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.

Pneumoperitoneum

Pneumoperitoneum, CO2 insufflation, provides a view of the surgical area, room for instruments to move

There is a high risk for complications as the inferior vena cava, aorta, iliac arteries, and veins, as well as bladder, bowel, and uterus are close to the infraumbilical site

Gas embolism symptoms

Hypotension, dysrhythmias, cyanosis, pulmonary edema, Millwheel murmur

  • Release Pneumoperitoneum, place on the left side, aspirate air if possible

Risk of pneumothorax due to barotrauma (increased PIP due to decreased pulmonary compliance)

Left shoulder pain (CO2) - alleviate with three big breaths after CO2 is released before the closure of the abdominal wall

Advantages

Decreased post-op pain, less post-op pulmonary impairment, reduction in post-op ileus, shorter hospital stays, earlier ambulation, a smaller incision

Anesthetic considerations

Increased intraabdominal pressure, which predisposes to passive gastric regurgitation, possible NG to decompress and minimize the risk of aspiration

Increased intraabdominal pressure also appears to decrease splanchnic perfusion and hepatic blood flow significantly

High risk of PONV

  • Zantac-Reglan-Alka-Zeltzer Gold (ZRA) PO and Decadron IV

Try to keep intra-abdominal pressure <15mmHg

Increased risk of atelectasis, decreased FRC, increased PIP

Risk of hypercarbia from absorbed CO2, monitor ETCO2 and decreased PaO2

Avoid Nitrous oxide as it can diffuse into CO2-containing intraabdominal space and increase distention

Decreased venous return, decreased CO, and increased SVR

Increased MAP, increased HR

Bradycardia due to the distension of the Vagus nerve

Trendelenburg’s position increases intrathoracic pressures (cephalad displacement of abdominal contents), which activates baroreceptor reflex through CN IX in the carotid and CN X in the aortic arch, leading to increased PNS and decreased SNS activity

Trendelenburg with increased risk of right main stem intubation

Reverse Trendelenburg with increased FRC and decreased work of breathing

Neuromuscular blockade facilitates lower insufflation pressures, better visualization, prevents movement

Celiac reflex can be initiated indirectly because of pneumoperitoneum; the symptoms are bradycardia, apnea, and hypotension