Introduction

The field of anaesthetics is vast and complex. This chapter can only aim to give a brief insight into this complex area of service provision. There are many good texts that you can use to gain more in-depth knowledge on particular aspects which we only touch on. Equally, the experience and expertise of the anaesthetic team are a good source for you to gain further knowledge about caring for the patient who is about to undergo surgery.

At the end of Chapter 6, a patient was transferred to the operating theatre from the ward accompanied by a nurse. The patient is then taken into the anaesthetic room and handed over from the ward nurse to either the anaesthetic nurse or operating department practitioner (ODP). This is a very vulnerable time for patients and, especially if they have never experienced an anaesthetic before, they will rely very much on the security of the familiar nurse from the ward. This may well be you.

Transfer of the patient to the anaesthetic room

If the patient is to undergo major surgery, they will be taken to the anaesthetic room either on their bed, a theatre trolley or, if day surgery, a wheelchair or on foot (Gilmour 2010). Here they will meet new staff, in particular the anaesthetist, the anaesthetic nurse or operating department practitioner. They all have roles to play in caring for the patient and ensuring safe practice in the anaesthetic room (see Box 7.1 for the main functions of staff providing anaesthetic assistance).

Box 7.1 Main functions of staff providing anaesthetic assistance

Provision of a safe environment

Preparing equipment, medicines and fluids.

Checking monitors and apparatus.

Ensuring adequate stock.

Ensuring a clean environment and equipment.

Administrative functions

Arranging to send for the patient from the ward/clinic.

Ensuring correct patient for correct procedure.

Recording patient details in departmental records/database.

Ensuring appropriate information accompanies the patient (case notes, results, forms, etc.).

Communication

Providing the patient with an explanation and reassurance.

Relaying information from the patient to the surgeon or anaesthetist.

Providing a link to ensure colleagues are appropriately informed (ward, scrub team, recovery).

Practical functions

Assisting with induction of anaesthesia and airway management.

Assisting with local anaesthetic blocks.

Assisting with the positioning of the patient.

Expertise

Observing the patient’s condition.

Monitoring for any adverse effects of the anaesthesia.

Monitoring for the maintenance of fluids and medications.

Ensuring that safe systems of work are being employed at all times.

Adapted from National Occupational Standards for Operating Department Practice (Scottish Government 2003)

In the handover period between ward staff and anaesthetic room staff, it is important that all details about the patient, their surgery and consent form have been checked – this may take place outside the immediate anaesthetic room, in the ‘clean area’ beyond the doors to the main operating theatre suite.

The patient must be treated with respect and dignity at all times. Any cultural or religious needs must be taken into account during this time and reassurance given about such issues as modesty, body fluids and skin

Activity

If the operating theatre is your main placement (hub), it is important that you consider what you need to learn in relation to caring for patients during the handover period and also what is going to happen to the patient when they receive anaesthesia and their subsequent management.

Your mentor may already have planned an experience for you during your placement which may include more than a day in this area, working alongside the anaesthetist and others (see Appendix 1 at the end of this chapter for specific learning outcomes that can be achieved).

Appendix 1

Specific learning experiences in anaesthetics: a checklist of learning outcomes

Understand importance of communication in relieving patients’ anxiety.

Experience of managing the patient handover from ward nurse to anaesthetic practitioner.

Ability to identify different methods of anaesthesia and the effects on patients.

Experience management of patients’ airways underpinned by principles of care and knowledge of physiology of airway management.

Understand basic principles underpinning monitoring of patients’ cardiac, respiratory and temperature control during anaesthesia.

Ability to recognise the role of members of the multidisciplinary team and demonstrate ability to work within a team.

care as necessary (see Association for Perioperative Practice (2007) for information on respecting cultural diversity in the perioperative setting).

See Box 7.2 for a description of what the anaesthetic nurse has to manage, and identify the areas you need to learn more about. Some of the activities are identified in this chapter as well as resources you can access to learn more.

Box 7.2 The role of the anaesthetic nurse

The anaesthetic nurse will, based on the information known, or relayed by the anaesthetist, prepare the anaesthetic room, anaesthetic machines and all other equipment to ensure the maintenance of a safe environment for the delivery of care during anaesthesia. This will include not only preparing the anaesthetic equipment but also applying knowledge and skills of anaesthesia related to age, medical history and surgical procedure to ensure that the patient’s individual needs are being met, e.g. if the patient is elderly, additional precautions are needed when caring for their skin; if the patient has language difficulties, an interpreter may be required.

(From Gilmour 2010:19)

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