Anaesthetic nurses provide care for patients prior to and during surgery or interventional procedures, under regional, local and general anaesthesia . They work in collaboration with the anaesthetist, preparing patients for surgery, preparing medication and equipment, delivering general, regional or local anaesthesia, monitoring the patient’s condition and managing complications that may occur.

In this blog post we talk about the 5 actions every anaesthetic nurse must do for every patient, receiving regional, local or general anaesthesia.

Regional, local and general anaesthesia

The type of surgical procedure or intervention, as well as the patients’ health status will determine the type of anaesthesia: regional, local or general

Every anaesthesia is associated with specific risks, some are systemic whilst others are localized to the area receiving anaesthetic medication. Respiratory failure is one of the most common and preventable anaesthetic risks that may occur in every type of anaesthesia. 1-11

The 5 actions below are a safe base for all types of anaesthesia. Specific actions, relating to each patient’s co-morbidities, anaesthetic medications and interventions, as well as surgical procedures will need to be added to minimize particular risks.

Action 1: Patient Assessment

Preparing your patient for the surgery or interventional procedure is the first step

This involves collecting the patient’s clinical history and a physical assessment, which will allow the nurse to assess the patient’s suitability for the proposed  anaesthesia. This is also the best opportunity to talk about the anaesthetic procedure, making sure the patient is aware of risks, answering possible questions and managing anxiety and concerns.

The preassessment information collected will provide important tips on possible complications and how to mitigate them. It is particularly important to ask about co-morbidities, to determine the risk of cardiac or respiratory failure.

For some emergency procedures, anaesthetic nurses may not have time to collect all the information and must focus on key information about fasting, allergies, airway, breathing, circulatory, and neurological problems.

Action 2: Environment Preparing

Making sure the environment is ready is an important step

This includes anaesthetic equipment and drugs that will be used, as well as the equipment and medicine that may be used in case of complications or adverse events. Typical equipment includes ventilators, capnography, a pulse oximeter, blood pressure monitor and airway equipment such as a video laryngoscope.

Preparing the environment also involves making sure you have the right team, with the right knowledge and skills.

Action 3: Patient Monitoring

An anaesthetized patient will, to a lesser or higher degree, have physiological functions that will be impaired and need to be monitored closely

Monitoring devices are part of the anaesthetic nurses’ responsibility, giving insight into the patient’s health status.

For instance, your patient’s respiration rate, SpO2, pulse rate, oxygen saturation or end tidal CO2. The anaesthetic nurse’s clinical vigilance and ongoing interpretation of parameters is crucial to manage risk, prevent complications, detect them early and intervene promptly.

Action 4: Managing Adverse Events

Every surgical procedure and anaesthesia – regional, local and general anaesthesia – is associated with risks

Despite adequate preparation and monitoring, complications may still occur. These may be related to airway or respiratory failure, hypoxia or hypoxemia, circulatory problems, and impaired consciousness. 

The anaesthetic nurse’s role is to detect adverse events as soon as possible and intervene promptly and adequately, communicating with the anaesthetist and other members of the team, assisting in interventions, delegating tasks when appropriate and keeping records.

Action 5: Emergence From Anaesthesia

An adequate handover to recovery nurses allows for continuity of care during the recovery phase

After the surgical procedure, the anaesthetic nurse must assist the patient in regaining the physiological functions that were impaired by the medication administered. The focus is on airway patency, ventilatory, circulatory and neurological systems to, for instance, avoid post-operative delirium.

 

If you are an anaesthetic nurse, caring for patients under regional, local and general anaesthesia, the 5 actions above are a good base to grow on, to keep your patients safe. Your patient’s journey starts with an initial assessment, moving on to a safe environment, being monitored closely, managing complications and finally regaining all physiological functions.

About the author

My name is Andreia Trigo RN BSc MSc, I am a nurse consultant with over a decade of experience in anaesthesia, sedation and pain management.

This involves patient care, as well as lecturing at post grad level on these topics, presenting at conferences and co-developing a very successful sedation course at SedateUK. My passion for creating safer environments for patients and professionals led me to collaborate with Medtronic and share my knowledge and expertise with our professional community.

 

The content of this article is written by a blogger with whom Medtronic has a relationship. However, the contents represent the personal objective views, comments and techniques of the blogger and are not statements from Medtronic. To the extent this material might contain images of patients or any material where a copyright is held by a third party, all necessary written permissions from the patient or copyright holder, as applicable, with respect to use, distribution or copying of such images or copyrighted materials has been obtained by the blogger.

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  • 2. Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456822/

  • 3. Respiratory physiology and anaesthesia. Available at: https://bjaed.org/article/S1472-2615(17)30147-4/pdf

  • 4. Respiratory complications of anaesthesia. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/anae.14137

  • 5. Postoperative Opioid-induced Respiratory Depression: A Closed Claims Analysis. Available at: https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2087871

  • 6. Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration. Available at: https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2477976

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  • 8. Local anaesthetic toxicity. Available at: https://emedicine.medscape.com/article/1844551-overview#a2

  • 9. Respiratory depression associated with meperidine spinal anaesthesia. Available at: https://www.ncbi.nlm.nih.gov/pubmed/7923521

  • 10. Respiratory Arrest After Spinal Anesthesia with Lidocaine and Fentanyl.  Available at: https://journals.lww.com/anesthesia-analgesia/Fulltext/1997/06000/Respiratory_Arrest_After_Spinal_Anesthesia_with.41.aspx

  • 11. Local anesthetic toxicity: acute and chronic management. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667269/

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