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Recommended Practices for Managing the Patient Receiving Local Anesthesia
APRIL 2002, VOL 75,NO 4
Recommended Practices for Managing the Patient Receiving Local Anesthesia
T
criteria developed through an interdisciplinary he following recommended practices were collaboration of health care professionals. developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were 2. Many healthy patients undergo minor surgical procedures that require only small doses of local presented as proposed recommended practices anesthetic medications. These patients are at low for comments by members and others. They are risk for anesthetic complications and require mineffective Jan 1,2002. imal observation and intervention. These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies 3. The decision to monitor, the parameters moniand procedures will reflect variations in practice settored, and the frequency of observation should be tings and/or clinical situations that determine the tailored to the patient and the surgical procedure.’ Iflwhen administering medications, the perioperadegree to which the recommended practices can be tive nurse must work within his or her scope of implemented. AORN recognizes the various settings in which practice. perioperative nurses practice. These recommended practices are intended as guidelines adaptable to var- 4. Local anesthesia is not practical for all patients or ious practice settings. These practice settings include all types of surgical procedures? Highly nervous, traditional ORs, ambulatory surgery units, physiapprehensive, or excitabIe patients or those who cians’ offices, cardiac catheterization laboratories, are unable to cooperate because of their mental state or age may not be good candidates for local endoscopy suites, radiology departments, and all ane~thesia.~ Each patient has a variety of unique other areas where operative and other invasive procephysical characteristics that can influence his or dures may be performed. her response to medications. Considerations Purpose: These recommended practices provide guidelines for RNs managing patients receiving local include, but are not limited to, the patient’s weight, age, and medication tolerance and the presence of infiltration anesthesia only. If any sedation is used, disea~e.~ A 0 R ” s “Recommended practices for managing the patient receiving moderate sedatiodanalgesia” should be followed. It is not the intent of these rec- 5. In the preoperative phase, the RN should review ommended practices to address situations that require the patient’s history, physical examination findthe services of anesthesia care providers or to substiings, laboratory results, and other diagnostic test results if indicated. During this preoperative tute RN services in those situations that require the assessment, the perioperative nurse should deterservices of anesthesia care providers, regardless of mine, at a minimum, the complexity of the surgical procedure. the patient’s allergies and sensitivities (eg. RECOMMENDED PRACWCE I medications, tape, latex, prep solutions); the patient’s age, current medications, altemaPatients receiving local anesthesia during a surgitivelcomplementary therapies, and emotional cal procedure should be assessed throughout the perioperative experience by an RN. status; when the patient last consumed solids andor 1. The selection of patients who are to receive local liquids by mouth (ie, NPO status); anesthesia should be determined by established 849 AORN JOURNAL
APRIL 2002, VOL 75, NO 4
whether the surgical site can be anesthetized completely with a local injection; and pulse, blood pressure, arterial oxygen percent saturation, skin status, mental status, and pain management s t a t u ~ . ~
tions and/or other factors related to the surgical encounter.loContinuously monitoring the patient’s physiological and psychosocial status facilitates early detection of potential complications.
The need for IV access andor fluids should be based on patient assessment data and facility policy.
3. The perioperative RN should monitor the dose, route, and time of administration for all local anesthetic medications given to the patient during the surgical procedure.”
6. The RN should develop a plan of care to include potential problems and stress responses to local anesthesia. Surgery may elicit physiological (eg, autonomic disturbances that may cause fainting) and psychological (eg, fear of the unknown that may cause anxiety) responses in the patient. The degree of combined stressfbl stimuli directly determines the response of the patient.6
4. The perioperative RN should be knowledgeable about medication administration and be able to recognize both desired responses and adverse reactions to anesthetic medications. Local anesthetic agents may cause cardiovascular, respiratory, or central nervous system depression. Adverse reactions may stem from hypersensitivity to the anesthetic agent and/or toxicity due to excessive levels of the medication.”
7. The RN should ensure the availability of emergency equipment and be prepared to intervene should an adverse reaction occur. Serious cardiac or respiratory complications can occur abruptly aRer the administration of local anesthetic medications. If the medication enters the bloodstream directly, convulsions, circulatory and respiratory distress, cardiovascular collapse, or even death can result.’ Emergency medications, suction apparatus, resuscitative equipment, and qualified personnel should be readily available.8 At a minimum, personnel should be competent in cardiopulmonary resuscitation.
Symptoms of hypersensitivity include, but are not limited to, urticaria, tachycardia, laryngeal edema leading to breathing difficulties, nausea, vomiting, elevated temperature, severe hypotension, and anaphylactic shock. Symptoms of toxicity include, but are not limited to, restlessness, unexplained anxiety or fearfulness, diaphoresis, nausea, palpitations, disturbed respiration, pallor or flushing, syncope, and convulsive movements.
RECOMMENDED PRACTICE II
The RN managing the nursing care of the patient receiving local anesthesia should monitor the patient’s physiological and psychosocial status throughout the procedure. 1. At a minimum, the perioperative RN should monitor the patient’s heart rate and regularity, respiratory rate, and mental status throughout the procedure. Other monitoring parameters include, but are not limited to: blood pressure, oxygen saturation by pulse oximetry, body temperature, skin temperature and color, and mental status and level of consciousness. 2. The perioperative RN should monitor the patient for physiological reactions to medications and for behavioral changes that may occur due to medica-
A hypotensive reaction also may occur as a toxic response to local anesthetic medications. A patient’s blood pressure may fall gradually or abruptly, and the heart rate may change from normal to tachycardiac to bradycardiac with faintness andor dizziness. Cardiac arrest may Injury to the anesthetized surgical site can occur
850 AORN JOURNAL
APRIL 2002, VOL 75, NO 4
ment desired patient outcomes, nursing diagnoses, and nursing interventions and activities. Use of a standardized language ensures meaninghl data collection and analysis within and across practice settings.
because a patient’s sensation is absent.14A patient undergoing a surgical procedure with local anesthesia may experience significant intraoperative bleeding.I5 He or she may be at risk for hypothermia from cool ambient temperatures, the use of unwarmed IV and irrigation fluids, or prolonged surgical time.I6Knowledge of undesirable medication reactions and implementation of appropriate interventions help protect the patient from undue harm.”
3. Documentation of patient care provides a record of the patient’s response to local anesthetic medications.
5. The perioperative RN should recognize and report to the physician significant changes in the patient’s status and should be prepared to initiate appropriate interventions.I*
4. Documentation of all nursing interventions and activities performed is legally and professionally important for clear communication, collaboration among health care providers, and continuity of patient care.23
RECOMMENDED PmCTICE 111
RECOMMENDED PRACTICEV
Policies and procedures for managing the patient receiving local anesthesia should be developed, reviewed and revised at regularly scheduled intervals, and readily available in the practice setting. 1. Policies and procedures for managing patients receiving local anesthesia should include, but are not limited to, patient selection criteria, type and frequency of monitoring, method and frequency of documentation, medications that may be administered by the perioperative nurse and the level of monitoring skills required, interventions that may be implemented based RECOMMENDED PRACTICE IV on preapproved protocol and that are within the Documentation should be consistent with AORN’s scope of nursing practice, and “Recommended practices for documentation of discharge criteria.24 perioperative nursing care.”2oThe Perioperative Nursing Data Set (PNDS)nomenclature should be used when documenting nursing activities on the 2. These recommended practices should be used as guidelines for developing policies and procedures patient record?‘ in the practice setting. Policies and procedures 1. Documentation should reflect use of the nursing establish authority, responsibility, and accountaprocess. When the nursing process is used, it bility. They also serve as operational guidelines demonstrates the critical thinking skills practiced and assist in the development of performance by perioperative RNs caring for the surgical improvement activities. A review of policies and patient.22 procedures should be included in orientation and ongoing staff member education. A 2. The PNDS nomenclature should be used to docu-
The RN monitoring the patient’s care should be clinically competent in the function and use of monitoring equipment, resuscitation equipment, and emergency medications. The monitoring RN should be able to interpret data obtained from the patient. 1. Serious cardiac or respiratory complications can occur abruptly after administration of local anesthetic medication. Knowledge of the hnction and proper use of monitoring equipment and emergency medications is essential to provide safe patient care.19
NOTES 1. J L Hoffer, “Anesthesia,” in Alexander 5. Care of the Patient in Sueery, 1lth ed, M H Meeker, J C
Rothrock, eds (St Louis: Mosby, Inc, 1999) 209,231-232.
2. Zbid, 231; N H Fortunato, Beny & Kohn 5. Operating Room Technique, ninth ed (St Louis: Mosby, 2000) 427; M Kost, “Local and regional anesthesia,” in Ambulatory Surgical Nursing, sec851 AORN JOURNAL
ond ed, N Burden et al, eds (Philadelphia: W B Saunders Co, 2000) 286-287. 3. Fortunato, Beny & Kohn ’s Operating Room Technique, ninth
ed, 427.
APRIL 2002, VOL 75, NO 4
4. A M Martinelli, “Administering drugs and solutions,” in Patient Care During Operative and Invasive Procedures, second ed, M L Phippen, M P Wells, eds (Philadelphia: W B Saunders Co, 2000) 114, 117. 5. Hoffer, “Anesthesia,” 232; Fortunato, Berry & Kohn S Operating Room Technique, ninth ed, 424-425; Kost, “Local and regional anesthesia,” 293. 6. R P Shumaker, “Perioperative nursing,” in Medical-Surgical Nursing: Clinical Managementfor Continuity of Care, fifth ed, J M Black, E Matassarin-Jacobs,eds (Philadelphia:W B Saunders Co, 1997) 45 1; J Luckmann, K C Sorensen, Medical-SurgicalNursing: A PsychophysiologicApproach, third ed (Philadelphia: W B Saunders Co, 1987) 265; K Blais, “Penoperative nursing process,” in Perioperative Nursing: Principles and Practice, second ed, S S Fairchild, ed (Boston: Little, Brown and Co, 1996) 274. 7. Kost, “Local and regional anesthesia,” 290; Fortunato, Berry & Kohn S Operating Room Technique, ninth ed, 427; Hoffer, “Anesthesia,” 232. 8. Hoffer, “Anesthesia,” 232. 9. Zbid; Fortunato, Berry & Kohn b Operating Room Technique, ninth ed, 426-427. 10. Fortunato, Berry & Kohn S Operating Room Technique, ninth ed, 425-427. 11. Hoffer, “Anesthesia,” 232. 12. Zbid; Kost, “Local and regional anesthesia,” 290-291. 13. A M Martinelli, “Physiologically monitoring the patient,” in Patient Care During Operative and Invasive Procedures, second ed, M L Phippen, M P Wells, eds (Philadelphia: W B Saunders Co, 2000) 146.
14. D Rivellini, “Local and regional anesthesia: Nursing implications,” The Nursing Clinics of North America 28 (September 1993) 560. 15. Martinelli, “Physiologically monitoring the patient,” 142. 16. Zbid, 139-140, 143. 17. C J Smith, “Preparing nurses to monitor patients receiving local anesthesia,”AORN Journal 59 (May 1994) 1036; Martinelli, “Physiologically monitoring the patient,” 146. 18. Hoffer, “Anesthesia,” 232; Fortunato, Berry & Kohn ’s Operating Room Technique, ninth ed, 426-427; Kost, “Local and regional anesthesia,” 29 1. 19. Zbid. 20. “Recommended practices for documentation of perioperative nursing care,” in Standarch, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2001) 199-201. 2 1. S Beyea, ed, Perioperative Nursing Data Set. The Perioperative Nursing Vocabulary, second ed (Denver: AORN, Inc, 2002, in press). 22. C S Ladden, “Concepts basic to perioperative nursing,” in Alexander 5. Care of the Patient in Surgery, 1lth ed, M H Meeker, J C Rothrock, eds (St Louis: Mosby, Inc, 1999) 6-13; J Gill et al, “Incorporating nursing diagnosis and King’s theory in the OR documentation,” Canadian Operating Room Nursing Journal (MarcWApril 1995) 10-11; Blais, “Perioperativenursing process,” 271-272,280,284,286288; Fortunato, Berry & Kohn S Operating Room Technique,ninth ed, 19-24. 23. L C A Simunek, “Legal and ethical dimensions of perioperative nursing practice,” in Perioperative Nursing: Principles and Practice,
852 AORN JOURNAL
second ed, S S Fairchild, ed (Boston: Little, Brown and Co, 1996) 390394; Blais, “Perioperativenursing process,” 286-290; B J Gruendemann, B Femsebner, ComprehensivePerioperative Nursing, Volume I: Principles (Boston: Jones and Bartlett Publishers, 1995) 95. 24. L K Groah, “Anesthesia,” in Perioperative Nursing, third ed, L K Groah,ed (Stamford, Conn: Appleton & Lange, 1996)245,248; A Ferran, “Anesthesia and perioperative nursing implications,” in Perioperative Nursing. Principles and Practice, second ed, S S Fairchild, ed (Boston: Little, Brown and Co, 1996) 105. RESOURCES Burden, N. “Ambulatory approach: A case study: Identification and treatment of narcotic depression in the ambulatory surgical patient,” Journal of Post Anesthesia Nursing 10 (April 1995) 94-99. Burden, N; Iyer, J. “Ambulatory approach: Local anesthesia: Not always benign,” Journal of Post Anesthesia Nursing 2 (February 1987) 45-50. Chang, W K, Mulford, G J. “Iatrogenic txigeminal sensorimotor neuropathy resulting from local anesthesia: A case report,” Archives of Physical Medicine and Rehabilitation 81 (December 2000) 1591-1593. Kern, K; Langevin, P B; Dunn, B M. “Methemoglobinemiaafter topical anesthesia with lidocaine and benzocaine for a difficult intubation,” Journal of Clinical Anesthesia 12 (Mach 2000) 167-172. Schecter, W P; Swisher,J L. “Local anesthesia in surgical practice,” Current Problems in Surgery (Jan~w 2000) 10-66.
Recommended Practices for Managing the Patient Receiving Local Anesthesia
T
criteria developed through an interdisciplinary he following recommended practices were collaboration of health care professionals. developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were 2. Many healthy patients undergo minor surgical procedures that require only small doses of local presented as proposed recommended practices anesthetic medications. These patients are at low for comments by members and others. They are risk for anesthetic complications and require mineffective Jan 1,2002. imal observation and intervention. These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies 3. The decision to monitor, the parameters moniand procedures will reflect variations in practice settored, and the frequency of observation should be tings and/or clinical situations that determine the tailored to the patient and the surgical procedure.’ Iflwhen administering medications, the perioperadegree to which the recommended practices can be tive nurse must work within his or her scope of implemented. AORN recognizes the various settings in which practice. perioperative nurses practice. These recommended practices are intended as guidelines adaptable to var- 4. Local anesthesia is not practical for all patients or ious practice settings. These practice settings include all types of surgical procedures? Highly nervous, traditional ORs, ambulatory surgery units, physiapprehensive, or excitabIe patients or those who cians’ offices, cardiac catheterization laboratories, are unable to cooperate because of their mental state or age may not be good candidates for local endoscopy suites, radiology departments, and all ane~thesia.~ Each patient has a variety of unique other areas where operative and other invasive procephysical characteristics that can influence his or dures may be performed. her response to medications. Considerations Purpose: These recommended practices provide guidelines for RNs managing patients receiving local include, but are not limited to, the patient’s weight, age, and medication tolerance and the presence of infiltration anesthesia only. If any sedation is used, disea~e.~ A 0 R ” s “Recommended practices for managing the patient receiving moderate sedatiodanalgesia” should be followed. It is not the intent of these rec- 5. In the preoperative phase, the RN should review ommended practices to address situations that require the patient’s history, physical examination findthe services of anesthesia care providers or to substiings, laboratory results, and other diagnostic test results if indicated. During this preoperative tute RN services in those situations that require the assessment, the perioperative nurse should deterservices of anesthesia care providers, regardless of mine, at a minimum, the complexity of the surgical procedure. the patient’s allergies and sensitivities (eg. RECOMMENDED PRACWCE I medications, tape, latex, prep solutions); the patient’s age, current medications, altemaPatients receiving local anesthesia during a surgitivelcomplementary therapies, and emotional cal procedure should be assessed throughout the perioperative experience by an RN. status; when the patient last consumed solids andor 1. The selection of patients who are to receive local liquids by mouth (ie, NPO status); anesthesia should be determined by established 849 AORN JOURNAL
APRIL 2002, VOL 75, NO 4
whether the surgical site can be anesthetized completely with a local injection; and pulse, blood pressure, arterial oxygen percent saturation, skin status, mental status, and pain management s t a t u ~ . ~
tions and/or other factors related to the surgical encounter.loContinuously monitoring the patient’s physiological and psychosocial status facilitates early detection of potential complications.
The need for IV access andor fluids should be based on patient assessment data and facility policy.
3. The perioperative RN should monitor the dose, route, and time of administration for all local anesthetic medications given to the patient during the surgical procedure.”
6. The RN should develop a plan of care to include potential problems and stress responses to local anesthesia. Surgery may elicit physiological (eg, autonomic disturbances that may cause fainting) and psychological (eg, fear of the unknown that may cause anxiety) responses in the patient. The degree of combined stressfbl stimuli directly determines the response of the patient.6
4. The perioperative RN should be knowledgeable about medication administration and be able to recognize both desired responses and adverse reactions to anesthetic medications. Local anesthetic agents may cause cardiovascular, respiratory, or central nervous system depression. Adverse reactions may stem from hypersensitivity to the anesthetic agent and/or toxicity due to excessive levels of the medication.”
7. The RN should ensure the availability of emergency equipment and be prepared to intervene should an adverse reaction occur. Serious cardiac or respiratory complications can occur abruptly aRer the administration of local anesthetic medications. If the medication enters the bloodstream directly, convulsions, circulatory and respiratory distress, cardiovascular collapse, or even death can result.’ Emergency medications, suction apparatus, resuscitative equipment, and qualified personnel should be readily available.8 At a minimum, personnel should be competent in cardiopulmonary resuscitation.
Symptoms of hypersensitivity include, but are not limited to, urticaria, tachycardia, laryngeal edema leading to breathing difficulties, nausea, vomiting, elevated temperature, severe hypotension, and anaphylactic shock. Symptoms of toxicity include, but are not limited to, restlessness, unexplained anxiety or fearfulness, diaphoresis, nausea, palpitations, disturbed respiration, pallor or flushing, syncope, and convulsive movements.
RECOMMENDED PRACTICE II
The RN managing the nursing care of the patient receiving local anesthesia should monitor the patient’s physiological and psychosocial status throughout the procedure. 1. At a minimum, the perioperative RN should monitor the patient’s heart rate and regularity, respiratory rate, and mental status throughout the procedure. Other monitoring parameters include, but are not limited to: blood pressure, oxygen saturation by pulse oximetry, body temperature, skin temperature and color, and mental status and level of consciousness. 2. The perioperative RN should monitor the patient for physiological reactions to medications and for behavioral changes that may occur due to medica-
A hypotensive reaction also may occur as a toxic response to local anesthetic medications. A patient’s blood pressure may fall gradually or abruptly, and the heart rate may change from normal to tachycardiac to bradycardiac with faintness andor dizziness. Cardiac arrest may Injury to the anesthetized surgical site can occur
850 AORN JOURNAL
APRIL 2002, VOL 75, NO 4
ment desired patient outcomes, nursing diagnoses, and nursing interventions and activities. Use of a standardized language ensures meaninghl data collection and analysis within and across practice settings.
because a patient’s sensation is absent.14A patient undergoing a surgical procedure with local anesthesia may experience significant intraoperative bleeding.I5 He or she may be at risk for hypothermia from cool ambient temperatures, the use of unwarmed IV and irrigation fluids, or prolonged surgical time.I6Knowledge of undesirable medication reactions and implementation of appropriate interventions help protect the patient from undue harm.”
3. Documentation of patient care provides a record of the patient’s response to local anesthetic medications.
5. The perioperative RN should recognize and report to the physician significant changes in the patient’s status and should be prepared to initiate appropriate interventions.I*
4. Documentation of all nursing interventions and activities performed is legally and professionally important for clear communication, collaboration among health care providers, and continuity of patient care.23
RECOMMENDED PmCTICE 111
RECOMMENDED PRACTICEV
Policies and procedures for managing the patient receiving local anesthesia should be developed, reviewed and revised at regularly scheduled intervals, and readily available in the practice setting. 1. Policies and procedures for managing patients receiving local anesthesia should include, but are not limited to, patient selection criteria, type and frequency of monitoring, method and frequency of documentation, medications that may be administered by the perioperative nurse and the level of monitoring skills required, interventions that may be implemented based RECOMMENDED PRACTICE IV on preapproved protocol and that are within the Documentation should be consistent with AORN’s scope of nursing practice, and “Recommended practices for documentation of discharge criteria.24 perioperative nursing care.”2oThe Perioperative Nursing Data Set (PNDS)nomenclature should be used when documenting nursing activities on the 2. These recommended practices should be used as guidelines for developing policies and procedures patient record?‘ in the practice setting. Policies and procedures 1. Documentation should reflect use of the nursing establish authority, responsibility, and accountaprocess. When the nursing process is used, it bility. They also serve as operational guidelines demonstrates the critical thinking skills practiced and assist in the development of performance by perioperative RNs caring for the surgical improvement activities. A review of policies and patient.22 procedures should be included in orientation and ongoing staff member education. A 2. The PNDS nomenclature should be used to docu-
The RN monitoring the patient’s care should be clinically competent in the function and use of monitoring equipment, resuscitation equipment, and emergency medications. The monitoring RN should be able to interpret data obtained from the patient. 1. Serious cardiac or respiratory complications can occur abruptly after administration of local anesthetic medication. Knowledge of the hnction and proper use of monitoring equipment and emergency medications is essential to provide safe patient care.19
NOTES 1. J L Hoffer, “Anesthesia,” in Alexander 5. Care of the Patient in Sueery, 1lth ed, M H Meeker, J C
Rothrock, eds (St Louis: Mosby, Inc, 1999) 209,231-232.
2. Zbid, 231; N H Fortunato, Beny & Kohn 5. Operating Room Technique, ninth ed (St Louis: Mosby, 2000) 427; M Kost, “Local and regional anesthesia,” in Ambulatory Surgical Nursing, sec851 AORN JOURNAL
ond ed, N Burden et al, eds (Philadelphia: W B Saunders Co, 2000) 286-287. 3. Fortunato, Beny & Kohn ’s Operating Room Technique, ninth
ed, 427.
APRIL 2002, VOL 75, NO 4
4. A M Martinelli, “Administering drugs and solutions,” in Patient Care During Operative and Invasive Procedures, second ed, M L Phippen, M P Wells, eds (Philadelphia: W B Saunders Co, 2000) 114, 117. 5. Hoffer, “Anesthesia,” 232; Fortunato, Berry & Kohn S Operating Room Technique, ninth ed, 424-425; Kost, “Local and regional anesthesia,” 293. 6. R P Shumaker, “Perioperative nursing,” in Medical-Surgical Nursing: Clinical Managementfor Continuity of Care, fifth ed, J M Black, E Matassarin-Jacobs,eds (Philadelphia:W B Saunders Co, 1997) 45 1; J Luckmann, K C Sorensen, Medical-SurgicalNursing: A PsychophysiologicApproach, third ed (Philadelphia: W B Saunders Co, 1987) 265; K Blais, “Penoperative nursing process,” in Perioperative Nursing: Principles and Practice, second ed, S S Fairchild, ed (Boston: Little, Brown and Co, 1996) 274. 7. Kost, “Local and regional anesthesia,” 290; Fortunato, Berry & Kohn S Operating Room Technique, ninth ed, 427; Hoffer, “Anesthesia,” 232. 8. Hoffer, “Anesthesia,” 232. 9. Zbid; Fortunato, Berry & Kohn b Operating Room Technique, ninth ed, 426-427. 10. Fortunato, Berry & Kohn S Operating Room Technique, ninth ed, 425-427. 11. Hoffer, “Anesthesia,” 232. 12. Zbid; Kost, “Local and regional anesthesia,” 290-291. 13. A M Martinelli, “Physiologically monitoring the patient,” in Patient Care During Operative and Invasive Procedures, second ed, M L Phippen, M P Wells, eds (Philadelphia: W B Saunders Co, 2000) 146.
14. D Rivellini, “Local and regional anesthesia: Nursing implications,” The Nursing Clinics of North America 28 (September 1993) 560. 15. Martinelli, “Physiologically monitoring the patient,” 142. 16. Zbid, 139-140, 143. 17. C J Smith, “Preparing nurses to monitor patients receiving local anesthesia,”AORN Journal 59 (May 1994) 1036; Martinelli, “Physiologically monitoring the patient,” 146. 18. Hoffer, “Anesthesia,” 232; Fortunato, Berry & Kohn ’s Operating Room Technique, ninth ed, 426-427; Kost, “Local and regional anesthesia,” 29 1. 19. Zbid. 20. “Recommended practices for documentation of perioperative nursing care,” in Standarch, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2001) 199-201. 2 1. S Beyea, ed, Perioperative Nursing Data Set. The Perioperative Nursing Vocabulary, second ed (Denver: AORN, Inc, 2002, in press). 22. C S Ladden, “Concepts basic to perioperative nursing,” in Alexander 5. Care of the Patient in Surgery, 1lth ed, M H Meeker, J C Rothrock, eds (St Louis: Mosby, Inc, 1999) 6-13; J Gill et al, “Incorporating nursing diagnosis and King’s theory in the OR documentation,” Canadian Operating Room Nursing Journal (MarcWApril 1995) 10-11; Blais, “Perioperativenursing process,” 271-272,280,284,286288; Fortunato, Berry & Kohn S Operating Room Technique,ninth ed, 19-24. 23. L C A Simunek, “Legal and ethical dimensions of perioperative nursing practice,” in Perioperative Nursing: Principles and Practice,
852 AORN JOURNAL
second ed, S S Fairchild, ed (Boston: Little, Brown and Co, 1996) 390394; Blais, “Perioperativenursing process,” 286-290; B J Gruendemann, B Femsebner, ComprehensivePerioperative Nursing, Volume I: Principles (Boston: Jones and Bartlett Publishers, 1995) 95. 24. L K Groah, “Anesthesia,” in Perioperative Nursing, third ed, L K Groah,ed (Stamford, Conn: Appleton & Lange, 1996)245,248; A Ferran, “Anesthesia and perioperative nursing implications,” in Perioperative Nursing. Principles and Practice, second ed, S S Fairchild, ed (Boston: Little, Brown and Co, 1996) 105. RESOURCES Burden, N. “Ambulatory approach: A case study: Identification and treatment of narcotic depression in the ambulatory surgical patient,” Journal of Post Anesthesia Nursing 10 (April 1995) 94-99. Burden, N; Iyer, J. “Ambulatory approach: Local anesthesia: Not always benign,” Journal of Post Anesthesia Nursing 2 (February 1987) 45-50. Chang, W K, Mulford, G J. “Iatrogenic txigeminal sensorimotor neuropathy resulting from local anesthesia: A case report,” Archives of Physical Medicine and Rehabilitation 81 (December 2000) 1591-1593. Kern, K; Langevin, P B; Dunn, B M. “Methemoglobinemiaafter topical anesthesia with lidocaine and benzocaine for a difficult intubation,” Journal of Clinical Anesthesia 12 (Mach 2000) 167-172. Schecter, W P; Swisher,J L. “Local anesthesia in surgical practice,” Current Problems in Surgery (Jan~w 2000) 10-66.