Last Words before Induction.......

TracyB,RN, RN · Apr 9, 2005

Our CRNA's & anesthesiologists usually say "we will take good care of you" in a very soft voice, while one of us circulators holds a hand & smiles as the pt goes off to sleep. Even with the mask on, you can still tell when someone is smiling.

gaspassah · Apr 9, 2005

i usually tell the patient what will happen while we travel to the room, ie monitors, etc. i dont tell them when they are going to sleep, i tell them to start thinking of their favorite activity or "happy place". now the attendings tend to tell them "your going to sleep now", and i can tell a difference, hr and if you have an art line you can watch the bp rise, almost every time.

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Laughing Gas · Apr 9, 2005

i usually tell the patient what will happen while we travel to the room, ie monitors, etc. i dont tell them when they are going to sleep, i tell them to start thinking of their favorite activity or "happy place". now the attendings tend to tell them "your going to sleep now", and i can tell a difference, hr and if you have an art line you can watch the bp rise, almost every time.
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One of my attendings always says " You are going to wake up hungry and thirsty."

I don't say anything at the moment of actual induction. You can usually gauge how much to talk to a patient by the way they handle themselves. Some are laughing and joking. Others are consumed in terror. You handle each situation differently.

rn29306 · Apr 9, 2005

Had one ADD MDA who I don't think took his medicine that am tell a patient to "take one LAST deep breath". i understand his meaning as take a last one before the induction agent hit, but you should have seen the surgeon's response........

looked like a "priceless" commercial to TV as no one liked this guy anyway..

loisane · Apr 9, 2005

now the attendings tend to tell them "your going to sleep now", and i can tell a difference, hr and if you have an art line you can watch the bp rise, almost every time.
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I must be completely out of the loop on this. I have never heard or noticed this phenomena!

Has anyone seen this documented in the literature? If so, I have missed it and would be interested in a reference. If not, this sounds like a great research project. Probably would take a pretty large sample, but it fits so well into NURSE anesthesia. It is not the technical, exciting kind of thing that usually attracts research attention. But I think the results would be fascinating, and very important.

loisane crna

jewelcutt · Apr 9, 2005

I always try to get my patients to laughor smile or tell them something funny but don't let them know they're going to sleep. It helps to relieve stress and keeps their mind off of "going to sleep"

NCgirl · Apr 9, 2005

I always try to get my patients to laughor smile or tell them something funny but don't let them know they're going to sleep. It helps to relieve stress and keeps their mind off of "going to sleep"

a helpful thing someone told me....don't say "we'll see you in recovery". Some pt's may think it means your'e gonna put them to sleep, then leave them. I usually say that "You're going to start feeling alot more sleepy--I'll be right here with you the whole time, keeping you asleep, comfortable, and safe." It's what i'd want to here if i was the pt.

prmenrs, RN · Apr 9, 2005

I realize I have no expertize in this area, but if I were the patient, I would prefer the "We're going to take good care of you" approach.

I've had 2 surgeries under epidural, no problems; I've had 3 prior under general, no problems til the last, they didn't say anything, just did it, like a coup de grace. I had a LOT of problems w/that one, including laryngospasm. I'd rather be told I'm going to sleep, calmly.

JMHO

JasmineTea · Apr 9, 2005

ok,what and why, if at all, do you say to your patients right before you push the propofol (or your drug of choice). some say don't say a thing!!!!--it stimulates the sympathetic response if you tell them they are about to go to sleep, some say gentle hypnosis, some say "describe to them how they will wake up". what are your famous "last words"????

not a crna yet, but as a patient, i liked that the 2 times i was put under, the crnas gently distracted me. i don't remember exactly what the first one said, but the second one asked me to look at the clock and see if i would remember what time it was when i woke up. i remember just having time to think, "i will remember the time..." and then that's it.

here's a question for you all, slightly off topic. are crnas *trained* to be so gentle and attentive to the patient (as a terrified human being, not just a "case"), or did i just get lucky the 2 times i was cared for by crnas?

rn29306 · Apr 9, 2005

Not a CRNA yet, but as a patient, I liked that the 2 times I was put under, the CRNAs gently distracted me. I don't remember exactly what the first one said, but the second one asked me to look at the clock and see if I would remember what time it was when I woke up. I remember just having time to think, "I WILL remember the time..." and then that's it.
Here's a question for you all, slightly off topic. Are CRNAs *trained* to be so gentle and attentive to the patient (as a terrified human being, not just a "case"), or did I just get lucky the 2 times I was cared for by CRNAs?

While there are certainly differences among CRNAs, I think you will see that this is a global thing, a part of us that was and still is - being a nurse first.

Laughing Gas · Apr 9, 2005

Here's a question for you all, slightly off topic. Are CRNAs *trained* to be so gentle and attentive to the patient (as a terrified human being, not just a "case"), or did I just get lucky the 2 times I was cared for by CRNAs?

Yes. It is beaten into you to be gentle :) I am 5'10 230 pounds and only alittle fat. All of my preceptors told me, "You're a big guy, you need to be extra gentle." I think they thought I was gonna accidentally rip someone's head off while performing laryngoscopy.

I forgot something I do say to patients right before induction. I usually tell them very calmly that the meds we are giving them may make their vision and hearing funny. Also warn that the amidate or propofol may feel warm in their IV, and it's all normal. Especially warn about the vision if the MD gave a priming dose of NDMR.