No other part of your job should be more rehearsed, studied, and in tip top shape than your anesthetic monitoring skills. In the past we've mentioned lazy anesthetists and doubling up with monitoring and dental cleanings, but let's focus now on the priority: the patient. Here are basic ways to improve patient care under anesthesia and make the entire experience less stressful for everyone.
1. Diligence with vitals
Monitoring anesthesia 101 will tell you that in most cases a patient's temp will drop along with their blood pressure. Instead of waiting for the inevitable, have warm bags of fluids/blankets/bair hugger all ready to use. Be prepared to increase the fluid rate or do closely monitored boluses when the blood pressure plummets. Actively keeping the patient warm during surgery will make a huge difference post-operatively and will prevent scrambling to keep them warm during recovery. And make sure you're recording vitals accurately!
2. Understanding O2 and gas anesthetic rates
Before cranking up the isoflurane because a patient seems light, check your tube and 02 rate first. If you are struggling to keep a patient in the proper anesthetic plane, likely you need to do more troubleshooting. Check to make sure the ET tube is properly placed and inflated without leaking. Next, check your 02 rate. Oxygen carries the isoflurane into the patient's body and simply increasing the rate can delivery the anesthetic more efficiently. Still having problems? Keep on reading...
3. Having a properly functioning and maintained anesthetic machine
All parts of your anesthetic machine and equipment must be properly maintained. You should check for leaks, clean the circuit and maintain proper levels of Sodasorb daily. Take a minute to read the manual for your machine and the manufacturer recommendations. They usually have a method to their madness, so follow the instructions closely. Also, make sure you are choosing the proper type of breathing circuit for your patient as this could affect how well they do under anesthesia. Smaller patients (<7kg) will benefit from a non-rebreathing circuit.
4. Using proper analgesics/multi-modal pain control
Pain control can really make a difference pre-operatively for a patient under anesthesia. It's a known fact that it's easier to prevent pain than to try to catch up to it after wind-up has happened. Just because your patient is under anesthesia doesn't mean they are not feeling the pain. Using proper pre-op and intra-op analgesia is not only gold standard for care, but will make for a much smoother anesthetic ride for you.
5. Proper ventilation
6. Emergency drugs
It's important not only to have your emergency drugs handy, but to have an idea of how much you will need to give your patient. Posting emergency drug charts right in the OR is a great idea, or having them already figured out for your particular patient is even more helpful. Also make sure to have the crash cart nearby, or at least some extra needles and syringes handy along with your emergency drugs right in the OR.
7. Don't rush the extubation process
8. Continuing education
Stay up to date with the latest and greatest information regarding patient care under anesthesia. You can find information online and at lectures and conferences.
Care under anesthesia should always be a top priority. We should continue to keep ourselves educated, on task, and alert with our anesthetized patients.
What else do you do to keep your patient a priority under anesthesia?
Check out the electronic anesthetic sheet working in a real life vet hospital!