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.

Laser Surgery

Light Amplification by Stimulated Emission of Radiation

Light

  • Monochromatic (one wavelength)
  • Coherent (oscillates (repetitive variation) in the same phase)
  • Collimated (narrow, parallel beam)

This provides excellent precision and hemostasis with minimal post-op edema or pain

Side effects depend on the wavelength

  • CO2 laser: long wavelength laser (10,600 nm)
  • YAG laser: shorter wavelength laser (1064-1320 nm) YAG= yttrium-aluminum-garnet

A longer wavelength equals increased water absorption and decreased tissue penetration; thus, the CO2 laser is superficial and localized, while the YAG laser goes deeper.

Anesthetic considerations

Wear eye protection and tape the patient’s eyes.

Minimize risk of tracheal tube fire

  • Inspired O2 as low as possible
  • No N2O, but use air
  • The tracheal tube cuff can be filled with saline dyed with methylene blue to dissipate heat and signal cuff rupture
  • The cuff minimizes O2 concentration in the pharynx
  • Limit laser intensity and duration as much as possible
  • Saline-soaked pledgets in the airway
  • Have water immediately available

Airway-fire protocol

  • Stop ventilation and remove the tracheal tube
  • Turn off oxygen, disconnect the circuit
  • Submerge tube in water
  • Ventilate with FM and reintubate
  • Assess airway damage with a bronchoscope, obtain chest-x-ray, perform ABGs
  • Consider bronchial lavage and steroids (swelling)