30/11/2019
Preoperative assessment • The pre operative management of sickle cell disease requires specialised knowledge and vigilance by the anaesthetists along with cooperation between many specialities. • Checking for signs of vaso-occlusion, fever, infection, dehydration and sequelae of the disease particularly pulmonary. • Intraoperatively anaesthesia may be achieved by either general or regional anaesthesia to avoid hypoxia, hypovolemia, hyper viscosity, acidosis and hypotension being the cornerstone of care. (Fanning et. al, 2006)
Preoperative assessment • Identify risks of peri-operative SCD complications and organ dysfunction with the intention of preventing or anticipating these problems.
• Identify patients risks (i.e.) type of surgery, disease activity, patient details and organ dysfunction following disease progression.
• Establish the most recent acute exacerbation of SCD (i.e.) last vaso- occlusive crisis, pain or any symptoms associated.
• Assess for the presence of silent/cryptic pulmonary, renal or neurologic vasculopathy that maybe unmasked in the surgical patient.
• Renal pathology is an important pre-operative objective, as SCD patients have significantly lower blood pressure than the general population. (Firth & Head, 2004)
25
26
Patient care
Pre-operative preparations
• Blood tests (FBC, U&E with CRP, LFTs), chest x-ray, pulmonary function tests, ABGs, ECHO and neurological imaging. • Prophylactic transfusion: X-match Rhesus antigen • Patient was kept NPO • IV fluids commenced as prescribed to maintain hydration in my patient during the period of fasting. • Consent for surgery by parents and patient
• General anaesthesia • Surgical and anaesthetic team briefing • Perioperative checklist is completed by the anaesthetic nurse • Weight, allergy status, past medical and surgical history, any reaction to the previous anaesthesia . • Current medication, any pain relief • Infection status, • Baseline vital signs
27
28
Intraoperative Nursing Care • Surgical safety pause observed • Patient in supine position on the table top with arms by the side pressure areas protected • Safe positioning aids used to appropriately secure the patient. • Maintain patient dignity • Diathermy pad applied • Aseptic solution used to cleanse the skin • Aseptic draping to provide good surgical site exposure • Video imaging equipment, and co2 dispenser, suction machine, diathermy machine.
Anaesthetic Nursing Care
• Time out :With the anaesthetic nurse, anaesthetist and patient confirming patients full name as known to the hospital, date of birth, MRN, allergy status and consent ensuring that patient had a good understanding of the surgery. • Sufficient pre-oxygenation • ET size 7 cuffed tube • Temperature probe inserted • Antibiotics: Augmentin and Flagyl as per surgeon’s recommendation. • Avoid the use of Nitrous oxide- risk of pulmonary complication
• Baseline temperature was 36.5⁰C. Temperature monitoring is very important for my patient as low core body temperature is a precipitant of SCD related pain (vaso- occlusive crisis). In addition the use of anaesthetic agents may further reduce his body temperature. Hence an external warming device was applied. In a recent audit on patient temperature in patients arriving to this department showed that patients drop their temperature rapidly at every stage from the holding bay till they arrive in the recovery room. (AAGBI, 2009)
29
30
5
Powered by FlippingBook