Ever wonder what goes on behind the operating room doors? In this episode, we pull back the curtain on the fascinating world of anesthesia and surgery. Certified Registered Nurse Anesthetists Tanner and Cole from the Core Anesthesia podcast provide an insider’s look at the perioperative process, from pre-op preparation to the orchestrated induction of anesthesia to navigating complications post-op. With vivid detail and expert insights, they break down the physiology behind general anesthesia, reveal secrets of the OR, and equip nurses with knowledge to better support surgical patients. Whether you’re an ICU, ER, or floor nurse, you’ll gain invaluable perspective on the surgical experience.
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Preoperative Process
Pre-Op, days before
- Assesses patient history, medications, and labs 1-2 weeks before surgery
- Some meds stopped before surgery. The meds and stopping time depends greatly from procedure to procudure (blood thinners, cardiac meds, glucose meds)
Pre-op, day of surgery
- Confirm labs, meds, medical history
- Delays/cancellations if unstable vitals, abnormal labs, infections, not NPO
Surgery
Surgical Prep/Induction
- Pre-oxygenation
- Sedative (often Versed, Fentanyl)
- Induction agent (often Propofol)
- Paralytic agents for intubation
Induction of anesthesia poses a high risk of hypotension, as sedating medications like propofol and fentanyl can substantially lower blood pressure before any surgical stimulation occurs to counteract their effects.
Maintenance of Anesthesia
Anesthetic gases (sevoflurane, desflurane, nitrous oxide) allow for tighter anesthetic control, however carry a higher risk for post-op nausea and vomiting (PONV) and malignant hyperthermia (MH).
Total intravenous anesthesia (TIVA) cases use a combination of agents given by the intravenous route without the use of inhalation agents. This is comparitavely more expensive, but reduces the risk of PONV and MH.
Postoperative Period
Postoperative nausea and vomiting (PONV)
- Risk factors include age, sex, motion sickness, smoking status, postoperative opioid use, and duration and type of surgery
- Controlled by antiemetics (Zofran, Decadron, Emend, Reglan)
Postoperative Urinary Retention (PO-UR)
- General anesthesia relaxes bladder smooth muscle, impairing bladder contraction
- Regional anesthesia blocks sacral nerve signals to the bladder
- Opioid analgesics inhibit bladder sensation and voiding signals