TIVA may be favoured as the anesthetic technique of choice for the following reasons ADVANTAGES OF TIVA: 1. Rapid smooth induction and maintenance of anesthesia Induction of anesthesia with propofol is smooth and associated with a low incidence of excitatory side effects. Doses of 1 to 2.5 mg/kg (depending on patient age, physical status, and use of premedicant drugs) induce anesthesia in approximately 30 seconds. The speed of onset and the dose of propofol needed for induction are dependent on the administration rate. (Sear, 2012) One advantage of propofol as an induction agent is the greater depression of pharyngeal and laryngeal reactivity. This can be of benefit during upper airway instrumentation and insertion of the laryngeal mask airway. …show more content…
The exposure of anesthetist to inhalational anesthetics is higher as compared to other operation theater personals and may even cross the limits of environmental tolerance. (Sukhminder & Jasbir, …show more content…
Environment friendly as eliminates waste gases Anesthetics are commonly used during surgery with the aim of providing the patient with an experience free of sights, sounds, and any other unpleasant sensations. The major atmospheric effects that may arise from emission of volatile anesthetics are their contributions to ozone depletion in the stratosphere and to greenhouse warming in the troposphere. (Yasny & White, 2012) Over the years there have been significant improvements in the control of environmental contamination by anesthetic gases. These have been accomplished through the use and improved design of scavenging systems, installation of more effective general ventilation systems, and an increased attention to equipment maintenance and leak detection, as well as careful anesthetic practice. TIVA is one of the main methods to achieve this as it totally eliminates these waste gases. (Yasny & White, 2012) 6. Ideal operating conditions for neurologic surgery with reduced cerebral brain flow, decreased intracranial pressure, and decreased cerebral metabolic rate for oxygen, and in the case of propofol, preservation of cerebral autoregulation and vascular
Justin is the registered nurse that has been given the handover for Kelly Malone’s postoperative care in the surgical unit. Kelly Malone is a 49 female patient who has had a septoplasty and a right ethmoidectomy. Justin is working with Kelly to identify Kelly’s needs in order for Kelly to be discharged from the hospital. Kelly’s postoperative observations were a temperature of 36.2 degrees celsius; heart rate of 68 beats per minute; respiratory rate of 18 breaths per minute, blood pressure of 111 systolic over 73 diastolic millimetres of mercury; oxygen saturation at 93 percent of room air and a self-rated pain score of two out of ten. Kelly has a history of ‘not being able to breathe well through her nose’ and a history of disturbed sleep.
There are also other associated risks such as hemorrhage anesthesia reactions (if
Arterial line kit for continuous hemodynamic monitoring b. Central venous catheter for drug administration c. Ice packs d. Cooling blanket and cooling machine filled with filtered water e. Rectal temperature probe for continuous temperature monitoring f. Sedation/ Neuromuscular blockade g. Mechanical ventilator without heated humidification N5. Baseline nursing assessment6,7,8,9 a. Baseline neurological assessment, including GCS and pupil assessment b. Baseline vital signs (heart rate, blood pressure, SpO2, ETCO2, EEG and cardiac rhythm assessment) c. Baseline skin assessment d. Baseline body temperature e. Baseline blood work: Potassium, Magnesium, Phosphate, Calcium, Glucose, ABG, PTT, INR, platelets, Amylase, AST, ALT, Bilirubin, Alkaline Phosphatase N6.
Then the patient exhales passively. Increasingly, PSV is used in ICUs as the primary ventilation mode. PSV is thought to improve the endurance of respiratory muscles (Morton & Fontaine, 2013). This mode is not for patients who are sedated, or receiving neuromuscular blockade or having any pathological conditions that leads to unreliable breathing PSV is used as a weaning mode, or a recovery mode to boost the patients effort in maintaining a tidal volume. and tidal volume and RR should be monitored to detect any decreased compliance of the lungs.
This helps provide more patient centered care. Guidelines to follow after opioid administration will vary by hospital but it is still necessary to use sedation scales with acceptable measures of reliability and validity for pain management. The use of sedation scales should be used with consistent monitoring of respirations. Pasero (2009) emphasizes that a comprehensive evaluation of respiratory status that includes depth, regularity, rate, and noisiness of respiration in addition to sedation assessment is essential to decision making during opioid administration for pain management. Respirations should be counted for a full minute while the patient is at rest in a quiet and relaxed environment.
24/9/15 Health and safety in a hospital setting report unit 3 6 potential hazards in a hospital and the harm that may arise from each Physical environment Spillages- spillages could happen in a hospital everyday due to broken or faulty equipmentas or human error, if this happens it should be cleaned up immediately because substances such as blood could be infectious to other people and be a slip hazard, same applies to bodily fluids and faeces. Ventilation-Ventilation in a hospital should be continuous to avoid carbon monoxide poisoning, fumes and smoke contaminating the air which could lead to an asthma attack, headaches, dizziness, nausea, breathlessness, collapse and loss of consciousness. Ventilation should remove stale air and the air in the room should
Anesthesia Plan – This plan notes the various medical conditions to be aware of for anesthesia and recommends the type and levels of anesthesia for the procedure.
The thought of oral surgery can be difficult at best, and nerve-wracking at worst. The best way to prepare for your oral surgery is to know as much as possible about the procedure and to discuss your anxieties and thoughts with your oral surgeon. This consultation is extremely important and can mean the difference between a successful surgery and a not-so-successful surgical outcome. In this article, we’ll discuss what to expect during your oral surgery consultation.
After observing these providers, I became increasingly intrigued by the profession. After a lot of research into this profession and shadowing multiple anesthetists, I knew I had found my calling. During my time at the Children’s Hospital, I learned that the Anesthesiologist Assistant is a skilled medical professional who works as part of the anesthesia care team in the operating room and receives direction from an Anesthesiologist. They have an extensive amount of training in the induction and maintenance of different anesthetics and also advanced monitoring techniques that allow them to keep the patient safe throughout the procedure. They are skilled providers who have training in inserting invasive catheters used for monitoring patient’s vitals, trained in advanced airway and life support techniques, and prepare an anesthetic plan with the licensed Anesthesiologist.
When a medical team deliberately reduces the core body temperature of their patients, they are using a technique called induced hypothermia. A human’s healthy, body temperature will typically hover around 98.6 degrees fahrenheit; however, once hypothermia consumes the patient, their body will reduce to a temperature between 89.6 and 93.2 degrees fahrenheit. Today, there are technologies that will use cooling blankets or cooling catheters, which contain cold saline and are inserted into the femoral vein, to rapidly drop the patient’s body temperature. The ultimate goal of induced hypothermia is to prevent neural and cell damage in the brain after traumatic brain injured patients.
Although nitrous oxide is the currently prevalent anesthetic used today, Chloroform is more effective as an anaesthetic. Chloroform’s rapid effects and great potency is due to it’s property of being well absorbed, metabolized, and eliminated rapidly by the body after oral, inhalation, or dermal exposure.
As a result, these patients can’t bring the carbon dioxide out, they become retain the carbon dioxide which makes it so hard for them to breathe
Most authors recommend that sedation with propofol should be performed by a registered nurse only in low risk patients (4). In two studies, Rex et al reported that, trained nurses administered sedation with propofol has low risk (3, 36). As a result, the ASA and the American Association of Nurse Anesthetists issued a joint statement in 2004 that, propofol for sedation/analgesia should be administered only by persons trained in the administration of general anesthesia. This restriction is concordant with specific language in the propofol package insert (123). In 2010 members of the European Society of Gastrointestinal Endoscopy (ESGE), the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) and the European Society of Anaesthesiology (ESA) published a guideline on non-anesthesiologist administration of propofol for gastrointestinal endoscopy (95).
The anaesthetist removed the ETT and proceeded to place a tight fitted mask on patients face. (REF)She then alerted the team that there was a problem with the patient airway (REF). The mask did not mist up – indicating of no air movement return, there was no carbon dioxide trace on the capnography and the patient oxygen saturation dropped steadily from 100% to 90%. He instigated vigorous jaw thrust to improve oxygenation, and using continuous positive airway pressure(CPAP) to deliver 100% oxygen flow through the breathing bag attached to the anaesthetic machine but all this effort was not having any effect on the ventilation. He then asked my mentor the Operating Department Practitioner (ODP) to administer 50mg/5ml of intravenous Propofol.
Assessment is a fundamental component of any nurse’s role. However, from what I observed today it seems particularly vital to the PACU nurse. While they do provide interventions, the majority of PACU nurses’ time is spent assessing their patients and documenting their findings. Patients in the PACU have undergone the significant stressor of surgery under general anesthesia and they have the potential for very serious complications. It is up to the PACU nurse to observe if the patient is declining and act quickly and appropriately.