Surgical Nursing and Anesthesia
This domain covers the sequence that keeps a patient alive and a wound clean: preanesthetic assessment, drug selection, machine and airway management, depth and vital-sign monitoring, asepsis, instrumentation, and recovery.
Anesthesia essentials
- Assign an ASA physical status before drug selection and flag brachycephalic, cardiac, hepatic, renal and obese patients.
- Rebreathing bag size is roughly 30-60 mL/kg. Check the circuit for leaks, confirm oxygen supply and scavenging, and inspect soda lime for exhaustion.
- Typical sequence: premedication (opioid with or without alpha-2 agonist or benzodiazepine), induction (propofol, alfaxalone, ketamine combinations), maintenance by inhalant or total intravenous technique.
- Monitor heart rate and rhythm, respiratory rate and character, mucous membrane color, capillary refill time, indirect blood pressure, pulse oximetry, end-tidal CO2 (about 35-45 mmHg), temperature, muscle tone and reflexes.
- Warm actively: forced-air blankets, warm fluids, insulation, and a warm recovery area.
Surgery and asepsis
- Clip a wide area, then alternate chlorhexidine scrub with rinse. Chlorhexidine is not for eyes, ears or meninges; iodine preparations suit mucous membranes.
- Cap, mask, sterile gown and gloves. Keep hands above waist level and never turn your back on the sterile field.
- Know instrument classes: cutting (scalpel, scissors), hemostatic (Kelly, Crile, mosquito), grasping (thumb forceps), retracting, and needle holders.
- Count sponges and needles before and after the procedure and record the count.
- Common patterns: simple interrupted, simple continuous, cruciate, mattress, subcuticular.
Worked example
A 20 kg dog needs a rebreathing bag: 30-60 mL/kg gives 600-1200 mL, so a 1 L bag is appropriate. A 500 mL bag on that patient would empty and refill too aggressively and make the system harder to control; a 3 L bag would add dead space and slow response to vaporizer changes.
Traps that cost marks
Overinflating or failing to recheck the endotracheal cuff, trusting a single monitor instead of the whole patient, forgetting to turn the vaporizer off at the end, extubating before swallowing returns, and using chlorhexidine in the ear canal.