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.

Hypospadias Repair, Circumcision, Chordee Release

Circumcision

Excision of the preputial skin to expose the glans

It can be done for religious, ethical, social or medical reasons

Consider the use of a caudal or penile block for pain control

Preoperative Diagnosis

Phimosis - tight foreskin

Balanitis - inflammation of the glans penis

Family preference for circumcision

Preoperative Considerations

Position

Supine

Age

Neonate to children

Surgical Time

30 min

EBL

Minimal

Associated Conditions

Infection

Hypospadias

Abnormal opening for the urethral meatus resulting from incomplete development of the urethra

Defects can be anywhere from the tip of the glans to the perineum, and some surgeries may be staged with extensive reconstruction

Preoperative Diagnosis

Hypospadias +/- chordee (head of penis curves downward or upward - especially with erections); fistula repair, epispadias repair (opening on the upper side of penis), penile torsion, concealed penis

Avoid postop urethral instrumentation as this can disrupt repair

An artificial erection is obtained by infusion of normal saline to evaluate the repair

  • Risk of fluid absorption in the small child

If a catheter is in place, then usually stitched to the glans penis

If there is no use of a urethral catheter for distal and/or midshaft repairs,

  • Avoid the use of a caudal block to limit the risk of surgical complications due to urine retention postop

Consider the use of penile nerve block

Note – the surgeon may need an additional 3-5 min for dressing applications to protect the Hypospadias repair.

In repeat cases for repair of the urethra

  • Bladder or buccal mucosa may be needed to create a new urethra

Preoperative Considerations

Position

Supine

Age

> 4 months

Surgical Time

1.5-4 hrs

EBL

<50 mL

Associated Conditions

Cryptorchidism, inguinal hernia, bifid scrotum

Anesthetic considerations

Renal abnormalities may be present as part of a congenital malformation complex

Patients < 5-10 yrs old: sevoflurane, N2O, O2

Older patients may agree to IV induction

Monitor closely for adequate ventilation during the procedure and before extubation

Pain mgt: acetaminophen, epidural or PCA

Ketorolac will decrease bladder spasms but causes renal insufficiency, so monitor renal function

Caudal: Age <2 yrs, not walking, Snodgrass procedure, chordee release