What do you do during to operation?

Specialties CRNA

Published

So I posted this on a different message board got more snide, condescending, unhelpful comments (that were making fun of me for asking) then helpful ones, I am hoping to find this info out here.

What do you do once the patient is asleep?

I know the basics:

monitor the VS and other monitors that were applied to the patient and make sure they stay asleep. But is there anything else you do?

Specializes in CRNA.

I also watch the surgery and how it is progressing. We try to anticipate changes in the level of surgical stimulation, and monitor the amount of bleeding. It's also helpful to gauge how much longer the surgeon will take to complete the procedure. We make subtle changes in the anesthetic throughout the surgery in order to have a quick, smooth, comfortable wakeup. A lot of times it looks like we aren't doing much actually, because most of it is going on in our head.

Thank you. That is the type of thing I was looking for. As alot of people on here are aware (and are made so if not by my name) I am a patient. I have had 12 surgeries, and I was just wondering what you guys did for me. I KNEW you were an important member of my team, I just did not know what exactly you did.

Specializes in surgical/trauma.

We also anticipate postop needs such as nausea/vomiting prophylaxis and pain management; monitor urinary output; ensure safe patient positioning is maintained; manage the vent ensuring the patient receives adequate tidal volume and peak pressures in conjunction with end tidal CO2 values...however if it is a MAC case where the pt is breathing spontaneously (no vent) then we may end up putting in an oral airway or do some head manipulation to ensure the pt isn't obstructing their airway, or if it's a general case where the pt has an LMA as opposed to an ETT then we bag the pt until they starting spontaneously breathing, or for peds if it's a quick, short case we will mask the pt thru the case; respond to VS changes which could trigger us to do a number of things such as increase/decrease iv fluids; give more narcs (or not);administer vasopressors/vasodilators in response to extreme BP changes; administer beta-blockers to address BP and HR.....(this could go on and on so I'm stopping here :0)~. We monitor the TOF (train of four) to determine receptor blockade of NMBAs (neuromuscular blocking agents) if used....this also tells us if we need to admin more during a surgery if necessary; listen to heart and lung sounds through a fantastic device called a precordial stethoscope....many times, if something is going to go wrong we can here it here long before it can show on the monitor; monitor temperature; if it's a surgery that involves invasive monitors (i.e. arterial line, central venous line, PCWP....these allow for more precise measurements of BP, preload, afterload, and filling pressures; pulmonary artery pressure, etc...). Planning for the extubation is super important.....you have to think, OK, so if the patient doesn't wake up the way I want them to then what will I do???? So as someone already mentioned most of what we do is in our head...planning for things that won't happen or being ready if they do.....being vigilant. Oh yea, the charting, I forgot to mention the charting....if you're in a facility where you have to do manual charting we do a lot of this :yawn: Hope this helps...

Specializes in ICU.

check out this link. i hope it helps

good luck

http://youtube.com/watch?v=xuzl9trqjoq

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