Lorna Calder (Nurse anaesthetist tutor)and Hyacinth Rankine (Nurse anaesthetist)
Calder and Rankine
Introduction
Safety is defined as freedom from danger or hazard, exemption from hurt, injury or loss (Oxford Dictionary).
Anaesthesia today is safer than it has ever been owing to advances in technology and pharmacology, as well as more stringent practice standards and educational requirements for anaesthesia providers.
Anaesthesia is now positioned as a speciality in medicine and is being practised by doctors and nurses who undergo intense specialised training in the art and science of anaesthesia.
Nurse anaesthetists are practitioners who safely administer thousands of anaesthetics each year, providing anaesthesia care for all types of surgeries and other procedures.
Nurse anaesthetists are hands-on caregivers who take pride in advocating for their patients. They stay with their patients throughout the surgery, diligently monitoring their vital signs and adjusting their anaesthetics as needed.
History
Before the introduction of anaesthesia with diethyl ether, many surgeons believed that pain was, and would always be, an inevitable consequence of surgery. In those days, patients approached surgery as though facing execution.
While awaiting the most minor procedure, patients often put their estate and personal affairs in order in the anticipation that their wealth would soon be passed on to the next of kin; many of these patients died.
Today, the anaesthesia machine has grown to become one of the most imposing objects in the operating room.
Physicians who practise anaesthesia with just a 'rag and bottle' would be amazed to observe modern techniques in which fresh gas flow are metered precisely; before a predetermined fraction is diverted through a calibrated vaporiser. Safer machines assured the clinician that an appropriate gas mixture is delivered to the patient.
Ventilators permit the mechanical control of respiration, while automated monitors continuously display numeric and oscilloscopic signals to reflect the well-being of the patient and the performance of the apparatus.
Services in main areas
The operating theatre and obstetric delivery suite remain the central interest of most members of the speciality.
Service in these areas brings anaesthetists into regular contact with new developments in pharmacology and bioengineering. After surgery, patients are transported to the post-anaesthesia care unit or recovery room, an area that is now considered the anaesthetists' hospital ward, where highly trained nurses ensure their safe recovery from anaesthesia. Fifty years ago, most patients returned immediately to their own bed post-operatively where they are sometimes cared for by very junior nurses who were not skilled or had the equipment to intervene when complications occurred.
Safe anaesthesia
Anaesthesia today is safer and more effective than ever before. Advancements in monitoring technology and anaesthetic drugs, extensive specialty education and training, and high professional standards have made the administration of anaesthesia one of the safest aspects of a surgical or obstetrical procedure.
Trained Nurse Anaesthetists
The caregiver must not only be trained initially, but must also continually upgrade their knowledge and be familiar with all the new equipment.
Practice Standards
The standards for nurse anaesthesia practice are intended to:
Assist the profession in evaluating the quality of care provided by its practitioners;
Provide a common base for practitioners to use in their development of a quality practice;
Assist the public in understanding what to expect from the practitionerl;
Support and preserve the basic rights of the patient.
Preparation for Anaesthesia and Surgery
When preparing for surgery, many people spend a great deal of time learning and thinking about the surgical procedure, but pay scant regard for the equally important aspect of their anaesthetic care. However, some persons are quite fearful about whether they will wake up from a general anaesthetic as in the early days anaesthesia was considered to be dangerous. In addition to their role in the procedure itself, nurse anaesthetists make many preparations for the patient's surgery.
The care of the patient begins with the pre-anaesthetic assessment. Before surgery, a pre-operative interview with the nurse anaesthetist provides valuable information that helps to determine care.
The nurse anaesthetist has an obligation to complete a thorough evaluation and to determine that relevant tests have been obtained and reviewed. Open communication and cooperation between the patient and the nurse anaesthetist is of major importance in preparing for a safe anaesthesia.
A careful history, including medical background, family history, previous anaesthetic, diet, drug and alcohol use, is helpful in planning the care for the patient. A possible reaction to an anaesthetic or an agent not being effective can be prevented using this information. Age and weight are important determinants in type of drug and dosages. History of diabetes, use of herbal medicines, and prescribed medications are essential information for the nurse anaesthetist to make right anaesthetic choices.
It is equally important to communicate with your anaesthesia provider after your surgery. The medications that you have been given can remain in your body for 24 hours or more after they have been administered, and you won't be back to your old self until the anaesthetic is completely eliminated from your body.
