Anaesthetic care

Anaesthetic care In the following text I the author will provide an account of the anaesthetic care given to a paediatric patient in my care during a surgical procedure to repair her cleft palate. I will discuss the rationale behind the chosen anaesthetic technique and will analyse why the method was identified as the most suitable backing the findings up with related literature. The text will explore the care given to the patient and the preparation needed to ensure a safe procedure starting from the pre-assessment visit right to the anaesthetic room looking at the roles of some of the multi disciplinary team members involved in the child’s care. An episode of care for any individual patient is a complex series of interactions that make up the process of care. The recipient of this anaesthetic care is an 8-month-old female, who, as patient confidentiality forbids the use of her real name (NMC 2002a) shall be known as Eve. Eve was born at 41 weeks gestation, during a routine prenatal scan at 23 weeks gestation an abnormality of her facial structure was noted, her parents were informed of this and counselling and advice was offered. The extent of the abnormality was not seen until Eve was born. She was born with a unilateral cleft lip and palate, which is were there is a single cleft of the lip, and the hard, and soft palate are also divided (Shprintzen and Bardach 1995) but was otherwise fit and well. In accordance to Watson et al 2001 clefts of the lip and palate may be isolated deformities or may be a part of a syndrome. Eve has not been diagnosed with a syndrome there for this is an isolated deformity. Watson (2001) suggests that non-syndromic clefts are multi-factorial in origin and could occur due to gene involvement, various environmental factors or embryo development in relation the mothers life choices during pregnancy i.e. excessive alcohol, drug abuse etc. Eve had previously undergone the first stage of the surgery, which was a repair to her cleft lip. This is done between the ages of two and four months within our trust. This is mainly due to cosmetic reasons but also to encourage oral feeding and sucking and to encourage the tissues to grow at the same rate as the child’s facial structure (Watson Et al, 2001). Eve was admitted to hospital the day prior to her surgery. Eve’s mother had requested this rather than attending pre-admission clinic as she had problems with transportation to the hospital. This highlights good communication (Department of Health, 2003) between the nursing staff and Eve’s mother, which is of benefit to both the child and the family’s needs (Clayton, 2000). The Department of Health (1989) states that the welfare of the child is paramount, however Smith and Daughtrey (2000) believe that it is also important to ensure that parental needs are also met. Wong (1999), states that good family centred care is considerate of all family members’ needs and not only the needs of the child. The initial assessment of Eve involved her primary nurse, Eve and her mother Joanne. The cleft palate pathway was used as assessment aid and highlighted any needs that Eve and her family had. The anaesthetist (Dr A) then examined Eve and was able to explain the procedure to Eve’s mother. This meeting with Dr A provided Eve’s mother with both verbal and written information therefore equipping the family with knowledge and support (Summerton, 1998).