intra op Flashcards
def: anesthesia
def: anesthetic
state of narcosis, analgesia, relaxation, loss of reflexes
chemical or gas
surgical unit
Pre-operative holding area
OR
Unrestricted: all people in street clothes
Semi-restricted : work and storage areas for clean & sterile supplies
Restricted : OR
-Admission & waiting area, either inside or adjacent to surgical suite
-Peri-op nurse identifies, assesses, and gives pre-op meds
Surgical attire and Masks
Sterile surgical supplies kept separate from contaminated
circulating nurse job
Manage the O.R., not scrubbed in gloves or gowned and remains in the unsterile field. Protects the patient, verify consent, coordinate the team, ensure cleanliness, proper temperature, safe functioning of equipment.
Monitors: aseptic practices, the patient
Nursing activities directly relate to preventing complications and achieving optimal pt outcomes
scrub nurse
As the incision is closed, the scrub and circulating nurses count all needles, sponges and instruments.
Tissue specimens must be labeled by the scrub nurse.
Activities include performing a surgical hand scrub, setting up sterile tables, preparing sutures, ligatures and special equipment, assisting the surgeon.
Classification of anesthesia
EXAM
General anesthesia
Local anesthesia
Regional anesthesia
Conscious sedation
General Anes
they are OUT + intubated
EXAM
-Choice for long procedures that require relaxation of skeletal muscles
-An altered physiological state:
reversible loss of consciousness
skeletal muscle relaxation
amnesia, and
analgesia
-Not arousable even to painful stimuli
-Require assistance in maintaining a patent airway
Can be achieved by IV or inhalation, or both.
IV : e.g., midazolam, propofol, ketamine
Inhalation: Nitrous oxide, Isoflurane
Inhaled through a mask, ETT, or tracheostomy
Most commonly admin via an endotracheal tube.
In today’s health care, 1 or 2 inhalation drugs in conjunction with IV meds are used.
General anesthesia is usually more than one agent:
IV opioids
Benzodiazepines
Neuro-muscular blocking drugs
antiemetic
(usually Sedative first, then the rest)
Local Anes
Without loss of consciousness
EXAM
Blocks the initiation and transmission of electric impulses along nerve fibres.
Allows surgery to be performed on certain areas of the body without loss of consciousness.
Topical application (directly on skin, mucous membranes, or open surface)
Injection of the agent into tissues.
Regional anes(peripheral nerve block)
EXAM
Injection of local anesthetic into or around a specific nerve or group of nerves.
Two types of regional anesthesia:
Spinal anesthesia
Epidural anesthesia
Spinal anesthesia
NO LOSS OF CONSCIOUSNESS
EXAM
Local anesthetic inj into CSF in SUBARACHNOID SPACE IN LUMBAR AREA
Allows surgery to be performed on certain areas with
no loss of consciousness
Blocks the initiation and transmission of electric impulses along nerve fibres
Epidural anesthesia
NO LOSS OF CONSCIOUSNESS
EXAM
Local anesthetic inj into EPIDURAL (extradural) space of thoracic or lumbar spine
between L3 and L4
Does not enter CSF
works by binding to nerve roots as they enter and exit the spinal cord.
At low dose: sensory pathways are blocked but motor fibres are intact.
Can still move, just can’t feel
At higher dose: both sensory and motor fibres are blocked.
uses:
- Caesarean section
- lower extremity vascular procedures
- hip and knee replacements.
Advantage over spinal anes: ↓ incidence of post-spinal headache
Procedural (conscious) sedation
endoscopy, interventional radiology, central line & chest tube placements
Administration of sedatives, with or without analgesics.
ex ketamine, fentynal
why:
↓ anxiety and discomfort during non-invasive or minimally invasive procedure.
Complications during surgery
Major blood loss
-dt antiplatelets, aspirin
-Monitor output , then replace blood loss
Anaphylactic reactions
-medications, latex, or other substances
-life threatening acute allergic reaction that causes vasodilation, hypotension
Hypothermia
-During anesthesia, pt’s temperature may fall. (cold OR, cool IV fluids, cool gases, open body wounds, decreased muscle activity = drop in temperature below 36.6 degrees is serious)
-Often, IV’s and irrigating fluids are warmed, wet gowns, drapes are removed and replaced ASAP and warm blankets are often utilized
Malignant Hyperthermia
-Is an inherited muscle disorder chemically induced by anesthetic agents
-Susceptible people include those with strong bulky muscles, a hx of muscle cramps, unexplained temperature elevations, and unexplained deaths of family members during surgery
-ASK if family members died during sx (increased HR, muscle rigidity, rapid increase in temp)
Nausea and vomiting
-May affect pts during the intraoperative period
-If gagging occurs, turn pt to their side, suction mouth prn
-Antiemetic’s are often administered
-If the pt aspirates, a number of pulmonary complications can occur and lead to extreme hypoxia
