hydrocarbons, potentially causing respiratory irritation and having mutagenic and carcinogenic effects. Smoke evacuators minimize this exposure.
Surgical fires, while preventable, have devastating consequences for both patients and staff. Safe practices and awareness of hazards are crucial.

Positioning the Patient

Patient positioning is crucial, overseen by the anaesthetist, allowing accessibility to the operative site, administration and monitoring of anaesthetic agents, and airway maintenance.
Considerations include proper musculoskeletal alignment, preventing undue pressure on nerves, skin over bony prominences, ears, and eyes, adequate thoracic excursion, preventing occlusion of arteries and veins, providing modesty in exposure, and respecting individual needs.
The nurse shares the responsibility of securing extremities, providing padding and support, and obtaining necessary assistance to avoid unnecessary straining.
Common positions include supine, prone, lateral, lithotomy, and beach chair, with supine being the most common.
Improper positioning can lead to muscle strain, joint damage, pressure ulcers, nerve damage, and other complications.
General anaesthesia causes peripheral vessel dilation, affecting blood pooling with position changes.

Preventing Hypothermia

Perioperative inadvertent hypothermia (PIH) can increase mortality, requiring measures to prevent this serious complication preoperatively and intraoperatively to maintain normothermia.
The surgical team monitors the patient's temperature before anaesthesia induction and every 30 minutes until the end of surgery.
At-risk patients require a thermal warming blanket, including ASA II–IV patients, those with preoperative hypothermia, those undergoing combined general and regional anaesthesia, those undergoing intermediate or major surgery, and patients at risk of cardiac complications.

Preparing the Surgical Site

Skin preparation, or "prepping," aims to reduce microorganisms near the surgical wound, performed intraoperatively.
Hair removal is done with clippers if it interferes with the procedure.
Skin is prepared by mechanically scrubbing or cleansing with an antiseptic solution, ensuring it's non-irritating, has broad-spectrum activity, is fast-acting, persistent, and non-allergenic.
Scrubbing is done in a circular motion, moving from the clean area (site of incision) to the dirty area (distal to the incision).
Antiseptic agents may contain alcohol and be flammable, requiring proper confinement and drying time before sterile draping.

The Patient After Surgery

The anaesthetist anticipates the end of surgery through observation and communication, ceasing anaesthetic agents and administering reversal agents (if muscle relaxants were used).
Once the procedure is completed and a final surgical count is done, the instrument and circulating nurse complete documentation and the "sign out" portion of the surgical safety checklist.
The anaesthetist, anaesthetic nurse, and perioperative nurse accompany the patient to the PACU, providing a handover of the patient's status and procedure performed.

Anaesthesia

Anaesthesia is a pharmacologically induced lack of sensation, with considerations made during a preassessment consultation.
Factors influencing anaesthetic technique selection include the surgical procedure, patient wellness, equipment availability, and the skills of the anaesthetist and assistant.
The anaesthetist assigns an anaesthesia classification based on the American Society of Anesthesiologists (ASA) physical status classification system, endorsed by ANZCA.
This classification ranges from ASA 1 (normal healthy patient) to ASA 5 (moribund patient), and an intraoperative complication is more likely with a higher classification number.

Classification of Anaesthesia

Anaesthesia aims to manage biological responses to surgery while minimizing risk.
It's classified based on its effect on the central nervous system, including general anaesthesia, regional anaesthesia, local anaesthesia, and procedural sedation (deep or conscious).
General anaesthesia: Loss of sensation with loss of consciousness, involving hypnosis, analgesia, muscle relaxation, and airway management.
Regional anaesthesia: Loss of sensation to a specific body region without loss of consciousness, achieved by blocking nerves with local anaesthetic agents.
Local anaesthesia: Loss of sensation without loss of consciousness, induced topically or via infiltration.
Procedural sedation: Sedative, anxiolytic, and/or analgesic medications used for minor procedures, with two types: deep sedation (less responsive, may require airway management) and conscious sedation (responsive, can protect their airway).

General Anaesthesia

Two main types: spontaneous ventilation general anaesthesia (SVGA) and relaxant general anaesthesia (RGA).
SVGA: Patient breathes on their own, with airway support via a bag and mask or supraglottic airway device (LMA, I-Gel).
RGA: Patient is paralysed requiring an endotracheal tube (ETT) for ventilation.
Total intravenous anaesthesia (TIVA): Anaesthesia administered solely intravenously, controlled manually (MCI) or target controlled (TCI).
Muscle relaxants: Used for procedures requiring complete paralysis, requiring an ETT to control breathing.

General Anaesthesia

Surgery does not always require muscle relaxants.
Surgery may require the patient to be unconscious.
General Anaesthesia is a continuum of stages:
- Pre-Induction: Patient receives pre-operative medications, IV access, monitors applied.
- Induction: Medications are administered to render the patient unconscious.
- Maintenance: Patient remains unconscious during surgery, airway is secured.
- Emergence: Patient is prepared to regain consciousness and airway devices are removed.

Roles

Anaesthetist:
- Determines final anaesthetic plan.
- Applies and monitors IV access.
- Administers medications for anxiety and aspiration prevention.
- Secure airway and positions patient appropriately for surgery.
- Monitors patient's physiological status, administers medications and titrates fluids as appropriate.
- Reverses neuromuscular blocking agents.
- Assesses return of protective reflexes.
- Removes airway assist devices.
- Assess pain.
Nurse:
- Completes preoperative assessment.
- Checks and confirms signed consent.
- Participates in sign in and time out.
- Undertakes nursing assessment and formulates care plan.
- Communicates with nursing and medical teams.
- Prepares anesthesia equipment.
- Assists with application of monitors.
- Participates in patient transfer and positioning in the operating theatre.
- Assists with induction and subsequent airway management.
- Adjusts patient position as necessary.
- Monitors patient safety.
- Adjusts nursing care in conjunction with the anaesthetist.
- Communicates with all team members.
- Assists anaesthetist with emergence of anaesthesia.
- Protects patient during return of reflexes.
- Participates in sign out.
- Prepares patient to move to PACU.

Medications Used

Pre-Induction:
- Benzodiazepines
- Opioids
- Antibiotics
- Aspiration prophylaxis:
  - H2-receptor antagonists (e.g., cimetidine, ranitidine)
  - Gastric motility agents (e.g., metoclopramide)
  - Anticholinergics (e.g., hyoscine)
Induction:
- Benzodiazepines
- Opioids
- Barbiturates
- Hypnotics
- Volatile Gases
Maintenance:
- Benzodiazepines
- Opioids
- Barbiturates
- Hypnotics
- Volatile Gases
Emergence:
- Reversal agents:
  - Anticholinergics
  - Anticholinesterases
  - Sympathomimetics
  - Opioid antagonists (PRN)
  - Benzodiazepine antagonists (PRN)
  - Supplemental opioids (PRN)
  - Antiemetics (PRN)
  - Sugammadex

General Anaesthesia Medications

Intravenous Agents:
- Barbiturates:
  - Thiopentone
  - Methohexitone
  - Advantages: Rapid induction and duration of action
  - Disadvantages: Not specified in text
  - Nursing Interventions: Not specified in text

Central Neural Blockade

Spinal anaesthesia involves injecting a local anaesthetic into the cerebrospinal fluid of the subarachnoid space, typically at levels L3–L4 of the spinal column.
The local anaesthetic is injected directly into the cerebrospinal fluid (CSF), which can cause vasodilation and lead to hypotension.
The duration of spinal anaesthesia depends on the chosen agent and administered dose.
Spinal anaesthesia is a one-time injection, meaning it cannot be re-administered or topped up.
Spinal anaesthesia is commonly used for procedures involving the extremities, lower gastrointestinal, prostate, and gynaecological surgeries.

Epidural Anaesthesia

Epidural anaesthesia involves injecting a local anaesthetic into the epidural space via a thoracic or lumbar approach.
A catheter can be placed in the epidural space between the dura mater and the ligamentum flavum for continuous intraoperative anaesthesia and postoperative analgesia.
Lower doses of local anaesthetic, with or without an opioid, are used for postoperative analgesia with an epidural.
Epidural anaesthesia is commonly employed in obstetrics, vascular procedures involving the lower extremities, lung resections, and renal and mid-abdominal surgeries.

Caudal Anaesthesia

Caudal anaesthesia involves injecting a local anaesthetic into the caudal canal or the sacral portion of the spinal canal.
Often referred to as a caudal block, it is commonly used for procedures below the umbilicus.

Common Side Effects & Complications of Central Neural Blockade

Hypotension
Bradycardia
Nausea and vomiting
Spinal headache
Total spinal
Failed spinal
Infection

Nursing Care During Central Neural Blockade

Airway equipment, emergency medications, and a cardiac monitor/defibrillator should be readily available for immediate advanced airway and cardiopulmonary support in case of emergencies.
In cases of inadvertent IV injection of the agent or excessive absorption of local anaesthetic like bupivacaine, convulsions, cardiac depression, severe arrhythmias, respiratory depression, or cardiac arrest may occur.
Nurses can assist in patient positioning, monitoring vital signs during block delivery, administering oxygen therapy, and using supporting devices like ultrasound imaging, nerve stimulators, and tourniquets under the anaesthetist's direction.

Procedural Sedation

Procedural sedation is used for diagnostic or therapeutic procedures performed in or outside of the operating room.
It helps patients tolerate procedures that might otherwise be painful or uncomfortable.
Procedural sedation can lead to a lack of memory, with patients often unable to recall events that occurred.
Conscious sedation involves reduced consciousness, where patients can respond to verbal commands or light touch.
Conscious sedation can be provided by nurse sedationists under specific ANZCA guidelines with ready access to an anaesthetist.
Deep sedation results in loss of consciousness, requiring airway assistance and requiring an anaesthetist to administer.

The Older Patient During Surgery

Older patients have a decreased functional reserve and general decline in organ function compared to younger individuals.
Comorbidities, polypharmacy, and medication interactions pose challenges for surgical teams.
Anaesthetic agents, while safer and more predictable now, can have altered pharmacokinetics in older adults impacting medication onset, peak, and duration.
Anaesthetic medications should be carefully titrated in older adults, considering their weight for accurate dosing.
Physiological changes in ageing affect the patient's response to anaesthetic agents, blood and fluid loss, hypothermia, pain, surgery tolerance, and positioning.
Increased risk of pressure ulcers, VTE, and postoperative confusion/delirium requires careful monitoring of older adults.
Older adults may have difficulty communicating and following directions due to hearing or vision impairments.
Impaired sensation in older adults requires vigilance regarding skin integrity, pressure on vulnerable areas, and maceration from solutions.
Older adults often have osteoporosis and osteoarthritis, increasing the risk of injury from misalignment, pressure, or other insults to arthritic joints.
Older adults have a greater risk of perioperative hypothermia, necessitating the routine use of warming devices and monitoring the patient's temperature intraoperatively.

Critical Events in Anaesthesia

Critical events in anaesthesia can occur at any time.
Examples include anaphylaxis, air embolism, VTE, cardiac arrest, haemorrhage, local anaesthetic toxicity, malignant hyperthermia, laryngospasm, and respiratory arrest.
Critical events should be managed using specific algorithms and guidelines.
Perioperative nurses must be familiar with and understand the specific requirements for managing each critical event in their facility.

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This quiz explores the key roles of perioperative nurses, including anaesthetic nurses, scrub nurses, and scout nurses. Participants will learn about their responsibilities, skills, and the importance of patient safety and teamwork in the surgical setting.