Anesthesia plan

Question 1

What does the Council on Accreditation say?

Answer 1

• We should provide nurse anesthesia care based on sound principles and research evidence.
• Perform a pre-anesthetic assessment and formulate an anesthesia care plan for patients to whom they are assigned to administer anestesia

Question 2

What information are you going to use to adjust your anesthetic care plan?

What should you have ready in case your plan changes?

Answer 2

• reassess vital signs
• airway status
• response to pre-procedure medications
• make sure all anesthesia equipment, supplies, and medications are checked and immediately available in case the pt needs change

Question 3

What are the components of the anesthetic plan?

Answer 3

• Drug plan/ anesthetic technique
• airway plan
• ventilation plan
• fluid plan/IV access plan
• monitoring plan
• positioning plan

Question 4

What will influence your plan?

Answer 4

• current physical status
• histor and physical assessment
• co-existing disease
• airway assessment/difficult airway?
• previous anesthesia complications
• family history of anesthesia problems
• planned surgery

Question 5

What are the choices of anesthetic technique?

Answer 5

• GA
• regional
• combined GA/Regional
• MAC
• Local

Question 6

What should your airway plan include?

Answer 6

• Type of airway
  
  • ETT, LMA, NC, face mask
  • ETT size (armored, oral rae, nasal rae, etc.)
  • LMA size
• Blade- miller, mac, glidescope,e tc
• Vent settings: TV, RR, FiO2, I:E, spontaneious vs assisted
• difficult airway cart
• airway blocks

Question 7

What is Standard 1 of monitoring?

Answer 7

• Qualified anesthesia personnel shall be present in the room throughout the conduct of all general anesthetics, regional, and MAC cases

Question 8

What is standard 2 of monitoring?

How is this done?

Answer 8

• During all anesthetics, the pt’s oxygenation, ventilation, circulation, and temperature shall be continually evaluated.
• Oxygenation
  
  • Oxygenanalyzer for inspired gasses
  • Pulse oximetry, observation of pt
• Ventilation
  
  • Auscultation of BS
  • observation of pt and reservoir bag
  • capnography
• Circulation
  
  • ECG
  • HR and BP recorded every 5 minutes
  • listen to Heart sounds, feel pulse
  • pulse ox
  • art line
• Temperature

Question 9

What are some other monitors that may be used?

Answer 9

Art line

CVP/PA

TEE

PNS

BIS

glucometer

EEG/SSEP

EMG

Question 10

What are the intraoperative fluid requirements?

Answer 10

• maintenance
• fluid deficit
• blood loss
• evaporative loss

Question 11

What are the most common operative positions?

Answer 11

• Supine
  
  • trendelenburg
  • reverse trendelenburg
• Lithotomy
• prone
• lateral decubitus
• sitting