Assisting The Anesthesia Provider

Learn About Commonly Used Equipment And Techniques in Anesthesia

Different Ways To Gain Airway Access

Endotracheal Intubation (ET Tube)

Soft, flexible tube passed orally into the trachea. The most common form of general intubation.

Oral or Nasal RAE

Named after it's inventors (Ring, Adair and Elwyn) this type of tube can be used during facial surgery. It has a preformed bend to prevent kinking that can occur if trying to bend a typical tube. The benefit to it's use is that it removes the connector and breathing circuit from the surgical field.

Awake Fiberoptic

Used for difficult airways, it allows the patient to maintain their respiratory drive and spontaneous ventilation.

Anesthesia intubation

Laryngeal Mask Airway

An airway tube connected to an elliptical mask with a cuff. AN LMA is inserted orally and once deployed forms an airtight supraglottic seal.

Nasotracheal

Slightly longer tube passed through the nasal passage into the trachea. Commonly used during oral surgery.

Tracheostomy Intubation

Airway obstruction, face or neck injury, or the need for long term intubation may warrant the need for a tracheostomy. Once the tube is surgically placed in the neck, it will connect to the anesthesia machine as usual.

Techniques Used During Anesthesia

When you are asked to apply cricoid pressure, the anesthesia provider is concerned about gastric contents entering the airway during intubation. By applying a downward pressure on the cricoid cartilage, it helps by occluding the esophagus and helps to bring the vocal cords into view. Apply soft pressure on an awake patient and slightly deeper pressure once they are asleep. Keep pressure until anesthesia has confirmed tube placement and gives you the okay to release. 

Anesthesia will place an arterial line to receive “real-time” blood pressures and have access to arterial blood for ABGs. Medications are never given through an arterial line. To assist the provider, stand by to help with handing them supplies, clean up or securing the line. Typically the patient will be anesthetized but sometimes they are awake during insertion. If that is the case, comforting the patient and keeping the limb still can be very helpful. Anticipate an arterial line for any ICU patient or potentially fragile patient that needs extra close monitoring during surgery. 

Central lines serve many purposes during surgery. They are larger bore catheters that give anesthesia direct access to large veins. They will be placed in the neck (internal jugular), the chest/clavical area (subclavian), or the groin (femoral). This multiple port access allows up to six lumens to be used for administering fluids or medications (specifically those caustic to peripheral veins), blood draws, and measuring central venous pressure (amount of fluid in the vascular system). Following heart surgery, a pulmonary artery catheter (Swan-Ganz) can also be used to measure the pressures in the right atrium, right ventricle, pulmonary artery, and filling pressure of the left atrium (wedge pressure). The line placement is a sterile procedure done by the anesthesiologist. Be prepared to assist with gathering of supplies, retracting skin or breast tissue, and calling for an xray immediately afterward to confirm line placement. 

Sometimes during surgery, the administering of blood products (red blood cells, platelets, plasma, cryoprecipitate) is necessary. Your role as the nurse in the room is to assist with checking the blood products, confirming blood band identification, and sometimes placing the order and fetching the blood from the blood bank (depending on circumstance and help available). Anticipating that anesthesia may need extra help during this time is also the role of the circulator.

Vital signs that are constantly monitored during surgery typically include blood pressure, oxygen saturation, heart rhythm, CO2 levels, and body temperature. As the surgical nurse, assisting with the placement of monitors and paying attention to alarms, is your responsibility. Being aware of the patient’s status and helping as needed is very important before, during, and after surgery.