Intraop Class Notes

Question 1

Older age as risk during operation…

Answer 1

o – fluid imbalance d/t blood loss problem b/c less cardiac reserve, organs less able to adapt
o - Need less anaesthetic – less body mass, impaired liver & kidney function
o -Comobidities: complicate
o Impaired skin integrity
o Hypothermia – impaired temperature regulation

Question 2

Child as risk intraop

Answer 2

o Kidneys immature up until age 5 – difficulty concentrating urine
o Process anaesthetics quickly
o Short necks = difficulty intubating
o Drug dose much be very carefully calculated
o Blood loss much more detrimental

Question 3

Obesity as risk intraop

Answer 3

o Inc pressure on joints
o Airway – larger abdomen and adipose around neck can make intubation difficult
o Risk for aspiration high because of pressure of adipose on stomach contents
o Risks for bleeding and anesthetic use higher b/c surgery takes longer
o Anesthetic stored in fat tissue – will need more, can create more side effects,

Question 4

Malnutrition as risk intraop

Answer 4

o More sensitive to fluid shifts

….?

Question 5

Alcohol or substance use as risk during sx?

Answer 5

o May go through withdrawal
o Liver function impaired – anesthetic
o Bleeding risk d/t possible liver disease
o Heart can go into dysrhythmias and cariomyopathies
o Alcohol can potentiate some drugs or may require more of the drugs
o Need to advocate that they get a LOT of anesthetic or analgesic b/c will be in great pain following

Question 6

Aspiration risk during sx? Who is as at increased risk of this and why?

Answer 6

o People with GERD more prone
o Obesity
o If no time to prepare, contents in stomach float up and may be pushed into lungs
o If stomach empty, may still have acid that moves up and into lungs in same way

Question 7

Risk of diabetes during sx? How is it managed?

Answer 7

• Has unpredictable course during sx
• Stress of sx often causes hyperglycemia (high stress hormones), which is bad.
• Blood sugar levels need frequent checking (usually q2h checks), usually on insulin drip

Question 8

Symptoms of malignant hyperthermia?

Answer 8

Tachycardia (usually earliest sign)
Rapid temp increase
Hypotension
Oliguria
Dysrhythmias 
Muscle rigidity (often seen in jaw)

Question 9

Why does a patient’s blood pressure drop after a spinal, epidural, or general anesthesia?

How is this managed?

Answer 9

anesthetics + opiods cause vasodilation; body also has no muscle tone, so blood prone to pooling in extremities, no longer in most important blood vessels

o Pt may immediately state can’t feel legs and nausea begins – nurse to position supine asap to prevent emesis
o Pre-op often given bolus of fluids to “front end load” in anticipation of BP drop that will occur with anesthetics