Anesthesia Cases in ICU

Quick Tips:

  1. Anesthesia team must use bedside (nursing) computer for vitals to flow into anesthesia record
  2. Use the "Case in ICU" macro and make sure to hit "Start Out of OR Vitals" and "Stop Out of OR Vitals" 
  3. Bring your own meds and document them in anesthesia record (not documented by bedside RN)
  • Team performing the procedure should book the case as they usually would for an OR case and coordinate with the OR front desk to schedule it.
  • Primary RN to confirm consents have been obtained appropriately
  • Ensure Respiratory Care Services is aware of case
  • Perform preop evaluation, anesthesia consent, and fill in pre-procedure evaluation note in Epic as you would for OR case
  • Confirm availability of meds, monitors, access, and safety equipment
    • EtCO2
    • Pulse oximetry
    • Blood pressure cuff, arterial line if indicated
    • Cardiac telemetry
    • Oxygen source, mask, vent if indicated
    • Airway equipment (consider bringing full anesthesia cart vs ICU airway cart)
    • Self-inflating resuscitation (ambu) bag
    • Suction/yankauer
    • Sedation/anesthesia meds (anesthesia team responsible for bringing)
    • Emergency meds (consider full anesthesia cart)
    • Patent IV, free flowing line with stopcocks
  • Anesthesia must document on bedside computer in order to bring vitals into anesthesia intraop record.  Primary RN to document on computer on wheels.
    • Open Intraop record as usual
    • Select Macro > Public > Case in ICU. 
    • To collect vitals, make sure to chart the Events “Start Out of OR Vitals” at the start of the case and “Stop Out of OR Vitals” at the end.  If not using the macro, find these Events under the “ICU” tab in Events.
    • Chart vent mode/data manually (it will not flow from Philips monitor or ICU vent)
  • Anesthesia team should document all meds given during case
    • If meds ordered and pulled from ICU Omnicell, anesthesia team should document off of the order using the Active tab within Meds. 
    • Meds brought by anesthesia team can be documented as usual as one-step meds

Protocol adapted from full "Procedural Cases in ICU Requiring Anesthesia", available on DPH intranet.

Updated Jan 2023 by A Wight