Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Anesthesia in the Third World
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• Temperature should be recorded every 15 minutes (more frequently if
elevated or rapidly changing)
D. Pain control
1. If the surgeon will perform local infiltration, the standard solution is lidocaine
0.5% + epinephrine 1:200,000. The maximum doses of this solution is 10
mg/kg of lidocaine, with the overriding recommendation that during halothane
anesthesia, no more than 10 mg/kg of epinephrine be infiltrated.
2. Local anesthesia and/or infraorbital nerve blocks are usually sufficient for
control of pain after lip repairs.
3. Use intravenous nalbuphone judiciously. It is recommended for palate repairs
and burn scar revisions for postoperative pain control in the appropriate
patient.
E. Emergence and Extubation
1. Do Not Deep Extubate Patients! Be certain the patient is awake prior to
extubation.
2. Ensure the patient has a patent, unsupported airway, has a stable SpO2
(>95%) on room air without CPAP, and is maintaining his/her own airway
before transporting him/her to the PACU.
Postoperative
A. Post Anesthesia Care Unit (PACU)
1. Record the patient’s vital signs on the anesthesia form upon arrival to the
PACU. The attending nurse will provide a set of vital signs immediately.
2. If the patient is stable, give the salient details to the attending nurse; then
return to the operating room to set up for your next case.
3. Assist as needed in the PACU (e.g., a patient with an airway emergency).
Remain to assist until you are no longer needed.
4. Ensure that all babies and young children remain in the prone position for
4 to 6 hours postoperatively to facilitate drainage and for detection of occult
hemorrhage.
B. Record keeping and quality assurance
1. Use a standard Anesthesia Form to be included in every patient chart. This
should be filled out in detail just as you would do at home.
2. A perioperative events log. During and immediately after the operation,
detail the appropriate events and write detailed explanations if untoward
events occur. If we do not accurately know what problems occur, we cannot
offer solutions. Quality assurance is one of the most important parts of the
mission.
Common Complications and Preventing Potential Problems
Difficult Airway
1. Call for help immediately if an unanticipated difficult airway is encountered.
2. Place the patient on 100% oxygen and continue to ventilate by bag/mask
utilizing positioning of the head and neck, jawthrust, and oropharyngeal
airway placement, and continuous positive airway pressure (CPAP) to maintain
the mask airway.
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