Where The Fun Begins (Into the OR)

Upon completion of the preoperative interview, getting the consent signed, ensuring the surgeon has marked the right spot on the right patient, the operating nurse has seen the patient and the operating room is ready, the patient is transported to the operating room from the preoperative area. Patients are typically given an IV medication called midazolam, which helps minimize anxiety and also has retrograde amnesic effects. Patients often forget that they were transported to the OR despite still being awake during that period from the preoperative area to the OR.

Upon entering the OR, they are assisted from the gurney to the OR table. At this point, various devices are attached to the patient so that the nurse anesthetist can monitor the patient’s vital signs (e.g., heart rate, blood pressure, oxygen saturation, respiratory rate, and temperature) during surgery.

What happens next depends on the anesthetic plan that the anesthetist has chosen for the patient.

MONITORED ANESTHESIA CARE
Basically, a patient is connect to a propofol infusion at a weight specific dose. The goal is to get the patient asleep and non responsive to any type of stimuli, but still breathing. Generally, pain medication and anti nausea medication are given in certain intervals to help the patient remain comfortable, asleep, and nausea free. The infusion rate is often titrated to effect; the effect being to keep the patient asleep and lying still during surgery.

REGIONAL ANESTHESIA
Without getting too specific, this anesthetic involves numbing the area of the nerves where the surgery will be performed. For example, if a patient is undergoing knee surgery, the anesthetist can perform a certain nerve block just above the knee, targeting the nerves that innervate the knee. Using a special computer (i.e., ultrasound), the nerve bundle is identified and local anesthesia is injected with a needle. Of course, prior to insertion of the needle, numbing medication is administered along the surface of the skin. The patient will have received some midazolam (anti-anxiety) and fentanyl (pain medication) prior to receiving a nerve block. Once the block sets in, the patient can either be placed on IV sedation (monitored anesthesia care) with a propofol drip or they may undergo general anesthesia.

GENERAL ANESTHESIA

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