The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [611]
Surgeon, anaesthetist and registered practitioner
What are the key concerns for recovery and management of this patient?
To ensure continuity of care and that the recovery nurse has the information to care for the patient in the PACU
Preprocedural considerations
Pharmacological support
Prior to commencing anaesthetic, the following medications may be used to ensure that the patient is comfortable, relaxed and asleep.
Analgesia: this will be administered intravenously with the muscle relaxants and sleep-inducing drugs. Drugs used are very much anaesthetist dependent but could include morphine or fentanyl. This is to ensure that the patient does not feel any pain at the time of skin incision.
Antiemetics are given with analgesia. These medications, such as cyclizine, metoclopramide and chlorpromazine, moderate any side-effects from administering analgesia. Antiemetics are also important to prevent inhalation if the patient vomits on arrival in the anaesthetic room or during the induction of anaesthesia. (Although the patient may have been nil by mouth, some contents may still be in the stomach, which may be vomited as the muscles relax.)
Induction agents are drugs which help to induce sleep. The mostly commonly used is propofol, a short-acting medication that can be administered twice during a procedure.
Inhalation agents: once the patient has been induced, they can then be kept asleep with inhalation agents although these can cause nausea and vomiting. Examples of inhalation agents are sevoflurane and isoflurane. These are administered through vaporizers which are attached to the anaesthetic machines.
Muscle relaxants are the last drugs to be administered during induction as they relax all muscles and patients are paralysed. This has to be done when the patients are asleep otherwise it can be a very frightening experience for them as they are awake but unable to move. The most commonly used relaxants/paralyzing agents are vecuronium and atracurium.
Specific patient preparation
When the patient arrives in the anaesthetic room, it is important to check the patients and their details to ensure that the correct patient is being received. At this point, consent is verified with the patient and the final phase of the preoperative checklist is completed to ensure that it is the correct patient. This is the final patient check prior to commencing surgery and is crucial to ensuring the patient’s safety.
Procedure guideline 14.3 Anaesthesia: caring for patient in anaesthetic room
Equipment
Suction
Anaesthetic machine
Medical gases
Monitoring equipment
Preprocedure
Action Rationale
1 Greet the patient by name. Confirm with the ward nurse that it is the correct patient for the scheduled operation. To reduce patient anxiety. P
Procedure
2 Identify the patient by checking the identification band (name and patient number) against the patient’s notes and the operating list. To safeguard against patient misidentification. Questioning the premedicated patient can be unreliable (AORN 2000, C).
3 Check and confirm the correct completion of the preoperative checklist. To ensure that all the listed measures have been completed and that any additional information has been recorded. E
4 Check that the results of the investigative procedures, for example blood results, X-rays, and so on, are included with the patient’s notes. To ensure that all the required results are available for the theatre team’s use. E
5 Maintain a calm, quiet environment and explain all the procedures to the patient including the monitoring of blood pressure, pulse and oxygen saturation. To reduce anxiety and enhance the smooth induction of anaesthesia (Mitchell 2009, E).
6 When the patient is anaesthetized, ensure that the eyes are closed and secured with hypoallergenic tape. To prevent corneal damage due to eyes drying out or accidental abrasion. E
Postprocedure
7 When the patient has been anaesthetized,