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.

Hypotensive Technique

The purpose of deliberate hypotension is often to decrease blood flow to limit blood loss, to improve visual in the surgical field, and to minimize the need for blood transfusions

  • Need A-line to monitor closely

Techniques

Several options to lower the BP are available for the anesthetist

  • Hypovolemia
  • Volatile agents (decreased SVR/BP)
  • Vasodilators (NGT/Nipride)
  • Calcium channel blockers - Cardene 5 mcg/kg/min / Cleviprex 1-2 mg/hr - NOTE:  looks like propofol

Use volatile agents, eg, isoflurane

  • Minimal effect on CO, decreases SVR, cerebral protection at low levels

Maintain MAP within 20-30% of preop

  • Considering medical history
  • The brain needs MAP > 50, GFR maintained with MAP >75 mmHg, but renal parenchyma perfused at MAP in the 60s

May inhibit Hypoxic Pulmonary Vasoconstriction

  • Internal protection in hypoxia, where the lungs redirect blood flow to well-oxygenated areas, leads to increased dead space, intrapulmonary shunt, and PaCO2.
  • Anesthesia >1 MAC and vasodilators inhibit HPV (Cardene has the least effect on HPV)

Risk of necrotic bowel with hypotension and hemodilution

Risk of post-op vision loss

  • Visual deficits, rarely blindness

The patient’s medical history dictates how much hypotension they can tolerate

Once bony dissection is complete, there is less advantage to the hypotensive technique