Role of anesthesia nurse in operation theatre

ROLE OF ANESTHESIA NURSE
IN OPERATION THEATRE
DR RAJESH T EAPEN
BURJEEL HOSPITAL
MUSCAT

• 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.

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

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.

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

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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
2

Types of laryngeal blades

Endotracheal tubes

Laryngeal mask airway

AMERICAN SOCIETY OF ANESTHESIOLOGIST
(ASA)
• American Society of Anesthesiologists (ASA) Score is a global
score that assesses the physical status of patients before
surgery.
• It is sometimed refereed to as ASA-PS, because it is a measure
of ‗physical status‘.
• ASA 1 A normal healthy patient.
ASA 2 A patient with mild systemic disease.
ASA 3 A patient with severe systemic disease.
ASA 4 A patient with severe systemic disease that is a
constant threat to life.
ASA 5 A moribund patient who is not expected to survive
• There are modifications – the addition of ―E‖ for an emergency,
the addition of ―P‖ for pregnancy, and ASA 6 for organ
retrieval in brain-dead patients.
• The ASA Score is a useful global measure of he

MALLAMPATI CLASSIFICATION OR
SCORE
The Mallampati score or Mallampati classification, named after the Indian-born
American anaesthesiologist Seshagiri Mallampati, is used to predict the ease of endotracheal
intubation. The test comprises a visual assessment of the distance from the tongue base to
the roof of the mouth, and therefore the amount of space in which there is to work. It is an
indirect way of assessing how difficult an intubation will be.

Factors to Address when assessing clients
for surgical risk
• Weight
• Age
• Lifestyle factors
• Pre-existing physical disorders
• Physical activity status

Nursing Interventions Common to
all Surgical Procedures
• Providing emotional support
– *previous surgeries may alter his/her response to
surgery
• Preparing client physically for surgery
• Ensuring legal matters are carried out
• Ensuring preoperative tests completed
• Teaching
• Providing routine preoperative and postoperative care

In Practice: Caring for the Client
Who Is Receiving Anesthesia
Make sure client is wearing an ID band and has been carefully identified
Check for allergies
Note any abnormal lab test results
After surgery using spinal anesthetics, keep the client flat until the
anesthetic has worn off
*Observe for respiratory depression and movement of
extremities
*Postop check all v/s, including pain, frequently as ordered,
report any deviations
*observe carefully for signs of respiratory distress following use
of neuromuscular blockers or any type of general anesthetic

Preoperative Nursing Care
• Orders written by surgeon or anesthesiologist
• Teach client to carry out orders exactly
– *make sure they can see/hear; could interfere with
teaching
• Provide emotional support
• *keep the heirarchy of basic human needs, in mind
– *consider needs-oxygen, food, water, elimination,
sleep

Nursing Alert
• *In most instances, the client is instructed to stop taking
– Aspirin
– Ibuprofen (Motrin, Advil)
– Other NSAIDs
– Any specific agents affecting blood coagulation
• For at least 7 days before surgery to reduce the risk of
excessive bleeding.

Immediately Before Operation
Record baseline v/s, assess pain
Assist them to void before going to the OR
Remove partial, complete dentures
Give preop. Meds as ordered
raise siderails and have client remain in bed, enc.
Them to call for assistance if a BR is needed (offer
bedpan prior to surgery

Nursing Alert
• **Be sure the client has signed the operative permit before
giving give any pre-sedation medications.
• The client is not considered to be responsible after being
medicated and cannot legally sign the operative permit.
• If the permit is not signed before medication is given, the
surgery would most likely need to be postponed.
• Obtaining the client‘s permission for surgery is the
responsibility of the surgeon; the nurse double-checks to make
sure this had been done.
• Remember the concept of informed consent—the client must
understand what is being done and why.
• The client must be able to verbalize the type of surgery being
done, and this statement must agree with the records and
consent forms.
• If surgery must be cancelled for an error, such as the
inappropriate or incorrect signing of the operative permit, this
is considered a sentinel event and must be reported and
investigated.

Key Concept
• Before giving any preoperative medications, make sure
the client does not have any drug allergies and that the
surgical permit has been signed, witnessed, and is on the
client‘s chart or electronic record.
• Make sure the client is wearing an allergy band, whether
or not an allergy exists.
• In addition, make sure the client is wearing one or two
facility ID ands and that all information is correct.
• Be sure to offer a bedpan or urinal to the client
immediately before he or she is taken to the operating
suite. The client should not get up to the bathroom at
that time.

Nursing Alert
• To prevent errors, always be certain that the client is properly
identified before transfer to the OR.
• No client should be allowed to go to the OR without an
identification bracelet! This would cause the surgery to be
cancelled. Some hospitals require an ID bracelet on both of the
client‘s wrists.
• The client must also be wearing an allergy band, stating
existing allergies or stating that the client has no known
allergies.
• If the client is a fall risk, a fall risk ID band is worn as well.
Blood ID bands (two) also must be worn if the client will
receive blood transfusions.
• The ID band of the client going to surgery must be checked by
at least two people.

Post-anesthesia Care Unit (PACU) or
Post-anesthesia Recovery Area (PAR)
• Articles that may be needed for care are located near the
client‘s unit in the PACU
– Breathing aids
– Circulatory aids
– Drugs
• Narcotics
• Sedatives
• Drugs for emergency situations

PACU or PAR, cont.
• Articles that may be needed, cont.
– Other supplies
• Surgical dressings
• Sandbags
• Warmed blankets
• Extra pillows
• Various other items

Transport
• Client transport to surgery
• Moving the client to the PACU
• Moving the client to the floor/unit

Nursing Alert
• Leave no client alone until he or she has fully regained
consciousness.
• Check the physician‘s orders and carry them out
immediately.

Immediate Postoperative Complications
• Observe the client postoperatively for immediate
complications, for example
– Hemorrhage
– Shock
– Hypoxia
– hypothermia

Peri-Operative Standards of Care
(example)
• All Policy & Procedures of the medical and surgical nursing
division will be followed.
• Patients shall ALWAYS wear a legible identification band
• Operative permit(s) must be signed and witnessed according
to hospital policy, The procedure documented on the
operative permit MUST MATCH what is scheduled on the OR
schedule
• The history and physical shall be completed according to
policy and be part of the medical record prior to surgery
• All ordered lab work shall be collected and results placed in
the medical record in accordance with the physician‘s orders
• Dentures, hairpins, jewelry, wigs, contact lenses, nail polish,
make-up and prosthesis shall be removed as requested by
the physician
• Any jewelry not removed shall be secured with tape and
documented as such

NURSING RESPONSIBLITIES ...
• Report anything of note that needs to be brought to the
attention of the anesthesiologist, surgeon, or OR nurse
• low potassium,
• fever,
• arrthymias,
• loose teeth,
• chest pain, or
• anything unusual
• Assure patient has ID bracelet on; Send current chart
and any old medical records with the patient;
• EVALUATE patients level of understanding, physical
stability, emotionally prepared, fulfilled hospital pre-op
policies

NURSING ASSESSMENT
• Assessment Data Base - vital signs, weight, height
• Review of Systems
• Past history of illnesses (i.e. HTN, pneumonia) that
may predispose client to complications
• Past experience with hospitalization or surgery
• Allergies to medications or foods, tapes, surgical
scrubs

The WRHA Surgical Safety Checklist

Doors closed? Checked!

• 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

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

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.

• 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)

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.

AT THIS POINT THE BRIEFING IS
COMPLETED AND THE TEAM MAY
PROCEED WITH INDUCTION OF
ANESTHESIA, FOLLOWED BY
POSITIONING, PREPPING AND
DRAPING.

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.

• 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?

AT THIS POINT THE TIME OUT IS
COMPLETED AND THE TEAM MAY
PROCEED WITH THE SURGERY

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

• 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)

HANDOFF TO PACU/RR, NURSING
UNIT OR ICU
SAFETY CHECKLIST IS NOW
COMPLETE

Role of anesthesia nurse in operation theatre

Role of anesthesia nurse in operation theatre

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