Anesthesia Alert

Anesthesia

By: Tricia Meyer

Published: 12/15/2007

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How to Create an Anesthesia Passport


To give patients a handy record of their anesthesia, we created a pocket-sized leaflet, dubbed Your Anesthesia Passport, which lists not only the anesthetics that the patient received, but also describes how these drugs are used and information about potential problems. The passport helps patients better understand the procedures they've undergone in the OR and potentially avoid unnecessary complications in future surgeries, whether at our facility or elsewhere. Here's how you can provide your patients with a simple handout that summarizes their anesthetic experiences and effects.

On the Web

To download a sample anesthesia passport that you can customize for your facility, go to www.outpatientsurgery.net/forms.

Folded into fours
I'd seen several different patient information tools at meetings and I took the ideas to create something effective for our surgery center. The first draft was a simple form briefly describing the anesthetics that the patient received. After getting suggestions from the rest of the staff, we added more specific descriptions about how these drugs are used and information about potential problems. We went through several revisions and reviews of the literature for patient education materials before printing our current passport on a single sheet of paper that we folded into fours:

  • Page 1. Has a passport-style illustration with a line for the patient's name and the name and address of our facility.
  • Page 2. Contains a paragraph of easy-to-read information about anesthesia and our recommendation that the patient show this to the anesthesia provider before any further procedures.
  • Page 3. Has spaces for the nurse to write the procedure the patient underwent and the date as well as a checklist so we can mark the agents that were used during the surgical procedure.
  • Page 4. The back page is a checklist of the possible complications with room to check "yes (describe)" or "no" to these common post-anesthesia symptoms. Examples include headache or vomiting, anesthetic concerns such as latex allergies or intubation difficulties. The passport also has a warning about the medication prescribed and alerts the patient about possible drowsiness.

A nurse writes in all the specific information and then reviews the pamphlet with the patient or a family member before discharge. At the end of the consultation, the nurse tells the patient to take the pamphlet with him if surgery is needed at another facility. The nurse explains that the passport will be useful if the patient has anesthesia at a different facility that may not have the patient's anesthesia history.

Pleased patients
It took a few revisions to get the passport to where it is now, and it's still a work in progress. We may change some of the text, develop a new illustration or start printing it on cardstock so it will be a more permanent document. Overall, our patients have been receptive to the idea of receiving more information about their procedures and are very satisfied with the passport. The patients who were likely to relocate or move indicated that they felt the passport was more valuable than those who planned to continue their surgical care at our facility.

Anesthesia Notebook

Continuous peripheral nerve block analgesia is effective in pediatric orthopedic surgery patients, according to an article in the November issue of Anesthesia & Analgesia. Physicians at the Children's Hospital of Philadelphia, who've used CPNB for pain management on almost 500 patients since January 2003, studied the outcomes for 217 children (averaging 13.7 years of age and ranging from 4 to 18 years) who received continuous peripheral nerve blockades between 2003 and 2006 and found this technique was associated with less pain and earlier discharge. Of the 217 children, 108 were discharged home with CPNB. The researchers found that 56 percent of children didn't require any opioids in the first 8 hours post-op, 26 percent didn't require opioids at 24 hours and 21 percent didn't require opioids at 48 hours, according to the study. ????-?"The main advantage is that the patients can leave the hospital sooner,????- ? says Arjunan Ganesh, MBBS, pediatric anesthesiologist and lead author of the study. ????-?"And, you are able to ensure better pain control and to decrease use of opioids and their side effects, such as itching and nausea.????- ? Fourteen percent of children experienced nausea and vomiting and 2.8 percent experienced complications.

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Patients may not like to see what's happening when surgeons are operating on their hands, but keeping them awake could be better for them in the long run. According to a presentation at the American Society of Plastic Surgeons' annual conference in October, using local anesthesia on conscious patients with fractures, carpal tunnel syndrome or other common hand problems can reduce the need for revisions as well as the procedure's expense and recovery time. The surgeons do not use a tourniquet for this technique so the patient can have a full range of motion with his fingers. This allows the surgeon to ask the patient to make any necessary adjustments on the reconstructed tendons and bones before the skin is closed, which could potentially decrease the need for revision surgery for tendon transfers and repairs. Compared to traditional surgery, the researchers' findings show that the wide-awake approach could reduce costs by 25 percent and reduce operating times without risking the patient's safety.

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Using low incremental doses of fentanyl can shorten the recovery time for colonoscopy patients. An article in the September issue of Surgical Endoscopy describes how 126 ambulatory colonoscopy patients were randomly assigned to either 25mcg of fentanyl, which was titrated to 50mcg, or 2mg midazolam, which was titrated up to 5mg. The patients in the fentanyl group reported lower discomfort scores as well as less pain and had a mean recovery time of 5.6 minutes compared to 16 minutes for the midazolam group.

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The Montana Supreme Court last month denied the state society of anesthesiologists' three-count appeal that sought to overturn the governor's 2004 decision to opt out of the requirement that CRNAs be supervised by a physician to receive Medicare/Medicaid reimbursement for anesthesiology services performed by CRNAs. For many years, Medicare /Medicaid rules required that CRNAs must work under the general supervision of a physician when they administer anesthesia in order to obtain reimbursement for CRNA services from Medicare/Medicaid. In 2001, the Code of Federal Regulations was amended to allow the governor of each state to ????-?"opt out.????- ? For several years CRNAs have been the sole providers of anesthesia services in many areas of Montana, particularly in rural areas of the state, the court noted. Only nine of the 40 medical facilities in Montana have an anesthesiologist on staff.

- Nathan Hall

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