ROLE OF ANESTHESIA NURSE

IN OPERATION THEATRE
• 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.
Where do they work?
Roles & Responsibilities must be clear,
Otherwise……
Duties

• Duties include getting supplies and equipment ready

for procedures
• They may be called upon to explain the procedures
to patients in an effort to secure cooperation and
increase confidence in the procedure.
• They assist in monitoring the patient's vital signs and
communicate the information to the physicians
• The nurse must also be able to prepare medications
appropriately and recognize their actions and
untoward reactions.
• Current cardiopulmonary resuscitation (CPR)
certification is an essential requirement
• During preoperative assessment, the Anesthesia nurse reviews the
patient’s chart and assessment data and assesses the patient’s
readiness for surgery, plans for the patient’s intraoperative care, and
identifies data pertinent to anesthesia such as comorbidities, history
of asthma, previous surgeries, experiences related to anesthetics,
and complications.
• Family history of adverse reactions with anesthetics such as
malignant hyperthermia
• Drug allergies and information about the patient’s current
medications, including herbal medications, is essential to prevent the
use of anesthesia medications that might react unfavorably with
current medications or cause an allergic reaction.
• Allergies to contrast dyes, iodine solutions, adhesive tape, food
allergies, and sensitivity to latex are relevant.
• History of smoking, drug and alcohol use can alter the effect of
anesthesia medications.
• Patients who will be intubated should be assessed for cracked lips,
lacerations in or around the mouth, and loose or chipped teeth.
Dentures should be removed prior to general anesthesia, because
they can become dislodged and interfere with intubation and
anesthetic delivery.
• Avoiding smoking for as few as 12 hours prior to surgery has been
shown to measurably reduce the negative effects of smoking.
Smokers should be encouraged to stop smoking as early as
possible prior to surgery.
• Smokers have also been documented to need increased anesthetic
dosages and greater amounts of postoperative pain medication.
• Check to ensure that any diagnostic
tests ordered were actually performed
and that the results are present in the
chart. Ensure that all team members are
aware of any abnormalities in the test
results.
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.
• Check ID bands and if the client is wearing an allergy band
• Be sure the client passes urine immediately before he or
she is taken to the operating suite.
• Any jewelry not removed shall be secured with tape and
documented as such
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;
• 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.
• The Anesthesia Nurse and the circulating nurse both
document relevant times related to the procedure
(e.g., time in the room, time of induction, time of
incision). It is essential that the documentation of
these times be consistent in all of the various patient
records.
• As much as possible, the room should be ready and
preparations for surgery completed before the patient
is brought into the operating-room suite and
transferred to the operating bed.
• Once the patient is in the room, the Anesthesia Nurse
must focus attention on providing emotional support,
ensuring patient dignity, instituting safety measures,
and assisting the anesthesia provider.
• Confirm that the safety strap, electrocardiographic leads, blood
pressure cuff, pulse oximeter probe and intravenous line are in place.
• Induction covers the time from administration of the first anesthetic drug
until the patient is stabilized at the desired level of anesthesia.
• Prior to anesthesia induction, there should be a working suction with
catheter in place within easy reach of the anesthesia provider.
• The Anesthesia nurse must be present and available to assist the
anesthesia provider and, if necessary, to restrain the patient
(particularly children).
• Just prior to induction, patients often become anxious. Remain at the
patient’s side, speak calmly, explain the process, and answer any
questions; be reassuring. Nonverbal support, such as making eye
contact and holding the patient’s hand, can be the most supportive
interventions in preparation for induction.
• The Anesthesia nurse might assist with intubation by pulling gently on the corner of the
patient’s mouth to increase visualization of the vocal cords and facilitate placement of
the endotracheal tube.
• The Anesthesia nurse might also pass the endotracheal tube to the anesthesia provider
so he or she does not have to look up to pick up the tube.
• Following the induction of anesthesia and positioning for the surgical procedure, the
perioperative nurse should scan the patient from head to foot to ensure that the body
alignment is maintained and padding is adequate to prevent pressure damage. This is a
critical review—once the patient is draped, it’s difficult to assess and adjust the patient’s
position.
• Before positioning or repositioning the patient, the Anesthesia nurse should confer with
the anesthesia provider to determine that the patient can be moved without compromise
to the airway or ventilation, and that he or she is ready to assist in repositioning by
guiding and securing the patient’s head to prevent accidental extubation or
disconnection from the ventilator.
• During the surgical procedure, the Anesthesia nurse helps the anesthesia provider
assess fluid balance by monitoring fluid output and replacement, blood loss, blood and
blood product replacement, and the amount of irrigating solution used
• Even where the Anesthesia nurse’s responsibilities
do not include postanesthesia care, he or she must
demonstrate competence in the use of monitoring
equipment and in the interpretation of the data. The
perioperative nurse must also be familiar with
anesthetic agents and techniques to anticipate
patient events, implement nursing interventions
quickly, and assist the anesthesia provider.
 2

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

 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
During Pre-op Briefing
• Anesthesia safety checklist
 Confirm anesthesia equipment safety check has been completed
 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.
Time-Out
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 Policy “Correct site, correct

procedure and correct patient for surgical procedures
(identification of)

• Team members are identified

 Team members are identified by name and role.
• 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 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
General Anesthesia …what to keep
ready!
What to keep ready!

Endotracheal tubes
 What to keep ready!

Laryngeal mask airway

Igel…simple to use!
• Emergence from anesthesia, particularly during extubation, is a
critical period when the Anesthesia nurse must be at the patient’s side
and immediately available to assist the anesthesia provider.

• Extubation can initiate bronchospasm or laryngospasm reflex. The

airway may become obstructed, and vomiting can occur. Airway
management and adequate ventilation are priorities. Prior to
extubation, the Anesthesia nurse should confirm that a suction
catheter is within reach of the anesthesia provider and that suction is
turned on and working.
Positioning for Spinal Anesthesia
Regional anesthesia
• Nursing responsibilities vary according to the type of regional
anesthesia being administered.
• Patients scheduled for regional anesthesia may be apprehensive
about being awake during surgery, believing that they will
experience pain.
• Provide reassurance, answer questions, and remain close to the
patient to alleviate their anxiety. Even patients who are sedated
• should be aware that the nurse is close by and is available to
provide support.
• Nursing interventions for all patients who receive regional
anesthesia should include preparation for toxic systemic reactions
of the central nervous system and cardiovascular collapse
• Resuscitation equipment must be immediately available, and the
Anesthesia nurse monitoring the patient must be able to use it
• competently.
Post-anesthesia Care Unit (PACU)

• 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
Nursing Alert--- Post op

• 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
Debriefing

• 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?
• The most common of the scoring systems used to assess a
patient’s recovery from general anesthesia is the Aldrete
system. Evaluation criteria include patient activity, respiration,
circulation, and oxygen saturation. Discharge from the post-
anesthesia care unit (PACU) depends upon the score the
patient achieves on each criterion

• The “passing” score varies with facility policy and where the
patient will go when discharged from PACU. A patient going to a
unit with continued nursing care might not require as high a
score as a patient who will be going home.
An ideal Anesthesia Nurse

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
Your turn…