MSN Unit B Perioperative care- Pre opp

ANESTHESIA & ANALGESIA

  • Definitions:

    • Anaesthesia: Means "sensation free".

    • Analgesia: Means "pain free".

HISTORY OF ANAESTHESIA

  • Overview: Pain management has been a longstanding challenge in medicine.

  • 1600s: Opium was commonly used by European doctors for pain relief.

  • 1800s: Introduction of ether and chloroform as anaesthetics for surgeries.

    • Ethical concerns arose about operating on unconscious patients.

  • 1900s: Use of morphine and heroin for pain relief began.

    • Tension between improving quality of life and addiction risks highlighted.

OLD METHODS OF ANAESTHESIA

  • Common Agents:

    • Ether (C2H5)O

    • Chloroform (CHCl3)

FIRST ANAESTHESIA USAGE

  • Historical Event:

    • The first public demonstration of ether anaesthesia took place on 16 October 1846 at Massachusetts General Hospital in Boston.

    • The operation involved surgeon John Warren and anaesthetist William Morton, who removed a lump from Gilbert Abbott's jaw.

KEY DEVELOPMENTS IN ANAESTHESIA

  • 1878: Invention of the first endotracheal tube.

  • 1885: Local anaesthesia using cocaine.

  • 1942: Introduction of Thiopental for anaesthesia.

  • Anaesthetists' responsibilities: Care provided during preoperative, intraoperative, and postoperative phases.

STAGES OF PERIOPERATIVE CARE

  • Phases:

    • Pre-operative Phase: Starts at the decision for surgery until patient is on the operating table.

    • Intra-operative Phase: Begins when patient is on the operating table until transfer to post anaesthetic care unit (PACU).

    • Post-operative Phase: From PACU until complete recovery.

INFORMED CONSENT

  • Definition: Process of informing the patient about surgical procedure, risks, and possible complications.

  • Importance:

    • Ensures patient understanding of treatment and potential complications.

    • Protects from unauthorized procedures and legal issues for the hospital.

  • Procedures Requiring Consent:

    • All anaesthesia and invasive procedures.

    • Radiological procedures involving contrast mediums.

  • Responsibility: Surgeons and anaesthetists must obtain respective consents.

  • Consent Protocol:

    • No sedation before consent is given and signed.

    • A witness from nursing or medical staff must sign the document.

PRE-OPERATIVE PREPARATIONS

  • Main Tasks:

    • Patient assessment to identify health issues.

    • Planning specific care and ensuring consent is signed.

    • Patient education on preoperative procedures (breathing exercises, etc.).

    • Addressing patient concerns and involving them in care.

PRE-OPERATIVE TEACHING

  • Key Topics:

    • Pain management post-operation.

    • Importance of deep breathing and coughing post-surgery.

    • Range of motion and early mobilization.

    • Usage of anti-embolytic ted stockings.

    • Understanding invasive devices like drains, catheters, IV lines, monitors.

PRE-OPERATIVE PREPARATION DETAILS

  • Key Activities:

    • Verification of signed consent.

    • Enemas and NPO instructions based on anaesthetist recommendations.

    • Skin preparation and marking.

    • Administration of pre-operative medications and IV access setup.

    • Maintenance of patient warmth and safety (side rails, etc.).

    • Discuss bladder care before the procedure.

    • Reassurance of patient and family.

PRE-OPERATIVE PATIENT ASSESSMENT

  • Physical Assessment:

    • Respiratory, cardiovascular, renal, hepatic, endocrine functioning, nutritional, fluid, and immune status.

  • Psychological Assessment:

    • Evaluating anxiety, stress levels, and knowledge deficits.

TRANSFER OF PATIENT TO OPERATING THEATRE

  • Verification:

    • Confirming consent form, medical history, and preparation details (dentures, jewelry removal, etc.).

  • Preparations Before Transfer:

    • Ensuring psycho-social safety and comfort (stretcher rails, warm blankets).

POST-TRANSFER PREPARATION

  • Before Patient Returns: Prepare surgical bed and necessary equipment for postoperative care:

    • Monitoring equipment, oxygen, drip stand, warm blankets, controlled environment for comfort.

ANESTHESIA & ANALGESIA

Definitions:

  • Anaesthesia: A medical term meaning "sensation free." It involves the use of medications that induce a reversible state of unconsciousness, ensuring that surgical procedures can be carried out without the patient experiencing pain or distress.

  • Analgesia: Refers to the relief from pain; medications used specifically for this purpose are known as analgesics. They work by blocking pain signals in the brain or affecting the perception of pain.

HISTORY OF ANAESTHESIA

Overview:

  • Pain management has been a longstanding challenge in medicine, evolving through centuries with advancements in practice and technology.

  • Effective pain relief is crucial not just for comfort, but also for psychological well-being, allowing patients to undergo surgical and medical procedures without fear or anxiety.

Key Historical Moments:

  • 1600s: Opium, derived from the opium poppy, was commonly utilized by European physicians for its potent pain-relieving properties.

  • 1800s: The introduction of ether and chloroform as anesthetic agents revolutionized surgery. These compounds allowed for painless operations, although ethical discussions surfaced concerning the safety of operating on unconscious individuals.

  • 1900s: The medical community began using morphine and heroin for pain control. This period highlighted a growing concern regarding addiction, balancing the imperative for improved quality of life against the risks of dependency.

OLD METHODS OF ANAESTHESIA

Common Agents:

  • Ether (C2H5)O: A volatile anesthetic that was widely used before the advent of safer alternatives.

  • Chloroform (CHCl3): Although effective, it was found to have significant risks associated with its administration, including potential toxicity and side effects.

FIRST ANAESTHESIA USAGE

Historical Event:

  • The first public demonstration of ether anesthesia occurred on 16 October 1846 at Massachusetts General Hospital in Boston. The operation, performed by surgeon John Warren and anesthetist William Morton, demonstrated the ability to remove a jaw lump from patient Gilbert Abbott without pain, marking a pivotal moment in surgical history and anesthesia practice.

KEY DEVELOPMENTS IN ANAESTHESIA

Milestones:

  • 1878: The invention of the first endotracheal tube, essential for maintaining a patient’s airway and delivering anesthetic gases directly to the lungs.

  • 1885: The advent of local anesthesia using cocaine, allowing for pain relief in specific areas rather than through general anesthesia.

  • 1942: Thiopental was introduced as a fast-acting intravenous anesthetic that paved the way for modern anesthesia techniques.

  • Anaesthetists' Responsibilities: They provide comprehensive care during the preoperative, intraoperative, and postoperative phases, ensuring patient safety and comfort throughout the surgical process.

STAGES OF PERIOPERATIVE CARE

Phases:

  1. Pre-operative Phase: Initiates at the decision for surgery and continues until the patient is positioned on the operating table. Preparations, assessments, and patient education take place during this stage.

  2. Intra-operative Phase: Begins when the patient is on the operating table, focusing on delivering anesthesia and monitoring vital signs until transfer to the post-anesthesia care unit (PACU).

  3. Post-operative Phase: Extends from the PACU until the patient achieves complete recovery, emphasizing pain management, monitoring for complications, and rehabilitation.

INFORMED CONSENT

Definition:

  • The process of informing patients about the surgical procedure, associated risks, and potential complications to ensure understanding and voluntary participation in their treatment.

Importance:

  • Facilitates patient autonomy regarding medical decisions and provides legal protection against unauthorized practices.

Procedures Requiring Consent:

  • All anesthesia and invasive procedures, as well as certain radiological interventions involving contrast mediums.

Responsibility:

  • Both surgeons and anesthetists have the obligation to obtain consent before undertaking their respective roles in a surgical procedure.

Consent Protocol:

  • Consent must be obtained without sedation; a witness, typically from nursing or medical staff, must sign the consent document to verify the process.

PRE-OPERATIVE PREPARATIONS

Main Tasks:

  • Conduct a thorough patient assessment to identify any underlying health issues.

  • Develop a care plan and ensure that signed consent is in place before proceeding.

  • Educate patients on preoperative procedures, such as proper breathing exercises, to promote recovery.

  • Address patient concerns and actively involve them in their care decisions.

PRE-OPERATIVE TEACHING

Key Topics:

  • Strategies for managing pain post-operation to enhance recovery.

  • Importance of deep breathing and coughing exercises following surgery to prevent pulmonary complications.

  • Understanding range of motion and the necessity of early mobilization to prevent complications like deep vein thrombosis.

  • Usage of anti-embolic TED stockings to promote circulation and reduce the risk of blood clots during recovery.

  • Familiarity with invasive devices, such as drains, catheters, IV lines, and monitoring equipment, to alleviate patient anxiety and promote cooperation.

PRE-OPERATIVE PREPARATION DETAILS

Key Activities:

  • Verify that signed consent has been obtained and documented.

  • Administer enemas and dietary restrictions (NPO) based on the anesthetist’s recommendations to ensure patient safety during surgery.

  • Conduct skin preparation and marking to prevent surgical errors.

  • Ensure pre-operative medications are administered and IV access is established for medications and fluids.

  • Maintain patient warmth and safety through proper environmental conditions and securing side rails on stretchers.

  • Discuss bladder management strategies and reassure both the patient and their family regarding the procedure and recovery.

PRE-OPERATIVE PATIENT ASSESSMENT

Physical Assessment:

  • Evaluate respiratory, cardiovascular, renal, hepatic, and endocrine functions, along with nutritional, fluid, and immune status to assess surgical risk factors.

Psychological Assessment:

  • Assess levels of anxiety, stress, and knowledge deficits that may impact the patient's experience and recovery.

TRANSFER OF PATIENT TO OPERATING THEATRE

Verification:

  • Confirm the consent form, review medical history, and clarify preparation details, including specific considerations like removing dentures and jewelry.

Preparations Before Transfer:

  • Ensure psycho-social safety by making the patient comfortable, with measures like stretcher rails and warm blankets to reduce anxiety during transport.

POST-TRANSFER PREPARATION

Before Patient Returns:

  • Prepare the surgical bed and the necessary equipment for postoperative care, which includes monitoring equipment, oxygen tanks, a drip stand, warm blankets, and creating a controlled environment conducive to patient comfort and recovery.