Complete a Thorough Anesthesia Care Plan

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

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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