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.

Ear Surgery

Three bones of the inner ear

  • The stapes, the incus, and the malleus

Eustachian tube

  • Runs from the middle ear to the oral cavity and equalizes pressures in the middle ear
  • If it is damaged, pressure will rise in the middle ear

Types

Stapedectomy

Stapes is removed and replaced with a small plastic tube of stainless-steel wire (a prosthesis) to improve the movement of sound to the inner ear

Tympanoplasty

Reconstruct a perforated tympanic membrane (eardrum) or the small bones of the middle ear

Mastoidectomy

Surgical procedure to remove an infected portion of the bone behind the ear when medical treatment is not effective

Myringotomy and insertion of tympanostomy tubes (M&T)

History of upper respiratory infections, episodes of otitis media

Release of accumulated fluid in the middle ear

Tubes provide long-term ventilation and drainage

Anesthetic considerations

Short procedure (M&T)

Inhalational anesthesia - sevo

FM or LMA

RAE for better access for the surgeon

Ask about NMBD - sometimes not indicated

  • Note N2O
  • 34 times more diffusible than nitrogen, will move into closed cavities (middle ear). If in use, turn off 30 min before graft placement - it is better to avoid completely
  • If the middle ear is open, no pressure build-up, but once the graft has been placed, the middle ear is a closed space, resulting in rising pressures and graft dislodgement
  • If N2O is discontinued after graft placement, negative pressure develops, resulting in graft dislodgement

Minimize bleeding and blood loss

  • Elevate head slightly, LA with epinephrine, controlled hypotension (MAP 60-70 mmHg)

Minimize cough and straining on extubation while trying to prevent aspiration at the same time

Expect nausea/vomiting

  • Zofran (0.1 mg/kg)
  • Dexamethasone
  • Reglan (0.15 mg/kg)