Regional Anesthesia UGRA: A Case Study

As a clinical requirement for my Adult 1: Medical-Surgical course, I had the opportunity to observe a patient in the Operating Room and in the Post Anesthesia Unit of Advocate Good Samaritan Hospital. The procedure that I observed was a left total knee replacement. The patient needed this surgery because she was experiencing osteoarthritis, and this surgery could alleviate her pain and discomfort. I was with the patient from the end of her stay in the pre-operative holding area to the Operating Room, and then to the Post Anesthesia Care Unit. This paper will include background inquiry, preoperative and operative

Anesthesiologists give patients anesthetics in a variety of ways, such as “orally, intravenously, by gas or direct injection to render patients insensible to pain Anesthesiologists typically maintain the same daily schedule a surgeon follows, participating in both scheduled and unscheduled operations. Anesthesiologists are responsible for determining the proper anesthetic and dosage level for each patient. They monitor the patients progress prior to, during, and after surgery.”(“Anesthesiologist” 31)

This Anaesthetic case study would describes and discussed the scenario of a patient through the anaesthetic role of their surgical procedure. It will include and discuss the anaesthetic safety procedures equipment and drug interventions used to ensure this particular patients maximum safety and comfort before and during the procedure. The case study will include pre and peri-operative assessment in order to describe the involvement contribution of various specialties in the holistic care of the critical care patient. This assignment will focus only on the anaesthetics side of the procedure but will also highlight the importance of the triad of anaesthesia and discuss the administration, maintenance and reversal of

The history of the Nurse Anesthetist dates back prior to the Civil War and were considered by many as the pioneers of the practice of anesthesia. As the complexity of administering anesthesia increased, physicians deemed the practice of anesthesia to be equivalent to the practice of medicine. As time progressed, some physicians attempted to have the practice of anesthesia banned from the nursing scope of practice. It was not until a case was brought in front of the California Supreme Court where they ultimately established the legal precedent granting nurse anesthesia its legality. Specifying that nurses can administer anesthesia and that they would be operating under their scope of practice as long as it was done under the guidance of a supervising physician (Hamric, Tracy, & O 'Grady, 2014). That law was federally mandated until 2001, when the Centers for Medicare and Medicaid changed the federal supervision rule of Anesthesiologist and Nurse Anesthetists in order for facility to receive reimbursement of care ("Certified Registered Nurse Anesthetists Fact Sheet", 2016). This offered states an “opt-out” rule allowing the unsupervised practice of nurse anesthetists. This change led to conflict in the anesthesia community between physicians and Certified Registered Nurse Anesthetists (CRNA) as the debate of a CRNA’s ability to practice autonomously was now the center of attention. With the costs of healthcare rising and the

(History of Nurse Anesthesia Practice. 2010, May), (Koch, E., Downey, P., Kelly, J. W., & Wilson, W. 2001).

• Since 1991, anesthetic and surgical techniques have improved, resulting in lower surgical risk for many patients. Concurrent with these changes, the VHA has implemented a rigorous program of surgical attending oversight of the process of care by resident operators, particularly in surgical suites.

She is with the patient throughout the full process. Before the operation, she will prepare the patient to receive the anesthesia and will perform a full patient assessment. This determines any patient allergies to certain chemicals or drugs; what medicine the patient can receive; how their bodies will react; and where the injection should be administered. Sometimes, the drug will be given in the form of an onsite injection, similar to an epidural. When the operation begins, Kelly will then assist the physician with monitoring and administering the anesthesia to ensure proper sedation. If the patient is not fully put to sleep, and a portion of his or her body is numbed instead, she monitors the input on the site of injection and ensures the patient cannot feel anything throughout their body. When the procedure is concluded, Mrs. Leonard’s duties will continue. She is in charge of overseeing that the patient recovers from the anesthesia smoothly and cares for the patient’s post-operative needs until they are

Could you imagine going through a surgery without anesthetics? You know, an anesthesiologist isn't the only one who gives anesthesia—it's a team effort. Nurse anesthetists have been the primary administers of anesthesia since World War II. Many health care facilities do not have anesthesiologists on staff, but they have a CRNA, or a Certified Registered Nursing Anesthetist. They are the nurses that put IVs (intravenous sedatives) into patients before surgery, as well as a combination of other medicines to relax the patient ("Nurse Anesthetist" Career Articles). The anesthesia promotes a controlled state of unconsciousness, muscular relaxation, and insensitivity to pain. So when you go to the operating room, you will most likely have a nurse

Cost effectiveness is the primary facilitator of ACT models, thus the model and its two subsets: directed versus supervised, should be evaluated. The medically directed model involves one anesthesiologist overseeing one to four CRNAs. This model requires the MDA to be present during the seven critical stages of anesthesia. The supervisory model gives more flexibility with the number of practitioners supervised, MDA presence is not required during the seven critical stages. If the MDA is not present during these stages, he or she is not reimbursed for these stages of care. The supervisory model has proven to be the most cost effective for the hospital (Hogan et al., 2010). Obviously, the supervisory model affords more autonomy to the CRNA, but it

Association of perioperative Registered Nurses (AORN) is a nonprofit organization that represents more than 160,000 perioperative nurses by providing nursing education, standards, and clinical practice resources-including the peer-reviewed, monthly publication-AORN Journal-to enable optimal outcomes for patients undergoing operative and other invasive procedures (ARON, 2015). The AORN organization focuses on best practice standards for quality patient care in the operating room. The OR setting is a fast pace environment that requires nurses to keep up on the latest technology, medicine, and positioning devices for the surgical patient. Nurses are advocates for patients during their surgical procedure to ensure safe and quality care. Our mission is to promote safety and optimal outcomes for patients undergoing operative and other invasive procedures by providing practice support and professional development opportunities to perioperative nurses (AORN, 2015).

For regional anesthesia, a local anesthetic will be injected into a nerve.[1] The anesthetic will then affect a series of nerves. The anesthetic blocks pain by interrupting nerve transmissions, also known as action potentials.[3] Action potentials occur at a constant rate within the body. Action potentials occur between nerve cells and all the body to feel pain.

Learning about the potential complications of epidural reinforced my knowledge in being able to choose the right anaesthetic monitoring equipment. Knowing that Spinal and epidural anaesthesia can cause unpredictable and profound arterial hypotension necessitate the use of adequate monitoring like the; Pulse oximetry, ECG and Blood pressure cuff. This knowledge will help me to be able to select appropriate monitoring devices during epidural catheter insertion. Also it goes without saying that an epidural must be performed in a work area that is equipped for airway management and resuscitation.

BACKGROUND Whether regional anesthesia is associated with tumor-free and long-term survival is controversial. Here, we focused on whether epidural anesthesia affects the long-term survival of gastric cancer patients after surgery. MATERIAL AND METHODS We obtained the records of 273 patients undergoing gastric cancer surgery between August 2006 and December 2010. All patients received elective surgery, and the end-point was death. The general anesthesia group comprised 116 patients and the epidural-supplemented group comprised 157 patients. The results were analyzed using a multivariable model to determine the relationship between epidural use and long-term survival. RESULTS No obvious association was detected between epidural use and long-term

As a senior nurse anesthesia student, I have been in the clinical environment for about a year. In this time, I have been precepted my numerous clinicians, Certified Registered Nurse Anesthetists (CRNA) and physician anesthetists alike. As registered nurse with no prior operating room (OR) background, I learned the OR culture, the norms and day-to-day workings by my preceptors. Furthermore, I acquired valuable skills and nuances which enhanced my clinical acumen as a practitioner.

Application of ultrasound in regional anesthesia has now become the standard of care and its use has shown to reduce complications. However, development of expertise in ultrasound guided regional anesthesia requires the acquisition of new cognitive and technical skills. The reduction of resident working hours and enforcement of labor laws and directives across various states and countries have led to a decreased number of procedures performed and witnessed by trainees. Together, these create challenges in the teaching and learning of ultrasound guided regional anesthesia are less suitable for the historical “see one, do one, teach one” apprenticeship model of learning. Therefore, it is imperative that we learn from our surgical colleagues who faced similar challenges at the advent of laparoscopic surgery. We need a shift in the paradigm from experience based learning to competency-based learning. In competency-based learning, there is a need for simulation training to attain skills for ultrasound-guided regional anesthesia prior to patient care. Deliberate practice on simulation models with feedback in a controlled environment may expedite training and improve skill proficiency. It is also important that a teaching curriculum is developed for ultrasound guided regional anesthesia, and the trainee be assessed for his competency in performing the blocks. In this review, we describe the theory behind surgical skill training and how it can be applied to ultrasound guided regional anesthesia training. Further study on evaluation tools, objective assessment, most suitable training model and the ease of transfer of the skills to the clinical settings is needed.