Anesthesia Management Assistance for Certified Perioperative Nurse (CNOR)

Anesthesia Management Assistance

Guidelines:

• Induction is critical time, RN should be immediately available and present
• Masking before intervention
  • Masking is king
  • Preoxygenate!
• Failed intubation = do something different
  • Consider floorwalker consult early
  • Laryngospasm
    • Paralyze, pos pressure, consider trach
• Do not allow surgeon to manipulate during induction, waitfor TOTS
• Assist with spinal placement
• Assess damage during intubation

Considerations:

• Intubation terrible time for BP cuff
  • Snap connector if needed
  • Pulse ox most critical
  • Pulse increases with intubation
• Know location of airway gear
  • KB on back table
• Quiet during emergence, “stage 2”
• Assess during surgery for anesthesia response
  • Insufflation pressure
  • Vent setting: pressure vs volume
• MAC/twilight: be aware of patient
  • “Oops”
• RSI if indicated, NPO violation common
• Know current tube size!“Need one smaller”
• ETco2 #1 indicator for tube placement
  • Beware mainstem
• Check cuff pressure! 20-30 mmhg

Nurse’s role:

• Expose chest
• Hold what told to hold
  • ET tube, attach syringe, pre fill syringe with <10cc, hold in ready state
  • When placed, hold with hand touching face pinch at teeth
• Call assistance
• IV maintenance
• Third hand common
  • Bagging or mask pressure vice versa
  • Cannot administer on their behalf for test
• Test equipment
  • Glyde scope, video laryngoscope
  • Backup o2
• Cric pressure
  • Don’t let go until told!
  • Feedback “i feel it”
• Safely ‘restrain’ for emergence if indicated
  • PTSD common

Pitfalls:

• Waiting too long for code
• Not masking!!
• “I checked it this morning” FALSE
• Scrub tech clanging gear = spasm
• Emergence fight
• Wrong medication label
  • Flush clamped
• Gas left on
  • Long emergence period

Examples:

• Induction, mask, intubation failed (mask again, regain o2, consider changes)
• Anesthesia places tube then turns for tap (grab tube, hold atteeth and hand braced to
  face)
• LMA placed (listen for leaks, preemptively pull next size)
• Masking easy yet declining o2 (masking stomach likely)

Linchpins (Key Points):

• The RN has a critical role in anesthesia management that often appears small until needed. Be ready when needed