Anesthesia Care Plan

  • Surgical Considerations

Anticipated Procedure:

Surgery Requirements: (positioning, surgeon requests, muscle relaxants, block placement, etc)

Position:

Anticipated Surgical Time:

Estimated Blood Loss (EBL):

Anesthesia Concerns:

  • Preoperative Considerations

Patient Data:Lab Values:

Weight (kg):

NPO Status:

Allergies:

Medical History:

Anesthesia Concerns/Impact on plan:

Ways to Maximize Patient Preoperatively:

(Correcting electrolyte/glucose imbalances, nausea prophylaxis, albuterol, infuse blood/platelets, medical consultation, Chest x-ray, reschedule, etc)

  • Anesthetic Technique

General General/IV sedationMACRegional PNB

-Intravenous-spinal-type:

-Inhalational-epidural-Bier Block

-Rapid Sequence-caudal

(RSI)Local used:

Comments/Reasoning:

  • Airway Management

Equipment:

Nasal CannulaMaskLMAETTSurgical Airway

Size:Size:Size:-tracheostomy

-oral/nasal-cricothyrotomy

-cuffed/uncuffed

-RAE, laser

-double lumen, uninvent

Intubation MethodBladesVentilation

Direct LaryngoscopyMacintoshHand Ventilate

RSI/Modified RSIMillerSpontaneous/Assisted

Awake/Asleep FiberopticSize:Machine: VCV or PCV

Flexible/Rigid Bronchoscope-Tidal Volume: RR: PIP: PEEP:

Blind IntubationJet Ventilation

C-spine tractionApneic oxygenation

Comments:

  • Fluid Considerations

Intravenous Line(s):IV Line Details: Fluid Options:

-place IV/no IV-10 or 60 drops/min-LR/NS

-place IV: pre-op/intra-op-Buretrol-Hespan

-Location:-Extension tubing-Albumin

-size:-T-connectors-PRBC (donor/autologous)

-number of IVs: -extra stopcocks-platelets

-FFP

-other:

Administration: (standard, pressure bag, rapid transfuser, etc)

Comments:

Calculating Fluid Requirements:

Hourly Fluid Requirements:

(4-2-1 rule: 4ml/kg for first 10 kg, 2ml/kg for next 10kg, and 1 ml/kg for remainder)

Fluid Deficit: (NPO hours x hourly requirement):

(Replace half of deficit in first hour, divide rest into second and third hour)

Third Spacing:

-minimal surgery 3-4 ml/kg/hr

-moderate tissue trauma5-6 ml/kg/hr

-extreme tissue trauma7-8 ml/kg/hr

Insensible Loss:

(generally 2ml/kg/hr, add for urine excretion and bowel prep)

Replacement of Blood Loss:

(replace with crystalloid 3:1, or 1:1 for blood or colloids)

Fluid Replacement Schedule:

1st hour / 2nd hour / 3rd hour / 4th hour
Deficit
Maintenance
3rd Space
Insensible
Blood Loss Replacement
TOTAL
  • Blood Loss Concerns

Calculate Estimated Blood Volume (EBV):

Neonate (1-30 days old) 90 ml/kg

Infant (1 month to 1 year)85 ml/kg

Child (1 year to puberty)80 ml/kg

Male Adult70-75 ml/kg

Female Adult60-65 ml/kg

Calculate Maximum Allowable Blood Loss (ABL):

Max ABL=EBV x (Hcti -Hctl)/Hcta

Hcti=starting Hematocrit

Hctl=lowest allowable Hematocrit

Hcta=average hematocrit (Hcti + Hctl)/2

  • Monitors and Equipment

Standard Monitors:

Pulse oximeter, NIBP, Capnograph, EKG, (3 or 5 lead), FIO2 monitor, nerve stimulator, precordial/esophageal stethoscope

Additional Monitors:

Arterial Line, central line, pulmonary artery line, foley, BIS monitor, ICP monitor, Doppler, EEG, evoked potentials

Additional Equipment:

Bair Hugger (upper, lower, full body), fluid warmer, infusion pump, oral/nasal gastric tube, axillary rolls, cushioning, padding, tourniquet

Comments:

  • Possible Pharmacological Intervention

(Nitroglycerin, beta-blocker, insulin, albuterol)

  • Anesthetic Agents

Premedication:

Agent:Dose Range:

Versed (IV, oral, nasal)

Glycopyrrolate

Fentanyl

Zantac/Reglan

Albuterol

Other (ABx):

Explain technique/reasoning:

Spinal/Epidural/Caudal/Peripheral Nerve Block/Bier Block

Drugs:

Techniques:

Dosing Strategy:

Comments:

Induction:

Pre-oxygenation Technique:

Airway Management Strategy:

Drugs with doses:

Maintenance:

Gases:

Drugs:

Emergence:

Emergence/Extubation Technique:

Drugs with doses: (reversal)

Post-operative Transport/Care:

PACU vs ICU, oxygen, drugs (If transporting to ICU, what will you need for the transport?)

Comments: