Interventions for Intraoperative Clients Care

Members of the Surgical Team  Surgeon  Surgical assistant  Anesthesiologist  Certified registered nurse anesthetist  Holding area nurse  Circulating nurse  Scrub nurse  Surgical technician/ Operating room technician

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

Surgical Scrub, Gowning, and Gloving

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

General Anesthesia  Reversible loss of consciousness is induced by inhibiting neuronal impulses in several areas of the CNS.  State can be achieved by a single agent or a combination of agents.  CNS is depressed, resulting in analgesia, amnesia, and unconsciousness, with the loss of muscle tone and reflexes.

Stages of General Anesthesia Stage 1: analgesia Stage 2: excitement Stage 3: operative Stage 4: danger

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

Administration of General Anesthesia  Inhalation: intake and excretion of anesthetic gas or vapor to the lungs through a mask  Intravenous injection: barbiturates, ketamine, and propofol through the blood stream  Adjuncts to general anesthesia agents: hypnotics, opioid analgesics, neuromuscular blocking agents

Balanced Anesthesia  Combination of intravenous drugs and inhalation agents used to obtain specific effects  Combination used to provide hypnosis, amnesia, analgesia, muscle relaxation, and reduced reflexes with minimal disturbance of physiologic function.

Complications from General Anesthesia  Malignant hyperthermia: possible treatment with dantrolene  Overdose  Unrecognized hypoventilation  Complications of specific anesthetic agents  Complications of intubation

Local or Regional Anesthesia  Sensory nerve impulse transmission from a specific body area of region is briefly disrupted  Motor function may be affected  Patient remains conscious and able to follow instructions  Gag and cough reflexes remain intact  Sedatives, opioid analgesics, or hypnotics are often used as supplements to reduce anxiety.

Local Anesthesia  Topical anesthesia  Local infiltration  Regional anesthesia -field block -nerve block -spinal anesthesia -epidural anesthesia

Complications of Local or Regional Anesthesia  Anaphylaxis  Incorrect delivery technique  Systemic absorption  Overdosage

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Epidural Anesthesia Local anaesthetic solutions are deposited in the peridural space between the dura mater and the periosteum lining the vertebral canal. The peridural space contains adipose tissue, lymphatics and blood vessels. The injected local anaesthetic solution produces analgesia by blocking conduction at the intradural spinal nerve roots. 22

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Differences between Spinal and Epidural Anesthesia Spinal anaesthesiaExtradural Anaesthesia Level: below L1/L2, where the spinal cord ends Level: at any level of the vertebral column. Injection: subarachnoid space i.e punture of the dura mater Injection: epidural space (between Ligamentum flavum and dura mater) i.e without punture of the dura mater Identification of the subarachnoid space: When CSF appears Identification of the Peridural space: Using the Loss of Resistance technique. Dosis: ml bupivacaine 0.5% heavyDoses: ml bupivacaine 0.5% Onset of action: rapid (2-5 min)Onset of action: slow (15-20 min) Density of block: more denseDensity of block: less dense Hypotension: rapidHypotension: slow Headache: is a probably complicationHeadache: is not a probable. 25

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

Special Drains Remove pus Remove blood Remove other body fluids from wound Does not result in faster wound healing or prevent infection.

Penrose Drain

Jackson Pratt or JP

Hemovac

Ace wraps To reduce the swelling of an injured area of the body To hold wound bandages in place To wrap around a arm or leg splint during healing To improve blood flow to a limb like an arm or leg To hold cold or hot packs in place on a body part

Ice pack A general rule of thumb is to ice an injury over a period of 24 to 72 hours. Apply cold packs for periods of up to 20 minutes every two to four hours. When your skin starts to feel numb, it's time to give your body a break from a cold pack.

Potential for Hypoventilation  Continuous monitoring of: -breathing -circulation -cardiac rhythms -blood pressure and heart rate  Continuous presence of an anesthesia provider