A small compilation of nurse anesthesia care plans
These anesthesia care plans are meant to inspire nurse anesthesia residents when they are making their care plans. Always make sure you fully understand and "own" your care plan. Your plan must be specific for your patient and should always be with the most up-to-date information.
Anesthetic Gases
Halogenated anesthetics depress cardiac output, and most surgical procedures stimulate catecholamine-induced vasoconstriction. This decreases hepatic blood flow and oxygen delivery during general anesthesia and surgery.
Isoflurane
Preserves hepatic blood flow and oxygen delivery even during open laparoscopy
Produces highly reactive (trifluoroacetyl metabolites) intermediates that bind covalently to hepatic proteins - little risk of developing hepatitis due to small amount metabolized.
Only 0.2% taken up is metabolized in liver
Sevoflurane
4-6% metabolized in liver
Preserves blood flow and oxygen delivery to the liver
1-2 MAC decreases MAP but preserves hepatic blood flow
Desflurane
Only 0.02 to 0.2% is metabolized in liver
It also produces trifluoroacetyl metabolites – there is little risk of developing hepatitis due to the small amount of metabolism.
Desflurane at 1 MAC decreases hepatic blood flow by up to 30%, and oxygen delivery is more than either isoflurane or sevoflurane, so be aware of marginal hepatic oxygenation.
Nitrous Oxide
A mild increase in sympathetic nervous system tone may lead to mild vasoconstriction of the splanchnic vasculature, decreasing portal blood flow and causing mild vasoconstriction of the hepatic arterial system.
Inhibitor of enzyme methionine synthase, prolonged exposure leading to Vitamin B12 deficiency.