Perianaesthesia describes the time surrounding anaesthesia.
This therefore involves the specialties of assistant to the Anaesthetist & Post-Anaesthetic Care Unit [PACU] nurse.
THE ASSISTANT TO THE ANAESTHETIST
Around the world, there are variations on who can perform the role of assistant to the Anaesthetist. You may have heard of the terms Physician’s Assistant, Anaesthetic Assistant, Anaesthetic Technologist, Anaesthetic Technician or Anaesthetic Nurse. Here in Australia, we currently have the latter two specialty roles – the Anaesthetic Technician & the Anaesthetic Nurse.
As the names suggest, one of these roles is a nursing position whereas the other is not. Healthcare facilities decide on who they will allow to perform these positions & is generally on a state by state basis. Western Australia, for example, employs mostly Anaesthetic Technician as the assistant to the anaesthetist. In New South Wales, there are now only nursing positions available – Anaesthetic Technicians were required over a decade ago to complete an Enrolled Nursing course (Diploma of Nursing) in order to maintain their positions as the assistant to the anaesthetist.
According to the Australian & New Zealand College of Anaesthetists [ANZCA], the Australian College of Perianaesthesia Nurses [ACPAN] & the Australian College of Perioperative Nurses [ACPAN], the anaesthetic nurse cares for the patient prior to, during & on emergence from anaesthesia. They assess & monitor the patient throughout this time & also provide sound assistance to the anaesthetist. This assistance includes assessing the function of the anaesthetic machine, preparing the anaesthetic environment & equipment required including those required for airway, breathing, circulation & temperature management. Communication is also a major role of the anaesthetic nurse. Most patients remember someone else asking them a bunch of questions before going into the operating theatre. They may also remember someone with the anaesthetist wiring them up for sound & space before ‘going off to sleep’! The anaesthetic nurse will also have a discussion with the anaesthetist surrounding the patient’s history & wishes & thus, the best anaesthetic technique for them along with what equipment & who might be needed in the event of a complication (most perioperative teams will complete a team huddle prior to each case so everyone on the team is aware of these points).
Ultimately, this role is no different to any other – the focus is on patient safety, dignity & respect. Perhaps the major point of difference to note is how vulnerable the patient is in this area. The patient advocate role is crucial here & with all other roles within the perioperative suite.
THE PACU NURSE
The Post-Anaesthetic Care Unit [PACU] is a high dependency unit staffed by Registered Nurses [RNs]. You may have Enrolled Nurses [ENs] employed in your department however this is not generally the norm. These ENs however have extensive perioperative & surgical experience (most have been anaesthetic nurses previously) & are extremely helpful - particularly when you are starting out in the perioperative suite.
This role centres on the recovery from the anaesthetic & the procedure itself. You’ve probably heard of people refer to this unit as the ‘Recovery Room’ which makes perfect sense. It focuses on the PACU Nurse’s ability to assess & monitor the patient throughout their stay. This also involves identifying any potential or actual complications & implement treatment strategies swiftly. The PACU nurse is adept to manage the deteriorating patient – major airway dramas, acute breathing issues & the patient trying to quietly bleed out are some of the main concerns here. Whilst medical help is only the press of a big red button away, these patients are still in a very crucial period of their procedure & the PACU nurse is reliant on their assessment skills.
Another major concern within this area is the management & treatment of acute pain & postoperative nausea & vomiting. Due to the length & type of surgery, the length & type of anaesthesia & the patient themselves, these issues may present as the most worrisome for patients.
Negative past experiences with either of these can lead to anxiety over future procedures & can even be as severe as post traumatic stress disorder. The PACU nurse is able to effectively manage the appropriate treatment protocols here with the help of the anaesthetist & their own knowledge & skills.
You may have also heard of the Certified Registered Nurse Anaesthetist [CRNA]. Unfortunately, this position is currently not available in Australia. It is however very prevalent in countries around Europe & the USA. There is a hope that one day this role may be the pinnacle of advanced anaesthetic nursing practice.
Next week, we will explore the advanced nursing opportunities in the perianaesthesia specialty.
ACORN. (2020). Nursing Roles. Retrieved from https://www.acorn.org.au/index.cfm?display=963487
ACPAN. (2020). Education. Retrieved from https://acpan.edu.au/education/
ANZCA. (2018). PS04: Statement on the Post Anaesthetic Care Unit. Retrieved from http://www.anzca.edu.au/documents/ps04-2006-recommendations-for-the-post-anaesthesia.pdf
Also consider reviewing the background paper found here http://www.anzca.edu.au/documents/ps04bp-statement-on-the-post-anaesthesia-care-unit.pdf
ANZCA. (2016). PS08: Statement on the Assistant to the Anaesthetist. Retrieved from http://www.anzca.edu.au/documents/ps08-2015-statement-on-the-assistant-for-the-anaes.pdf
Also consider reviewing the background paper found here http://www.anzca.edu.au/documents/ps08-bp-2016.pdf