Intraoperative Procedures Flashcards
who is part of the surgery team
- Attendants
- Central Sterile
- OR Team
- PA/NP/Assistant
- Anesthesia
- Surgeon
What happens during the Day of Surgery
- Check in - Vitals, change into gown, any preop labs, IV started, preop meds if needed, H&P if needed
- Holding Room - Chart check, vitals, review AM labs
- Anesthesiologist confirms surgery and type of anesthesia
- Surgeon marks surgery site - Universal Protocol
- Verification of patient name, DOB, Procedure
- Operative site marked (not an X), must be signed
- Time out in OR immediately before procedure
Once in Operating Room, how to prepare for Anesthesia?
●Apply monitors (BP, O2 sat, EKG leads, temp strip)
● Anesthesia induction (General Anesthesia) - Amnesia, Analgesia, Muscle relaxation, and Sedation
● O2 mask
● IV Drug Administration
- Opioids - “Pretreatment” Agents
- Fentanyl
● Anesthetic agonist: Decreases HTN response during intubation
Anesthetics - “Induction” Agents
- Propofol (Diprivan)
- Ketamine
effects of propofol
- Rapid Onset of Action (less than 1 minute)
- Side Effect = Pain at injection site
effect of ketamine
CNS effects - hallucinations
Muscle Relaxant/Neuromuscular blocker - “Paralysis” Agents
Succinylcholine - M/C
Succinylcholine is CI in pts with a h/o?
Malignant Hyperthermia
SE of succinylcholine
myalgia
which anesthetic
which anesthetic is MC for children
Inhalation anesthetics (isoflurane)
What is Malignant Hyperthermia?
A pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases
tachypnea, increased oxygen consumption, cyanosis, cardiac dysrhythmias, metabolic acidosis, respiratory acidosis, muscle rigidity
1st sign of What is Malignant Hyperthermia will most likely noticed by ?
anesthesia provider
presentation of malignant hyperthermia
- Unexplained tachycardia
- Increased end-tidal CO2
- Increase of body temperature above 38.8 C
- Masseter rigidity
tx for maignant hyperthermia
1) Dantrolene – stops the release of calcium into the muscle
2) Oxygen
3) Body cooling and extra fluids
4) Supportive care
If personal or family hx of malignant hyperthermia, you must notify anesthesia as it requires them to do what?
Requires flushing of anesthesia machine prior to case
Anesthesia Induction
- Preparation 10 mins before
- Preoxygenation 5 mins before intubation
- Pretreatment 3 mins before induction
- Paralysis with agent
- Protection 30 seconds after induction
- Placement of ET Tube 45 seconds after induction
- Post-intubation Management 60 seconds after intubation
what 3 things can help with ET intubation if it is a difficult airway?
- Application of cricoid pressure
- Fiberoptic laryngoscope
- GlideScope
Once Endotracheal tube is inserted, what are the next steps?
- Inflate bulb on tube to secure airway
- Connect to O2
- Confirm placement of tube by auscultation of lungs/condensation in the tube
- Tape in place
complications of ET intubation
- Damage to teeth, soft tissue of mouth/pharynx, lips
- Tachycardia, BP irregularities
- Laryngospasm on extubating
Types of Intraoperative Anesthesia is Dependant on several factors:
- patient’s medical history,
- the surgical procedure that is to be performed,
- the preference of the surgeon and anesthesiologist, and
- the patient’s first choice.
4 Types of Anesthesia
- General Anesthesia
- Conscious Sedation or Monitored Anesthesia Care (MAC)
- Regional Blocks
- Local anesthesia
- Monitored, without intubation
- Medications Commonly Used: Propofol, Fentanyl, Versed
- Common with Endoscopies
which type of anesthesia
Monitored Anesthesia Care (MAC) or Conscious Sedation
- Common with invasive surgeries of the extremities, or below the waist pelvic surgery (C-section, bladder sling)
- Common Medications - Lidocaine, Bupivacaine
what type of anesthesia
Spinal and Epidural
how to inject for Spinal anesthesia
- Lumbar Level (L3-L4)
- Enter subarachnoid space, inject anesthetic into CSF
how to inject for epidural anesthesia
- Any point in vertebral column
- Inject anesthetic into epidural space
Proper Positioning for spinal ansthesia
- Lateral Decubitus
- Sitting, bending forward
SE of spinal anesthesia
- HA
- Most Serious - Cauda Equina Syndrome
- Hypotension, Sedation, Respiratory Depression, Infection (Abscess)
which has less potential SE, spinal or epidural anesthesia?
Epidural - Less potential for side effects
still has Hypotension, Sedation, Respiratory Depression, Infection (Abscess)
CI for spinal/epidural anesthesia
Back abnormalities and infections
agents for local anesthesia
Lidocaine (with/without Epinephrine), Bupivacaine
Should not use Epinephrine local anesthesia on where of the body
distal end points
Penis, nose, fingers and toes
how to prepare/inject for local anesthesia
- Skin cleaned and prepped first
- Inject Deep & Superficial around surgical site
- Use caution not to inject into vasculature
local anesthesia is common for what types of procedures
- Common for minor skin procedures
- Commonly used to control postoperative incisional pain
- Digital Blocks
How to Prevent injury to patient when positioning a pt
Provide padding with towels or gel pads
Heels, elbows, wrists, under knees, neck
why avoid malpositioning of arms and legs
Can result in nerve injury - ie - brachial plexus or ulnar nerve injury
how to position pt for surgery
- Proper positioning for surgical procedure
- Prevent injury to patient
- Avoid malpositioning of arms and legs
- During operation, avoid leaning on patient
- Cover exposed body parts not in the operative field with warm blankets - May use bear hugger.
- Apply ground pads to skin out of the operative field
what preparation must be performed using sterile technique (Performed by circulating OR-RN)
Skin Prep
what solutions to use for skin prep
Chlorhexidine
Betadine
Hibiclens
Alcohol
Multiple Application Methods: Sponges, Stick Applicator
Proper Way to Gown and Glove
- Remove jewelry (rings, bracelets, dangling earrings)
- Remember: Fingernails short, nail polish without chips (No acrylic) - Put on protective equipment
- Haircover and facial hair/sideburn cover
- Shoe Covers
- Mask
- Eyewear - Gather all supplies in OR
- Gown, Gloves
- Open using sterile technique - Scrub
- Enter OR
- Dry off with sterile towel
- Don sterile gown + gloves
