Anesthetic care

from Wikipedia, the free encyclopedia

The anesthesia care is a portion of the nursing and includes the nursing activities within the scope of anesthesia . The profession is carried out by health and nursing staff or specialist nurses for intensive care and anesthesia , who assist the anesthetist in the preparation, implementation and follow-up of the anesthesia (applies to Germany).

education

In principle, a completed training as a health care professional is necessary to work in anesthesia care. In addition, specialist training to become a specialist nurse for intensive care and anesthesia can be completed.

For some years now, the three-year training to become an anesthesiologist has also been offered. This authorizes the use in operative functional areas as well as in recovery rooms, but not in wards.

history

Until the 1960s, anesthesia was performed by the surgeons themselves, by nurses or medical students under their supervision. In the 1950s, the first demands arose for special training courses for "anesthetic nurses", which were offered at the beginning of the 1960s in individual hospitals, for example in Freiburg im Breisgau , Munich or the Bundeswehr Central Hospital in Koblenz according to different guidelines. Shortly before that there was the first specialist in anesthesia in Germany . In 1964, the first systematic specialist training began in Mainz over two years.

tasks

An anesthetist and an anesthetist work together as a team in an operating theater . The work of the nurse consists of preparation and assistance. This includes the preparation and regular checking of the anesthesia machines, the monitoring monitors and other monitoring devices, preparation of the anesthetics and other necessary medication.

Before the induction of anesthesia , the patient is connected to the monitoring equipment by the nurse and a venous access is established for infusions. The induction of anesthesia itself, maintenance and recovery are medical tasks with which the nurse assists.

Another task is the positioning of the patient on the operating table, for which the doctor is generally responsible (the anesthetist during induction of anesthesia, the surgeon from the start of the operation). Usually, however, the positioning is delegated to the appropriate nursing staff, for example a specialist for surgical positioning .

In addition to the anesthesiologist, the anesthesiologist is responsible for handing the patient over to the recovery room , which is also occupied by the anesthesia or intensive care staff, the post-processing of the anesthesia workstation and the hygienically correct reprocessing of used materials.

In the recovery room, depending on the type of operation, patients are closely monitored for up to several hours with the help of the surveillance monitor until they are transferred back to the ward.

In some hospitals, the emergency room and in-house resuscitation are also looked after by the anesthetist.

Future prospects

Since around the beginning of the 21st century there have been pilot projects in Halle / Saale and Frankfurt / Main to train anesthesia technical assistants (ATA), but these are not included in the nursing profession.

In the HELIOS-Kliniken-Group there has been an internal, one-year advanced training program for anesthesiologists to become Medical Assistants for Anesthesia (MAfA) since 2004 . On March 9, 2007, the MDR reported that HELIOS had ended the program. The MDR report spoke of a "highly controversial program for organizing anesthesia" and referred to a previously unresolved incident. It says: “One and a half years ago, a high school graduate suffered cardiac arrest during a routine operation at the Helios Clinic in Erfurt . His brain was badly damaged. A MAfA was used during the anesthesia. Helios, however, denies a connection. ”Also on March 9, 2007, HELIOS Kliniken GmbH announced a new“ Group Regulation on Anesthesia ”, with which doctors are instructed not to use the MAfA beyond the framework prescribed by the medical specialist associations.

Both approaches are controversial because they include the concept of parallel anesthesia, i.e. an ATA / MAfA is responsible for each patient, while the anesthetist only comes in for induction, diversion and problems so that he can supervise several anesthesia at the same time. This practice, which saves staff and therefore costs and is common in other European countries, is supported by the professional associations of anesthesiologists, the German Society for Anesthesiology and Intensive Care Medicine (DGAI) and the Professional Association of German Anesthesiologists (BDA) in the "Münster Declaration on Parallel Anesthesia " for legal and qualitative reasons clearly rejected.

Individual evidence

  1. ↑ Information from the University of Halle on ATA training accessed on March 6, 2019
  2. ^ Münster declaration on parallel anesthesia (.pdf) accessed on March 6, 2019
  3. ↑ Erik Hahn: The use of non-medical anesthesia assistants in the context of parallel anesthesia - A legal consideration KU Gesundheitsmanagement 08/2008, pp. 34–36

Spickhoff / Seibl , MedR 2008, 463–473, Liability aspects of the delegation of medical services to non-medical medical staff with special consideration of anesthesia

literature

  • Lothar Ullrich, Dietmar Stolecki, Matthias Grünewald (eds.): Thiemes intensive care and anesthesia , Georg Thieme Verlag, 2006, ISBN 3131309105
  • Rainer Christ: Anesthesia, intensive medicine, intensive care , Elsevier GmbH Germany, 2004, ISBN 343725717X
  • Eva Knipfer, Martin Allgeier: Clinical Guide Anesthesia Care , Elsevier GmbH Germany, 2006, ISBN 3437274503

Web links