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.
Maxillofacial Reconstruction and Orthognathic Surgery
Maxillofacial: Trauma, developmental malformations, radical cancer surgery, or obstructive sleep apnea
Orthognathic: LeFort osteotomies, mandibular osteotomies for skeletal malocclusions
Anesthetic considerations
- Thorough airway evaluation (jaw opening, mask fit, neck mobility, micrognathia (small lower jaw), retrognathia (small or recessed jaw (either the upper jaw - maxilla or the lower jaw -mandible) that may predispose to obstruction of the airway and sleep apnea), maxillary protrusion (overbite), macroglossia, dental pathology, nasal patency, any intraoral lesions or debris
- RAE tube - secure well, as the operating table may turn
- LeFort fractures
- Nasal intubation is contraindicated due to the risk of coexisting basilar skull fracture and cerebrospinal fluid rhinorrhea
- Limit blood loss: slight head up, controlled hypotension, local infiltration with epinephrine
- Epi 5 mcg/kg with sevoflurane or isoflurane 1-1.5 MAC
- Epi 7 mcg/kg with desflurane 1-1.5 MAC
- Sensitization (increases excitability of receptors to stimuli) of the heart to arrhythmogenic effects of epinephrine
- Oropharyngeal pack
- If intermaxillary wiring - have a wire cutter at the bedside
- Evaluate for edema; may need to leave intubated