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.

Robot-Assisted Radical Prostatectomy (RARP)

Procedure Options

Simple Prostatectomy

Benign prostatic hypertrophy is too significant to be resected transurethrally

Radical Prostatectomy

The entire prostate, both seminal vesicles and pelvic nodes, are removed

Open as opposed to transurethral or endoscopic operations are common

Patients with significant cardiovascular/respiratory disease or glaucoma/central nervous system disease should be considered for an open procedure if needed due to the steep Trendelenburg position and CO2 insufflation

Da Vinci Robot:

  • Used for radical prostatectomy
  • Minimally invasive
  • The surgeon sits at a console away from the patient, with a three-dimensional view, 10x magnification, manipulating instruments
  • Improved precision due to the robot's ability to reduce any surgical hand tremor using size scaling (5 cm can be 1 cm)
  • Outcomes improve with surgical volume and surgeon experience
  • Advantages are improvement in continence (8-12 months) and erectile function (8-12 months), the latter dependent on nerve-sparing technique while dissecting the neurovascular bundle
  • Reduced blood loss, reduced analgesic requirements, reduced length of stay

Preoperative Considerations

Information

Swelling to face and eyes post-surgery

Foley Catheter in place

Usually stays overnight and goes home the next day

Surgery Time

2-4 hrs for surgery and time for set-up

Antibiotics

Cefazolin 1g

Pain Score

2-4

Anesthetic Considerations

Secure the ETT tube, possibly with Mastisol, due to increased oral salivation and steep Trendelenburg position

Eye Protection

  • Eye lube
  • Tegaderm
  • Eye-pad
    • A rigid shield is applied to both eye
  • Foam pad over face
    • Instruments on top of the face

2 BP cuffs

  • Difficult to access and troubleshoot a non-working BP cuff during the case

Pulse ox on finger

  • Note earlobe with increased venous pressure in steep Trendelenburg, which may cause inaccurate readings

Trendelenburg with Lithotomy position

  • Increased risk of nerve injuries
  • Peroneal nerve and ulnar nerve

Pneumoperitoneum in Trendelenburg position

Cardiac

Increased SVR, MAP, and myocardial oxygen consumption

Decreased renal, portal, and splanchnic flow

Respiratory

Decreased FRC, VC, and compliance

Increased peak airway pressure and ventilation

Perfusion mismatch

  • Shunt with under-ventilation compared to perfusion

Pulmonary congestion and edema

Risk of ETT displacement

Increased ETCO2, respiratory acidosis

CNS

Increased ICP, cerebral blood flow, and intra-ocular pressure

GI

Risk of aspiration, risk of regurgitation of acidic fluids onto facial skin

Other

Facial and airway edema due to steep Trendelenburg position

Venous air embolism

  • Entrainment of air when pressure within an open vein is subatmospheric/wound above the level of the heart
  • Symptoms: decrease in ETCO2

Limit fluids during the procedure, but catch up at the end when closing the skin

  • Otherwise, significant urinary leak into the surgical field, making it difficult for the surgeon to visualize