Anesthesia Assistants: Patient Management during General Anesthesia & Procedural Sedation/Analgesia

Medical Directive ID: 
ANE-2014-002
Lead Contact Person: 
Kevin Tiggeloven, Coordinator Respiratory Therapy, LHSC
Physician/Nurse Lead: 
Dr. Jim Watson, Anesthesiologist
Program: 
Anesthesia & Perioperative Medicine
Approval By: 
Medical Advisory Committee
Original Effective Date: 
Tuesday, April 1, 2008
Revised Date: 
Thursday, December 11, 2014
To Be Reviewed Date: 
Sunday, December 11, 2016
This Medical Directive Applies to the following sites: 
St. Joseph’s
This Medical Directive Applies to the following patient population: 
In-Patients
Out-Patients
Order: 

This medical directive is to guide the provision and monitoring of local, regional, general and neuraxial anesthesia in stable adult (greater than16 years of age) patients by Advanced Practice Anesthesia Assistants (AA) in the operating room and throughout the hospital where procedural sedations are done under the direction of anesthesia in accordance with the hospital standards: Preoperative, intraoperative and postoperative procedure FOR ASSISTANCE in providing anesthesia by an Advanced Practice Anesthesia Assistant (AA).  It directs patient monitoring, oxygenation and mechanical ventilation, IV initiation, crystalloid fluid administration, arterial line initiation, thermoregulation, laboratory investigations, maintenance of inhalational anesthesia, maintenance/reversal of neuromuscular blockade and emergency treatment of bradycardia, hypotension, hypertension and hypoxemia.

The Anesthesia Assistant must continuously monitor the patient and inform the anesthesiologist if:

  • There is any change in the clinical or surgical situation which they are concerned about or if any other significant signs, symptoms or complications arise
  • Systolic blood pressure falls below 80 mmHg or rises above 130 mmHg unless instructed otherwise by the responsible anesthesiologist
  • Heart Rate falls below 50 bpm or rises above 100 bpm unless instructed otherwise by the responsible anesthesiologist
  • ECG changes consistent with arrhythmia, ischemia or infarction appear
  • Greater than 50% FiO2 is required to maintain oxygen saturation greater than or equal to 93% unless instructed otherwise by the responsible anesthesiologist
  • End-tidal CO2 rises above 45 mmHg or if RR greater than14 is required to maintain normocarbia in a mechanically ventilated patient or end-tidal CO2 rises above 50 mmHg in a spontaneously breathing patient unless instructed otherwise by the responsible anesthesiologist
  • Urine output is less than 0.5 mL/kg/h unless instructed otherwise by the anesthesiologist
  • Temperature is less than 35.5°C or greater than 37.5°C unless instructed otherwise by the responsible anesthesiologist
  • There is unexpected surgical blood loss
  • Surgery is 20 min. from ending unless instructed otherwise by the responsible anesthesiologist
  • Surgery is finished

The specific patient interventions and orders are described fully in Appendix A and Appendix B, attached.

This medical directive does not include the delegation of a controlled act/procedure.

References:

Appendix A – Intervention Tree for the Management of Bradycardia, Hypotension and Hypoxemia

Appendix B – Intervention / Diagnostic Test / Drug Table

Appendix C – American Society of Anesthesiologists (ASA) Definitions

Appendix D – Medication Review

Click the link to view the entire medical directive in detail: 

Signatures

SurnameKnown ByDate Signed
AhmadMohamadJan 21 2015 03:31:56:750PM
Al-AreibiArifJan 15 2015 05:53:24:950AM
ArangoMiguelMar 1 2015 08:04:35:593AM
ArmstrongKevinJan 25 2015 08:46:58:827AM
ArmstrongPaidrigJan 25 2015 06:33:45:207AM
BatohiPravinFeb 2 2015 11:41:35:163AM
BellinghamGeoffMar 2 2016 10:02:42:910AM
BorgerJonathanJan 20 2015 11:57:09:487AM
BrookesJonathanJan 15 2015 03:15:47:880PM
BruniIdaJan 15 2015 02:20:16:853PM
CaveAnitaMar 30 2015 02:23:16:890PM
CherryRichardFeb 15 2015 10:19:03:417AM
ChuiJasonJan 15 2015 10:55:10:587AM
ChurchBrianMar 29 2016 03:47:54:067PM
ClarkeCollinJan 30 2015 01:42:14:180PM
CraenRosemaryJan 16 2015 11:54:44:510AM
DhirAchalJan 16 2015 03:44:10:507AM
DhirShaliniJan 15 2015 06:09:53:107AM
Espinosa TadeoAldoJun 12 2019 11:55:02:687AM
GordonNeilFeb 18 2015 12:41:14:243PM
GrosMichelleJan 15 2015 09:09:37:167AM
HarleChristopherFeb 12 2015 09:42:18:110AM
HerrickIanJan 16 2015 11:18:37:590AM
HoogstraJasonMar 25 2015 09:52:17:760AM
IglesiasIvanJan 25 2015 07:03:26:253PM
KatsirisSandraJan 19 2015 10:51:50:140AM
KumarKamalJan 25 2015 09:43:28:967PM
LaviRonitApr 30 2017 04:15:38:897PM
MarmaiKristineFeb 9 2015 09:04:11:763AM
McCabeGregoryFeb 24 2015 02:45:03:107PM
MorrisonStephenApr 5 2015 11:05:37:187AM
MurkinJohnJan 25 2015 02:42:28:480PM
NewtonPeterMar 10 2015 09:45:34:560AM
NicolaouGeorgeJan 26 2015 01:38:25:777PM
OwerKateFeb 11 2015 10:04:52:193AM
PoolacherlaYuvaRajuFeb 14 2015 09:22:01:040PM
RachinskyMaximAug 14 2017 09:24:02:707AM
RailtonCraigFeb 2 2015 09:38:37:277AM
SinghInduFeb 16 2015 09:37:03:017AM
SischekWilliamJan 15 2015 01:14:01:157PM
SommerfreundDavidJan 25 2015 10:45:14:230AM
St-AmandMarcJan 15 2015 02:57:11:997PM
TawficQutaibaJan 15 2015 12:52:11:380AM
TurkstraTimothyJan 16 2015 10:52:12:750AM
VannelliAntonioJan 26 2015 05:35:17:583AM
WatsonJamesJan 15 2015 01:30:26:397PM
YangHomerJan 27 2018 06:28:15:863PM
YuJulieSep 16 2020 09:43:53:803AM