Anaesthetic Practice

The patient will be referred to as "the patient" throughout this assignment. I intend to utilise Driscoll’s (2000) model of reflection (appendix 1) to discuss and analyse my role within perioperative practice and management of this emergency situation. This model provides a structured framework of three main elements with keys questions. According to Driscoll &amp. Teh (2001:95) reflection helps practitioners to make more sense of difficult and complex practice.
The first step in the Driscoll’s model is "What", "returning to the situation". This critical incident occurred in a 68-year-old patient for elective hip replacement, on the orthopedic list, scheduled for spinal anesthetic with sedation. This was the last operating theatre operating late in the evening, this was the last case. therefore the department was quiet with only one team working. I was the senior practitioner on that shift. I accompanied the consultant anaesthetist on the preoperative ward round. According to Wicker &amp. O’Neill (2006) the anesthetic practitioners role begins prior to the patient entering operating theatres and suggests the advantages of preoperative visiting helps to gain information to plan the patient’s care.
As part of my role prior to the commencement of the orthopedic operating list was to set up the equipment myself with a check on the operating room environment, full drugs check, anticipating any emergency (Chambers et al. 2002 : 272). All the necessary checks on monitoring and equipment were performed and documented in accordance with (The Association of Anaesthetists of Great Britain and Ireland 2004) (AAGBI) guidelines. Controlled drugs and all cupboard medication were checked in line with local policies, pharmacy "A-Z medicines required for theatre stock protocol". Wicker &amp. O’Neil (2006:93) discuss practitioners developing safe working practices, including preparation of drugs before the operating list.
The patient’s journey from the ward to the operating theatre was as planned, the spinal anaesthetic was successful, patient was sedated, positioned with assistance from the surgeon, and oxygen was administered via face mask at 5 litres, then transferred to the operating theatre and connected to the monitors. "Time Out" the "STOP", moment in theatre (World Health Organization, 2009) (WHO), Surgical Safety Checklist (Appendix 2) was implemented with no allergies verbalised by me, the allergy elements on the care pathway and theatre check list were checked by the scrub practitioner and written on the theatre patient/procedure information board by me.
The surgeon requested a perioperative dose of antibiotic shortly after surgery commenced. I brought in the antibiotic Cefuroxime into the theatre for administration by the anesthetist. A few minutes after this was injected, the patient rapidly became pale, clammy and diaphorectic, the monitor alarmed showing the oxygen saturation dropping from 99% to 88%, the blood pressure and heart rate reduced dramatically. The anesthetist requested a pressure bag to increase the