CNA532 - Nursing - Anaesthetics And Recovery Nursing - Brian Jones - Case Study - Assignment Help

CNA532: Anaesthetics And Recovery Nursing  Brian Jones Case Study Assignment Help

Assessment Task:

Brian Jones, 67 years old, was admitted to theatre for laparoscopy/laparotomy to investigate anaemia and abdominal pain (patients name changed to ensure
confidentiality). Brian had a history of ankylosing spondylitis (AS) and on examination had severe kyphosis and limited mouth opening due to temporomandibular joint involvement. Airway assessment revealed minimal cervical spine mobility, inability to assess mallampati score on direct laryngoscopy and absence of subluxation (Cook & Simpson, 2013 in Hamlin et al 2016, p. 195). Thyromental distance was less than 6cm indicating difficult or impossible laryngoscopy (Padley 2015, p. 173).
Tracheal intubation remains the most common technique for laparoscopic surgery. This technique allows for protection from gastric secretions, neuromuscular relaxation and positive pressure ventilation (Hayden & Cowman 2011, p. 177). In patients with AS awake fibreoptic intubation (AFOI) is considered the safest option for tracheal
intubation (Woodward & Kam 2009, p. 540). A primary plan of nasal AFOI was discussed and equipment prepared. Additional difficult airway equipment and other adjuncts were available. A backup plan of a  blade on CMAC was ready for use. Brian consented to the procedure following discussion. IV access was established and
he was sedated with Midazolam. Following topical anaesthesia to the airways multiple attempts at nasal AFOI were attempted. Brian became increasingly distressed and the procedure was abandoned. A decision was made to progress with oral tracheal intubation utilising the CMAC with D blade. Brian was anaesthetised with propofol and
suxamethonium and intubation was successful.

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