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Angeles University Foundation Angeles City College of Nursing

Anesthesia

A written report about anesthesia its history, types, uses and possible complication. In partial fulfilment of therequirements in Related Learning Experience 102.

Submitted to:

Anita Viray, RN, MN

Submitted by:

Johnrey I. MagcalingGroup 17; III-5

07-0132-335

Anesthesia,

has traditionally meant the condition of having sensation(including the feeling of pain) blocked or temporarily taken away. This allowspatients to undergo surgery and other procedures without the distress andpain they would otherwise experience. The word was coined by OliverWendell Holmes, Sr. in 1846. Another definition is a "reversible lack of awareness," whether this is a total lack of awareness (e.g. a generalanesthetic) or a lack of awareness of a part of the body such as a spinalanesthetic or another nerve block would cause. Anesthesia is apharmacologically induced reversible state of amnesia, analgesia, loss of

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Anesthesia

consciousness, loss of skeletal muscle reflexes and decreased stressresponse.Surgical anesthesia is intended to render the patient insensitive topain. In a typical clinical procedure, known as

balanced anesthesia

, thepatient is premedicated with a sedative intended to relieve pre-operativeanxiety and facilitate the induction of anesthesia itself (often this is abenzodiazepine such as diazepam or midazolam; otherwise, a barbituratesuch as thiopental or nonbenzodiazepine such as propofol may perform thisfunction). Sedation is followed by the induction of general anesthesia byintravenous injection of a sedative, narcotic (e.g., morphine, fentanyl,alfentanyl), or ketamine. In addition, a nondepolarizing curare-like derivative(e.g., vecuronium, d-turbocurarine) or a depolarizing drug (e.g.,succinylcholine) is administered to induce muscle paralysis. After intubationand connection to a ventilator for artificial respiration, general anesthesiamay be maintained by a mixture of oxygen and nitrous oxide, often incombination with a volatile agent (e.g., halothane, enflurane, or isoflurane)or intravenous drug. At the conclusion of the surgery, muscle relaxation isreversed (e.g., by neostigmine or other anticholinesterase), and normal(unassisted) breathing is restored. In addition, the patient may be given ananalgesic agent (e.g., morphine) to manage any acute pain experiencedpostoperatively.Another method, commonly used in office procedures and outpatientsurgery, is known as "conscious sedation". In this procedure, the patient issedated by barbiturates (e.g., sodium pentothal) or benzodiazepines (e.g.,Valium), and receives a local or regional anesthetic (e.g., Novocain). Becauseno general anesthetic is involved, the patient never loses consciousness. Heor she remains awake and able to move during the procedure, and caninteract with the medical team, but feels no pain. Because of the amnesicproperties of most sedative drugs, the patient may have no memory of theprocedure after it is over. Some surgical procedures are appropriatelyperformed with only local or regional anesthesia. Examples include the useof Novocain for routine dental work, or epidural blocks in obstetrics. Withoutsedation or anesthesia, the patient remains fully aware during theprocedure, and retains conscious memory for the events of surgery. Inneurosurgery, for example, patients are not commonly anesthetized becausethe brain has no afferent neurons to conduct pain messages.

HISTORY OF ANESTHESIA

Anesthesia for surgery was introduced in America only in the 1840s.Before this time, surgical patients were simply expected to withstand thepain of the procedure. Alternatively, they were intoxicated with alcohol oropiates (e.g., laudanum). Humphry Davy (1778-829), a famous Englishchemist, discovered through self-experimentation that nitrous oxide relievedheadache and dental pain, but his report went unnoticed in the medialcommunity; it did, however, led to the use of "laughing gas".

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