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Chapter 17

Chapter 17. Care of Intraoperative Patients. Members of the Surgical Team. Surgeon and surgical assistant Anesthesia providers: Anesthesiologist and CRNA Holding area nurse Circulating nurse Scrub nurse Surgical technologist Specialty nurses. Operating Room.

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Chapter 17

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  1. Chapter 17 Care of Intraoperative Patients

  2. Members of the Surgical Team • Surgeon and surgical assistant • Anesthesia providers: • Anesthesiologist and CRNA • Holding area nurse • Circulating nurse • Scrub nurse • Surgical technologist • Specialty nurses

  3. Operating Room

  4. Minimally Invasive and Robotic Surgery

  5. Environment of the Operating Room • Preparation of the surgical suite and team safety • Layout • Health and hygiene of the surgical team • Surgical attire • Surgical scrub

  6. Surgical Asepsis

  7. Surgical Scrub, Gowning, and Gloving

  8. Anesthesia • Induced state of partial or total loss of sensation, occurring with or without loss of consciousness • Used to block nerve impulse transmission, suppress reflexes, promote muscle relaxation, and, in some cases, achieve a controlled level of unconsciousness

  9. General Anesthesia • Reversible loss of consciousness induced by inhibiting neuronal impulses in several areas of the central nervous system • Involves a single agent or a combination of agents

  10. Four Stages of General Anesthesia • Stage 1—analgesia and sedation, relaxation • Stage 2—excitement, delirium • Stage 3—operative anesthesia, surgical anesthesia • Stage 4—danger • Emergence—recovery from anesthesia

  11. Administration of General Anesthesia • Inhalation • IV injection • Balanced anesthesia • Adjuncts to general anesthetic agents: hypnotics, opioid analgesics, neuromuscular blocking agents

  12. Balanced Anesthesia • Combination of IV drugs and inhalation agents used to obtain specific effects • Example: thiopental for induction, nitrous oxide for amnesia, morphine for analgesia, and pancuronium for muscle relaxation

  13. Complications from General Anesthesia • Malignant hyperthermia; possible treatment with dantrolene • Overdose • Unrecognized hypoventilation • Complications of specific anesthetic agents • Complications of intubation

  14. Local Anesthesia • Briefly disrupts sensory nerve impulse transmission from a specific body area or region • Delivered topically and by local infiltration • Patient remainsconscious and able to follow instructions

  15. Regional Anesthesia • Type of local anesthesia that blocks multiple peripheral nerves in a specific body region • Field block • Nerve block • Spinal block • Epidural block

  16. Nerve Block Sites

  17. Spinal and Epidural Anesthesia

  18. Complications of Local or Regional Anesthesia • Anaphylaxis • Incorrect delivery technique • Systemic absorption • Overdose • Local complications

  19. Treatment of Complications • Establish open airway. • Give oxygen. • Notify the surgeon. • Fast-acting barbiturate is usual treatment. • Epinephrine for unexplained bradycardia.

  20. Conscious Sedation • IV delivery of sedative, hypnotic, and opioid drugs to reduce the level of consciousness. • Patient maintains a patent airway and can respond to verbal commands. • Amnesia action is short with rapid return to ADLs. • Etomidate, diazepam, midazolam, meperidine, fentanyl, alfentanil, and morphine sulfate are the most commonly used drugs.

  21. Collaborative Management • Assessment • Medical record review • Allergies and previous reactions to anesthesia or transfusions • Autologous blood transfusion • Laboratory and diagnostic test results • Medical history and physical examination findings

  22. Surgical Positions

  23. Risk for Perioperative Positioning Injury Interventions include: • Proper body position • Risk for pressure ulcer formation • Prevention of obstruction of circulation, respiration, and nerve conduction

  24. Impaired Skin Integrity and Impaired Tissue Integrity Interventions include: • Plastic adhesive drape • Skin closures, sutures and staples, nonabsorbable sutures • Insertion of drains • Application of dressing • Transfer of patient from the operating room table to a stretcher

  25. Common Skin Closures

  26. Potential for Hypoventilation • Continuous monitoring of: • Breathing • Circulation • Cardiac rhythms • Blood pressure and heart rate • Continuous presence of an anesthesia provider

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