We’re continuing our five part series with certified nurse anesthetist Kimberly Zweygardt.
Welcome back, Kim.
Last post we discussed who is in the OR. Today let’s talk about the OR setting then discuss the anesthetic.
The OR is a cold, sterile, hard surface, brightly lit environment that is all about the task instead of comfort. Cabinets hold supplies, the operating room bed is called a table, Mayo stands hold instruments for immediate use during the operation and stainless steel wheeled tables hold extra instruments and supplies. IV poles, wheeled chairs/stools and the anesthesia machine and anesthesia cart complete the setting.
When a patient comes in, the staff does a “time out.” The circulating nurse, the surgeon and anesthetist all say aloud that it is the correct patient and procedure. It sounds like this, “This is Mrs. Harriet Smith and she’s having cataract surgery on her left eye.” Once done, the staff swings into action, the circulator “prepping” the surgical site (washing it off with a solution to kill the germs) while the scrub nurse prepares the instruments after “gowning and gloving” (putting on sterile gown and gloves). Meanwhile, the surgeon “scrubs” meaning washing his hands at the sink outside the room. When he is done, he’ll enter the room to get gowned and gloved. Before all this is happens, I’ve started my care of the patient.
I meet the patient before this to fill out a health history specific to anesthesia. Are they NPO (Have they had anything to eat or drink after midnight)? Do they have allergies? Have they ever had an anesthetic and if so, any complications? Has anyone in their family ever had complications with anesthesia? Then I ask about medications and other health problems so I can choose the best anesthetic. But an even bigger job is reassuring them that I am there to take care of them.
When they come to the OR, I attach monitors—EKG heart monitor, blood pressure cuff, and pulse oximetry (a small monitor that fits on the finger to measure the oxygen levels in the blood). Once the monitors are on, I give medicines for the “induction” of anesthesia. As the patient goes to sleep, they are breathing oxygen through a face mask. Drugs include the induction agent (most likely Propofol), narcotics (Fentanyl most common), an amnestic (Versed which provides amnesia), plus a muscle relaxant (Anectine)that paralyzes the muscles. When asleep, the breathing tube is placed using a laryngoscope that allows me to visualize the vocal chords. Then the anesthetic gas is turned on.
I am with the patient through the whole operation, watching monitors, giving medications and making adjustments. At the end, I reverse the muscle relaxants, turn off the anesthetic gas, and begin the “emergence” process waking the patient up.
Now, that’s the norm but we’re writers where normal is boring! Next post I’ll let you in on all the things that can go wrong!
***Content originally posted January 21, 2011.***
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Kimberly Zweygardt is a Christ follower, wife, mother, writer, blogger, dramatist, worship leader, Certified Registered Nurse Anesthetist, a fused glass artist and a taker of naps. Her writings have been featured in Rural Roads Magazine, The Rocking Chair Reader, and Chicken Soup for the Soul Healthy Living Series on Heart Disease. She is the author of Stories From the Well and Ashes to Beauty, The Real Cinderella Story and was featured in Stories of Remarkable Women of Faith. She lives in Northwest Kansas with her husband where their nest is empty but their lives are full. For more information: www.kimzweygardt.com
Redwood's Medical Edge 
I have a question. I have had several surgeries, including foot surgery where a block was used. The list of meds on my bill was astounding! I understand the induction agent, narcotics and versed, but what is the anesthesia gas for? Just to keep the patient asleep? I love these posts! Susan Snodgrass
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Hi, Susan! Thanks for your question. One of the fascinating things about anesthesia is that there are as many different ways to give an anesthetic as there are different types of patients! Anesthesia is based on the type of surgery you are having, your own health/anesthetic surgery, preferences of the surgeon as well as the experience and preference of your anesthetist!
In the old days, you breathed an anesthetic gas until you were asleep. If you ever had anesthesia with ether, you’d understand why we’ve continually looked for better ways to render patients insensible to pain! Another way was to “block” the pain impulses by the use of local anesthesia either as a “field block” (blocking the area similar to what a dentist does), or as a spinal or epidural or a block of an extremity. One thing we’ve learned through the study of pain is that blocking the area with a local anesthetic decreases the over all amount of pain a person has post op! Because the nerve impulses to the brain are blocked, the brain doesn’t respond by releasing stress chemicals that cause inflammation until after the local wears off which means that less pain and inflammation happens over all.
So the “modern” way of doing an anesthetic has changed to what we call a multi-modal approach. 1) The block was to prevent pain and to keep you comfortable for a time after surgery. 2) The induction agent (versus breathing enough gas to go to sleep which isn’t especially pleasant in an adult) puts you to sleep initially, while the Versed (amnestic) and narcotic (pain relief) provide other pieces of the anesthetic puzzle. 3) The anesthetic gas is added after you are asleep from the induction agent and also provides amnesia and pain relief. It also helps to control blood pressure changes from surgical stimulation or the use of a tourniquet in extremity surgery (used to keep the sterile field “bloodless” and expedite the surgery).
With the advent of out patient surgery, patients no longer snooze the day away waking up from their anesthetic. They need to be deeply asleep and then awake enough to go home in a matter of hours. Using a multi-modal approach (using a combination of drugs for different reasons) is much more effective than each of those drugs by themselves. For example, without the use of the anesthetic gas, much more narcotic is required. Without the narcotic, much more gas is required to do the same job. Every drug has side effects which increase with dosage and in the case of anesthetic gasses, time. Using a combination of drugs allows us to keep the side effects to a minimum. It is a common misconception that we give a patient an anesthetic drug and then coast through the surgery! And like magic they wake up when it is over! Even surgeons think so! In reality, though it seems like a large number of medicines, each one has a specific purpose. And one of the reasons anesthesia is safer and more pleasant than the old days! Probably more info than you wanted, but I enjoy when people are interested in what I do. I’ve been a CRNA for 34 years and I still find it absolutely fascinating!
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