Intraoperative Care Flashcards
Anesthesia
a state of narcosis, analgesia, relaxation, and loss of reflexes
Anesthesiologist
physician trained to deliver anesthesia and to monitor the patient’s condition during surgery
Anesthetic
the substance, such as a chemical or gas used to induce anesthesia
Surgical Asepsis
absence of micro-organisms in the surgical environment to reduce the risk of infection
Physical environment of Surgical Suite: Surgical suite is divided into 3 distinct areas
Unrestricted: all people in street clothes
Semi-restricted: work and storage areas for clean & sterile supplies
Restricted: OR
Pre-Operative holding areas
Admission & waiting area, either inside or adjacent to surgical suite
Pre-op nurse identifies, assesses, and gives pre-op meds
Operating Room
Surgical attire and Masks
Sterile surgical supplies kept separate from contaminated
Circulating Nurse
Manage the OR not scrubbed in gloved 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
- Activities include performing a surgical hand scrub, setting up sterile tables, preparing sutures, ligatures and special equipment assisting the surgeon
- 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
Surgeon
Heads the surgical team, performs the surgical procedure
RN/First Assistant
Varies by institution, assists the surgeon
Anesthesiologist
Interview and assesses pt prior to surgery, selects and administers anesthesia, intubates if necessary
Principles of surgical asepsis
Prevents the contamination of surgical wounds
All surgical supplies must be sterilized
Team wears long sleeved sterile gowns, masks, and gloves
Classifications of Anesthesia (4)
- General anesthesia
- Local anesthesia
- Regional anesthesia
- Conscious sedation
General anesthesia
choice for lengthy surgical procedures that require relaxation of skeletal muscles
An altered physiological state
- reversible loss of consciousness
- skeletal muscle relaxation
- amnesia
- analgesia
Not rousable even to painful stimuli
Require assistance in maintaining a patent airway
How is general anesthesia acheived
IV or inhalation, or both
IV: midazolam, propofol, ketamine
Inhalation: Nitrous oxide, Isoflurane
In todays health care, 1 or 2 inhalation drugs in conjunction with IV meds are used
usually the sedative is given first
General anesthesia is usually more than one agent: (4)
- IV opioids
- Benzodiazepines
- Neuro-muscular blocking drugs
- Antiemetics
Inhalation general anesthesia
- Mixed vapours with oxygen, many used are volatile liquids
- Inhaled through a mask, ETT, or tracheostomy
- Most commonly admin via an endotracheal tube
Local Anaesthesia
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 Anaesthesia (peripheral nerve block)
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
lumbar area in the subarachnoid space
between the arachnoid mater and the pia mater
Epidural anesthesia
goes into the epidural space at the thoracic or lumbar area of the spine
Spinal Anesthesia
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
Alternative to GA in a physiologically compromised patient
Local anesthetic is injected into cerebro-spinal fluid (CSF) in subarachnoid space
Epidural Anesthesia
Local anesthetic is injected into epidural (extradural) space
Does not enter the CSF but works by binding to nerve roots as they enter and exit the spinal cord
At low does: sensory pathways are blocked but motor fibers are intact
At higher dose: both sensory and motor fibers are blocked
For C-section: lower extremity vascular procedures, hip and knee replacements
Advantage of Epidural anesthesia over spinal anesthesia
decreased incidence of post-spinal anesthesia headache
Procedural (conscious) sedation
Administration of sedatives, with or without analgesics
Decreased anxiety and discomfort during non-invasive or minimally invasive procedure
e.g., enoscopy, interventional radiology, central line & chest tube placements
Complications During Surgery: Major Blood Loss
-Maybe they didn’t stop taking their anticoagulants
-Monitor and record all fluid accumulation in suction container
-It is the circulating nurses responsibility along with the anaesthesiologists to replace blood loss
Complications During Surgery: Anaphylactic Reactions
A reaction can occur in response to many medications, latex, or other substances. Anaphylaxis is a life threatening acute allergic reaction that causes vasodilation, hypotension
Complications During Surgery: Hypothermia
- During anesthesia, pts temperature may fall. if you add a cooler OR room, cool IV fluids, cool gases, open body wounds, decreased muscle activity - the drop in temperature below 36.6 degrees is serious
- Often, IVs 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
Increased HR, tachypnea, muscle rigidity and increase in temp
Complications During Surgery: Nausea and Vomiting
- may affect pts during the intraoperative period
- if gagging occurs, turn pt on their side, suction mouth prn
- antiemetics are often administered
- if the pt aspirates, a number of pulmonary complications can occur an lead to extreme hypoxia
