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.
Head and Neck Cancer Surgery
Laryngectomy, glossectomy, pharyngectomy, parotidectomy, hemimandibulectomy, and radical neck dissection.
Tracheostomy depends on the patient's status
Possible reconstruction surgery with muscle flap
Anesthetic considerations
Elderly, history of smoking/alcohol/COPD, CAD.
Secure airway after thorough evaluation (iv-induction-fiberoptic laryngoscopy-inhalational induction-tracheostomy).
The tracheostomy may be placed after induction and intubation
- Dissection down to the trachea, deflate the cuff, pull ETT tube cephalad to the incision, place the tracheal tube in the trachea, confirm the position, remove ETT
Two large bore IVs
Foley catheter with temperature monitoring
Maintain normal temp
- Hypothermia causes vasoconstriction and subsequent less perfusion of a microvascular free flap
The surgeon may request no NMBD to identify nerves and preserve them
- Facial nerves, spinal accessory CN XI
- Provides motor innervation from the central nervous system to two neck muscles: the sternocleidomastoid muscle and the trapezius muscle
Compromised cerebral perfusion pressure (CCP = MAP-ICP or CVP, whichever is higher)
- Should be >60 mmHg
Note: vasoconstrictors will decrease flap perfusion/vasodilators will decrease perfusion pressures
Monitor for blood loss
Avoid diuresis to allow adequate graft perfusion postop
Manipulation of the carotid sinus and stellate ganglion can cause labile BP, bradycardia, arrhythmias, sinus arrest, and prolonged QT
- Sympathetic ganglion formed by the fusion of the inferior cervical ganglion and the first thoracic ganglion
- The stellate ganglion is located at the level of C7, just below the subclavian artery