Anaesthetics Flashcards
Role of the anaesthetic nurse
- Cares for the patient in the immediate time period prior to, during and after surgery.
- Provides nursing care to the patient and procedural support to the anaesthetic team during the preparation for and induction of anaesthesia, throughout maintenance of anaesthesia and during emergence from anaesthesia.
Anaesthetic nursing responsibilities (WSPCM)
- Works collaboratively
- Supports the anaesthesia care delivered by the anaesthetist.
- Patient advocate
- contributes to monitoring, and interventional care.
- Minimum of one designated anaesthesia nurse
Emergency surgery definition
An unplanned nature of identification of the need for surgery, and a relative urgency for surgical intervention, without which the patients health may deteriorate and risk poor clinical outcomes. Including loss of life, limb or function or reduce quality of life.
patient assessment
- collection of objective (physical assessment) and subjective (history) data
Adults having elective procedure - pre-op fasting
- Solid food may be taken up to 6 hours prior to anaesthesia
- Clear fluids up to 2 hours prior to anaesthesia
Children 6 months + having elective procedure - pre-op fasting
- Breast milk/formula, limited solid food up to 6 hours prior to
- Clear fluids up to one hour prior to
Infants under 6 months having an elective procedure
- Formula up to 4 hours prior
- Breast milk 3 hours prior
- Clear fluids (no more than 3ml/kg/hr) up to 1 hour prior to
ACE inhibitors with anaesthesia
Can cause severe hypotension at induction of during maintenance of anaesthesia
Diuretics with anaesthesia
Can cause hypokalaemia which may potentiate the effects of muscle relaxants.
Lithium with anaesthesia
Potentiates non-depolarising muscle relaxants
Anticoagulants with anaesthesia
Increased risk of bleeding or surgical haemorrhage.
Oral contraceptive pill with anaesthesia
Increased risk of thromboembolic complications
Benzo’s with anaesthesia
Potentiate action of intravenous anaesthetic agents and opioids
Calcium channel blockers (Verapamil) with anaesthesia
Interacts with volatile anaesthetic agents leading to arrhythmias and decreased cardiac output
Garlic with anaesthesia
Potential for irreversible inhibition of platelet function
Grapefruit/ cranberry with anaesthesia
Interacts with warfarin
Valerian and Kava with anaesthesia
Potentiate GABA mediated systems, interfering with inhalation anaesthetics which work on GABA receptors.
St John’s Wort with anaesthesia
May potentiate or prolong anaesthetic agent effect
Ginkgo Biloba with anaesthesia
May increase bleeding
Ginger with anaesthesia
Potent inhibitor of thromboxane synthetase enzyme that can prolong bleeding time.
Echinacea with anaesthesia
Increases the risks of poor wound healing and opportunistic infections post surgery.
Negligence
Not informed about all of the risks associated with the treatment/
Trespass
Either assault/ battery and false imprisonment if pt is not informed of broad nature and effects of proposed treatment.
Nurses and consent
- Verify the consent and pt ID
- Nurses can only witness the pt signature on consent form
- Ensure a valid consent is obtained prior to all procedural/ research activities
- Identify instances when guardian relative or attorney should be consulted regarding pt consent,.
Airway assessment
Identify predictable problems with the maintenance of oxygenation during airway management and to formulate an airway plan in the event of the unexpected difficult airway or emergency airway management.
- body habitus and obesity
- characteristics of the neck
- shortness or a lack of mobility
- characteristics of the jaw, including a receding jaw or limited ability to open the mouth and dentition of lose or protruding teeth.
Components of airway assessment (PPPBMMTUTC)
- Previous hx of previous anaesthesia issues including difficult intubation
- Presence of gastroesophageal reflux
- Presence of obstructive sleep apnoea
- BMI
- Mouth opening and interincisor gap (IIG)
- Modified Mallampati score
- Teeth examination
- Upper lip bite test (ULBT)/ Mandible protrusion test
- Thyromental distance (TMD)
- Cervical spine movement
Mallampati Score
A simple scoring system relating to the amount of mouth opening to the size of the tongue and provides an estimate of space available for oral intubation by direct laryngoscopy.
Thyromental distance
Used to estimate mandibular space.
Simplified Airway Risk Index Assessment (SARI)
Multivariate risk score for predicting difficult tracheal intubation.
- Combines the criteria as set out by the ANZCA.
- Score ranges from 0-12
- E.g., SARI score of 4+ indicates difficult intubation.
Factors affecting airway choice:
- Age
- Type of procedure, including pt positioning
- Length of procedure
- Medical condition
- Fasting status of pt
- Type of anaesthetic being administered
