Intra-Operative
Malignant hyperthermia is a medical emergency:
Key points to remember with MH
genetic
triggered by "flurane" and succinylcholine
increase in cellular calcium
-sustained muscle contraction
can occur immediately ---- PACU
list the different types of regional anesthesia
nerve, spinal, epidural, caudal
what are some local anesthetics and their complications
amides:
-lidocaine (can be mixed with epinephrine to control bleeding at the site)
esters:
-cocaine
Complications:
-mild reactions (rash, hives, itching)
-severe anaphylaxis
What are the safety measures a circulating RN must complete in the OR
correct skeletal alignment
prevent pressure on skin and nerves
adequate thoracic expansion
prevent occlusion of arteries/veins
provide modesty
recognize/respect individual needs
S/sx of malignant hyperthermia
tachycardia (1st)
hypoxemia & hypercapnia
skeletal muscle rigidity
arrhythmias
myoglobinuria (muscle enzymes in urine)
hyperthermia (late sign)
Side effects and treatment of spinal anesthesia
s/sx: hypotension, N/V, urinary retention, headache
Treatment: treat headache with rest, fluid, tylenol, and/or blood patch
Airway management:
what is physically happening with an airway becomes compromised
relaxation of the soft tissues of the oropharynx
What are some standard surgical positions
supine
trendelenburg
reverse trendelenburg
fowlers
prone
jackknife
lateral
high lithotomy
low lithotomy
Treatment of malignant hyperthermia
stop triggering meds
dantrolene
cool the patient
correct imbalances
what is a blood patch
blood patch is a small bit of the patients blood used to plug (clot) the hole left behind by the needle in the spinal cord
what are some complications associated with maintaining an airway for your patient
laryngospasms
bronchial intubation
tracheal and esophageal perforation
aspiration
list some high risk patient
geriatric patients
pediatric patients
extremely thin/obese
paralyzed
diabetic
trauma patients
patients with infections
long surgical procedures
vascular surgeries
demineralizing bone conditions
excessive sustained pressure
Key points to know with monitored anesthesia (conscious sedation) - MAC
IV benzdiazepines: diazepam & midazolam
maintains patient airway
decreased level of consciousness
-can still answer questions & respond to physical stimulation
-amnesia
IV narcotics or local anesthetic for pain
less risk & rapid recovery
-requires monitoring and oxygen
Complications of spinal anesthesia
migration of medication causing systemic vasodilation, respiratory and cardiac depression
Who is responsible for positioning the patient for the surgeon
circulating RN
what are some intraoperative complications
hypothermia
hemorrhage
fluid and electrolyte imbalances
cardiovascular complications
pain
anaphylactic reaction
complications with monitored anesthesia
airway obstruction, respiratory depression, hypoxia, aspiration, hypotension
Key points for epidural plus side effects and complications
catheters can be left in for ongoing pain control
s/sx: same as spinal but no headache
complications: same as a spinal, generally safer
What must a circulating RN do while positioning a patient for surgery
Assess
comfort
safety
position using surgical table, straps, wedges, pillows, etc
protect patient privacy and dignity at all times
What are some never events that should never happen intra-operative
wrong body part
wrong patient
wrong surgery
DVT after total knee or hip replacement
PE after total knee or hip replacement
foreign body left in a patient
surgical site infection after certain elective procedures