Professional Documents
Culture Documents
VN 122
MODULES A/B
SURGICAL TEAM
PATIENT
SURGEON
ANESTHESIOLOGIST OR ANESTHETIST
CIRCULATING NURSE
SCRUB NURSE
SCRUB TECHS
SURGICAL ASEPSIS
ALL STERILE EQUIPMENT
ALL STAFF SCRUB, PROTECTIVE CLOTHING
ONCE SCRUBBED/GOWNED-TOUCH ONLY STERILE FIELDS/OBJECTS
PT COVERED IN STERILE DRAPES
O.R. VENTILATION MORE OFTEN
LIMITED STAFF
METICULOUS HOUSEKEEPING
PATIENT RISKS FROM SURGERY/ANESTHESIA
CARDIAC DYSRHYTHMIA
CIRCULATORY COLLAPSE
CNS AGITATION, SEIZURES, RESP ARREST
OVER/UNDERSEDATION
AGITATION/DISORIENTATION
HYPOXEMIA/HYPERCARBIA
LARYNGEAL TRAUMA, ORAL TRAUMA
HYPOTHERMIA
HYPOTENSION
INFECTION
THROMBOSIS
MALIGNANT HYPERTHERMIA
NERVE DAMAGE, SKIN BREAKDOWN
ELECTRICAL OR LASER BURNS
DRUG TOXICITY, FAULTY EQUIPMENT, HUMAN ERROR
ANESTHESIA CLASSES
1. THOSE THAT SUSPEND SENSATION IN THE WHOLE BODY: GENERAL,
CONSCIOUS SEDATION
2. THOSE THAT SUSPEND SESATION IN PARTS OF THE BODY: LOCAL,
REGIONAL, EPIDURAL, SPINAL
SEDATION LEVELS
1. MINIMAL SEDATION
MODERATE SEDATION (CONSCIOUS SEDATION)
DEEP SEDATION
ANESTHESIA
MODERATE SEDATION
1. IV ANESTHESIA
USED ALONE OR WITH LOCAL, REGIONAL, SPINAL ANESTHESIA
DEPRESSED LOC, PATENT AIRWAY, ABLE TO RESPOND TO PHYSICAL OR
VERBAL STIMULATION
PROVIDES AMNESIA
GENERAL ANESTHESIA
1. IV OR INHALATION
ADMINISTERED WITH O2
3. MOST COMMON: NITROUS OXIDE
MASK OR ENDOTRACHEAL TUBE
LARGER AMOUNTS DURING INDUCTION, THEN DECREASES
STAGES OF ANESTHESIA
1. I: BEGINNING ANESTHESIA
2. II: EXCITEMENT
III: SURGICAL ANESTHESIA
IV: MEDULLARY DEPRESSION
NORMALLY NO SHARP SEPARATION OF STAGES, AND NO STAGE IV.
MAY NOT HAVE ALL STAGES IF OPIOIDS OR NEUROMUSC. BLOCKERS
GIVEN
IV ANESTHESIA
1. BARBITURATES, BENZODIAZEPINES, NONBARBITURATE HYPNOTICS,
DISSOCIATIVE AGENTS, OPIOIDS
USED FOR INDUCTION OR MAINTENANCE OF ANESTHESIA
USED ALONE OR WITH INHALATION ANESTHESIA
USED FOR CONSCIOUS SEDATION
BENEFITS OF IV ANESTHESIA
1. PLEASANT ONSET
DURATION OF ACTION BRIEF
EASY TO ADMINISTER, LITTLE EQUIPMENT NEEDED
DECREASED POSTOP N/V
IV ANESTHESIA AGENTS
1. OPIOIDS
2. MORPHINE
MEPERIDINE HYDROCHLORIDE (DEMEROL): IV,SC, IM
IV ANESTHESIA AGENTS
1. NEUROLEPTANALGISICS: COMBINATION OF SHORT ACTING OPIOID
AND A BUTYROPHENONE
FENTANYL (SUBLIMAZE) IV OR TD AND DROPERIDOL
IV ANESTHESIA AGENTS
DISSOCIATIVE AGENT: KETAMINE, IM, IV. APPEARS AWAKE BUT
DISSOCIATED. HTN, HALLUCINATIONS, DEPRESSED RESP
BARBITURATE: PENTOTHAL: IV, RECTAL. RAPID INDUCTION, RESP
DEPRESSION COMMON
NONBARBITURATE HYPNOTICS: DIPRIVAN (PROPOFOL), IV. MYOCARDIAL
DEPRESSION RISK, HYPOTENSION
NEUROMUSCULAR BLOCKERS
1. NONDEPOLARIZING: TUBARINE-RAPID ACTING AND EXCRETION.
DON’T GIVE IF ALLERGY, ASTHMA
2. DEPOLARIZING: SUCCINYLCHOLINE (ANECTINE, SUCOSTRIN)-RAPID
ONSET/SHORT DURATION. TXS STATUS ASTHMATICUS & TOXIC
REACTIONS TO LOCAL ANESTHETIC
REGIONAL ANESTHESIA
INJECTED AROUND NERVES THAT SUPPLY AREA TO BE CUT
BLOCKS MOTOR NERVES MOST READILY
3. NOT RECOVERED UNTIL MOTOR, SENSORY, AND AUTONOMIC
SYSTEMS ARE NO LONGER AFFECTED
SPINAL ANESTHESIA
1. CONDUCTION NERVE BLOCK PRODUCING ANESTHESIA OF LOWER
EXTREMITIES, PERINEUM, LOWER ABDOMEN
LUMBAR PUNCTURE USU BETWEEN L4/L5-PT IN KNEE/CHEST POSITION,
AFTER INJECTION, ON BACK
NOVOCAINE, PONTOCAINE, XYLOCAINE, MARCAINE
BENEFITS OF SPINAL
EASILY ADMINISTERED
2. INEXPENSIVE
3. MINIMUM EQUIPMENT
4. RAPID ONSET
5. MUSCULAR RELAXATION
EPIDURALS
1. LOCAL ANESTHESIA INTO SPACE SURROUNDING DURA MATER
2. BLOCKS SENSORY, MOTOR, AUTONOMIC FUNCTION
3. DOSE HIGHER THAN WITH SPINAL
4. BENEFIT: NO SPINAL HEADACHE
5. RISKS: SIMILAR TO SPINAL
LOCAL ANESTHESIA
INJECTION INTO TISSUES AT INCISION SITE
SIMPLE, ECONOMICAL, NONEXPLOSIVE
SHORT ACTING, NO GEN’L ANESTHESIA
GOOD FOR SHORT/SUPERFICIAL SURGERY
SAFETY IN POSITIONING
1. COMFORTABLE AS POSSIBLE
2. OPERATIVE AREA EXPOSED
3. VASCULAR SUPPLY UNOBSTRUCTED
4. NO UNDUE PRESSURE ON A PART
NO INTERFERENCE WITH RESPIRATION
PROTECT NERVES FOR PRESSURE
GENTLE RESTRAINT PRN
SPECIAL CARE WITH ELDERLY, FRAIL, OBESE
INTRAOPERATIVE COMPLICATIONS
NAUSEA/VOMITING
ANAPHYLAXIS
HYPOXIA/RESPIRATORY DEPRESSION
HYPOTHERMIA
MALIGNANT HYPERTHERMIA
PREVENTION OF MH
EARLY SCREENING/IDENTIFICATION
ASK RE: FAMILY/PERSONAL HX OF THIS OR SUDDEN HIGH FEVER ASSOC WITH
A SURGICAL PROCEDURE
BULKY STRONG MUSCLES, STRESS
CONTINUOUS EVALUATION OF VITAL SIGNS
TREATMENT OF MH
DC TRIGGERING AGENT
DC SURGERY
HYPERVENTILATION W/100% O2
IV DANTROLENE SODIUM
IV COOL SALINE
TOPICAL COOLING BLANKET
GASTRIC OR PERINEAL LAVAGE
ICE BAGS IN AXILLAE AND GROIN
POSSIBLY CARDIOPULMONARY BYPASS
SAFETY IN SURGERY
ENSURE PROPER INFORMATION, DOCUMENTATION
SURGICAL ASEPSIS
EQUIPMENT WORKING PROPERLY
O.R. AND EQUIPMENT AVAILABLE
SAFETY STRAPS, PROPER GROUNDING, STAY WITH PATIENT
SPONGE/INSTRUMENT COUNT
POSITIONING
PHYSICIAN DECIDES
NURSE ASSISTS WITH POSITIONING, ENSURE PROPER PADDING, NO PRESSURE
ON NERVES, CIRCULATION
CHECK PERIPHERAL PULSES