4 2 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 7
• Bookending propofol. My
"bookending" technique
(osmag.net/WS3Yuy) uses
propofol for induction and again
at the end of cases when the gen-
eral anesthetic is discontinued.
• Hydration. A well-hydrated
patient is less likely to be nau-
seous. I'm pretty aggressive with
IV fluids and won't hesitate to give up to a liter of fluid over an hour to a healthy
adult patient.
• Regional blocks. Your anesthetist should be willing and able to provide region-
al nerve blocks. I wouldn't be serving my patient well if I didn't offer a regional
block that can significantly relieve post-op pain. To optimize patient satisfaction,
you should be able to place blocks, including an interscalene or femoral block, as
part of an anesthetic.
• Prophylaxis. I proactively treat nausea by adding 8 mg of low-cost
Decadron in the IV bag. It's fairly benign and effective. I save Zofran for when I
need it post-operatively, unless the patient has a history of PONV. If so, I give it
pre-operatively.
• No nitrous oxide. I avoid nitrous oxide, especially in cases lasting longer
than 2 hours. Nitrous oxide displaces air in closed spaces such as the bowel,
which can cause distention and potentially nausea and vomiting.
2. Use airway aids. If you can place a supraglottic airway device, the
comfort level of patients when they awaken will be noticeably improved. No
sore throat or potential tooth, gum or lip damage from intubation. An added
benefit is being able to go lighter on the anesthesia because patients don't have
to tolerate an endotracheal tube. Less depth of anesthesia means patients can
wake up sooner. It's much less aggressive — just one step deeper than sedation.
• POWERFUL SEAT Who's at the head of your table and how is he impacting
patient satisfaction?
Pamela
Bevelhymer,
RN,
BSN,
CNOR
