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Role of anesthesia nurse in operation theatre
1. ROLE OF ANESTHESIA NURSE
IN OPERATION THEATRE
DR RAJESH T EAPEN
BURJEEL HOSPITAL
MUSCAT
2. • Anaesthesia is a state of temporary induced loss of
sensation or awareness. It may include analgesia
(relief from or prevention of pain), paralysis (muscle
relaxation), amnesia (loss of memory), or
unconsciousness.
• In preparing for a medical procedure, the Anesthetist
giving anesthesia chooses and determines the doses
of one or more drugs to achieve the types and
degree of anesthesia characteristics appropriate for
the type of procedure and the particular patient.
3. Anesthesia Nurse
• In existence for nearly 150 years, the
specialty practice of nurse
anesthesia has become one of the most
challenging and rewarding
areas of advanced nursing practice.
• But here the role is that of an assistant
to the Anesthetist
6. Roles
Assist to Conduct a pre- and post- anesthesia and pre- and post-analgesia visit and assessment
with appropriate documentation;
Assist to develop a general plan of anesthesia care with the physician
• select the method for administration of anesthesia or analgesia;
• Help to administer appropriate medications and anesthetic agents during the peri-anesthetic
or peri-analgesic period;
• order necessary medications and tests in the peri-anesthetic or peri-analgesia period;
• induce and maintain anesthesia or analgesia at the required levels;
• support life functions during the peri-anesthetic or peri-analgesic period;
• recognize and take appropriate action with respect to patient responses during the peri-
anesthetic or peri-analgesic period;
• manage the patient’s emergence from anesthesia or analgesia; and
• participate in the life support of the patient.
7. If someone listens, or stretches out a
hand, or whispers a kind word of
encouragement, or attempts to
understand a lonely person, extraordinary
things begin to happen
Loretta Gizarlis (1920)
American writer and educator
An ideal Anesthesia Nurse
10. Perioperative Care
The time span that includes preparation for, the process of,
and recovery from surgery
Three phases of perioperative nursing care
Preoperative: before surgery
Intraoperative: in operating room (OR), post-anesthesia
recovery (PAR), or post-anesthesia care unit (PACU)
Postoperative: after surgery
37. • At a minimum, requires presence of
anesthesiologist and nursing.
• Performed before induction of
anesthesia.
• Performed with patient
awake/participation.
• Refusal of patient to participate requires
documentation.
Briefing
38. Briefing
• Verbal confirmation with the patient:
Identity using two patient identifiers;
Consent for surgery;
Type of procedure planned; and;
Site (side and/or level of surgery).
• Site marked/not applicable
Confirm surgeon performing the surgery
has marked the surgical site according to
Policy
39. Briefing (cont)
• Allergies/Precautions
Does the patient have any known allergies? If so
what are they? Latex allergy precautions required.
Is the patient on any specific infection control
precautions? If so what?
• VTE prophylaxis
Is the patient receiving/to receive chemical VTE
prophylaxis?
Is the patient receiving/to receive mechanical VTE
prophylaxis?
Confirm TEDs/SCDs have or will be applied as per
surgeon request &/or hospital policy.
40. • Equipment, instrument(s) and/or implant(s)
concerns
Equipment:
Confirm availability of special equipment required;
Confirm intended position; and
Discuss any problems with equipment.
Instruments
Confirm availability of instruments;
Nurse verifies sterility indicator/integrator; and
Any particular concerns.
Implants
Confirm availability of implant(s) required; and
Confirm availability of various sizes that could be used.
• Anesthesia safety checklist
Confirm anesthesia equipment safety check has been
completed in accordance with local/departmental policies.
Briefing (cont)
41. Briefing (cont)
• Difficult Airway/Anesthesia Risk?
Confirm airway equipment is available; and
Confirm if difficult airway anticipated or likelihood of
pulmonary aspiration of gastric contents.
• Risk of > 500ml of blood loss?
May include PT/PTT/INR concerns;
Medications or morbidities that may lead to complications
and any intention to transfuse blood products; and
Confirm if blood products are required and if they are
available.
• Postoperative destination
Confirm postoperative destination and any potential for
changes.
42. AT THIS POINT THE BRIEFING IS
COMPLETED AND THE TEAM MAY
PROCEED WITH INDUCTION OF
ANESTHESIA, FOLLOWED BY
POSITIONING, PREPPING AND
DRAPING.
44. Time-out
• At a minimum, requires surgeon, anesthesiologist, and nurse(s)
to be present.
• Performed after induction, prepping/draping immediately prior to
surgical incision.
• Completed in accordance with WRHA Policy “Correct site,
correct procedure and correct patient for surgical procedures
(identification of) #110.220.020.
• Team members are identified
Team members are identified by name and role. If previously
introduced, it is not required to repeat this step.
• Team verbally confirms:
Correct Patient;
Correct Procedure; and
Correct Site.
45. • Antibiotic prophylaxis given within the
appropriate time frame.
Confirm antibiotic prophylaxis has been given within
60minutes (2 hours for Vancomycin and Fluoroquinolones)
and when next dose will be given;
If not given, give before incision;
If administered, when is next dose due; and
Consider antibiotic circulation time and duration of tourniquet
time.
• Essential imaging displayed?
Confirm essential imaging has been displayed and is
displayed correctly.
• Team communicates anticipated complications.
• STOP! Does everyone agree we are ready to go?
46. AT THIS POINT THE TIME OUT IS
COMPLETED AND THE TEAM MAY
PROCEED WITH THE SURGERY
47. Debriefing
• At a minimum, requires surgeon, anesthesiologist, and nurse(s)
to be present.
• Performed during or immediately after wound closure before the
patient is transferred from the operating room.
• Should be initiated when informing the surgeon that “Count is
Correct”
• Nurse verbally confirms with the entire team
Confirmation of procedure performed as stated by surgeon;
Verbal confirmation of specimen details;
Verbal confirmation of surgical count; and
Identification of equipment problems.
• Surgeon reviews with the entire team
Summary of important intra-operative events
Indicate management plans
48. • Anesthesiologist review with the entire team
Summary of important intra-operative events
Confirm blood/fluid loss
Recovery plans including concerns/issues related to
postoperative care
Confirm normothermia
• Is there anything we could have done better?
Must be asked for each procedure
Team members must respond with either a negative or a
specific answer to the question
Consider three (3) questions when answering:
What did we do well?
What did we learn?
What could we do better/do differently?
Debriefing (cont)