Complete a Thorough Anesthesia Care Plan

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Please complete a thorough anesthesia care plan and upload it.

This careplan is for a SWBP and application of skin substitute to the Face

bellow you have the rubric that you need to follow

2 references minimun AMA edition 11

complete a thorough anesthesia care plan

Anesthesia Care Plan for Split-Thickness Wound Biopsy and Application of Skin Substitute to the Face

Patient Information

  • Age: [Insert patient age]
  • Gender: [Insert gender]
  • Height/Weight: [Insert height and weight]
  • ASA Classification: [Insert classification, e.g., ASA II]
  • Medical History: Include comorbidities such as hypertension, diabetes, smoking, or other pertinent conditions.
  • Surgical History: [Insert details of prior surgeries, if any]
  • Allergies: [Insert known allergies, especially to anesthetic agents]
  • Medications: List current medications, including anticoagulants, antihypertensives, or steroids.

Preoperative Assessment

  1. Airway Assessment:
    • Mallampati Score: [Insert score]
    • Neck Mobility: [Normal/Restricted]
    • Teeth: [Intact/Missing/Loose]
    • Other Considerations: History of sleep apnea or difficult intubation.
  2. Cardiovascular Assessment:
    • Baseline vital signs: BP, HR, O2 saturation.
    • History of cardiovascular disease.
  3. Respiratory Assessment:
    • Lung auscultation for clear air entry.
    • History of asthma or COPD.
  4. Neurological Assessment:
    • Mental status and cognitive function.
    • Any history of seizures or strokes.
  5. Laboratory Results:
    • CBC, CMP, coagulation studies, and other pertinent labs.

Anesthetic Plan

  1. Type of Anesthesia:
    • Regional Anesthesia: Consider a local anesthetic such as lidocaine with epinephrine for localized analgesia.
    • Sedation: IV sedation using midazolam (2-5 mg) and/or fentanyl (25-50 mcg) titrated to effect.
    • General Anesthesia (if required): For patient comfort or if regional anesthesia is insufficient, a general anesthetic plan should include:
      • Induction: Propofol (1.5-2.5 mg/kg) or etomidate (0.2-0.6 mg/kg).
      • Maintenance: Sevoflurane or isoflurane with oxygen/nitrous oxide mixture.
      • Airway Management: Endotracheal intubation or LMA, depending on the procedure’s duration and airway assessment.
  2. Monitors:
    • Standard ASA monitors: ECG, NIBP, pulse oximetry, end-tidal CO2.
    • Optional: Temperature probe, if needed for prolonged procedures.
  3. Positioning:
    • Supine position with head elevated slightly to optimize airway and reduce facial edema.
    • Padding for pressure points to prevent nerve injury.
  4. Medications:
    • Premedication:
      • Midazolam (1-2 mg IV) to reduce anxiety.
      • Ondansetron (4 mg IV) for prophylaxis against postoperative nausea and vomiting (PONV).
    • Intraoperative:
      • Local anesthetic: Lidocaine 1% with epinephrine for hemostasis and analgesia.
      • Analgesics: Fentanyl (25-50 mcg IV) for intraoperative pain.
      • Muscle relaxants (if GA used): Rocuronium (0.6-1.2 mg/kg) or succinylcholine (1-2 mg/kg) for intubation.
    • Emergence:
      • Glycopyrrolate and neostigmine for neuromuscular blockade reversal.

Intraoperative Management

  1. Airway Management:
    • Maintain a clear airway using LMA or endotracheal tube based on patient assessment.
    • Adjust ventilation parameters to maintain ETCO2 within 35-45 mmHg.
  2. Fluids:
    • Maintenance fluids: Lactated Ringer’s or normal saline at 4-6 mL/kg/hour.
  3. Blood Loss Management:
    • Minimal expected blood loss; use local hemostatic agents as needed.
  4. Temperature:
    • Use a warming blanket or forced air warming device to maintain normothermia.

Postoperative Management

  1. Recovery:
    • Transfer to PACU with continuous monitoring of vital signs and oxygenation.
    • Assess for PONV and administer ondansetron or dexamethasone if needed.
  2. Pain Management:
    • Local infiltration of bupivacaine (0.25%) for prolonged analgesia.
    • Oral acetaminophen or ibuprofen for mild pain.
    • Avoid NSAIDs if bleeding risk is a concern.
  3. Discharge Criteria:
    • Stable vital signs.
    • Pain controlled with oral analgesics.
    • No active bleeding or airway compromise.

References

  1. Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s Clinical Anesthesiology. 6th ed. New York: McGraw Hill; 2020.
  2. Barash PG, Cullen BF, Stoelting RK, et al. Clinical Anesthesia. 8th ed. Philadelphia: Wolters Kluwer; 2017.
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