SEDATION & ANESTHESIA Stage 2: Excitement

- State of “Narcosis” - START: during LOC

- Anesthetics can produce muscle relaxation, - END: loss of eyelid reflexes
block transmission of pain nerve impulses - There is increase in autonomic activity,
and suppress reflexes irregular breathing and may struggle
- It can also temporarily decrease memory
retrieval and recall Nursing Intervention
- The effects of anesthesia are monitored by - Assist anesthetist in restraining the client
considering the following parameters: - Touch the client only for purpose of
o Respiration restraint
o O2 saturation
o CO2 levels Stage 3: Surgical Anesthesia
o HR and BP - START: loss of eyelid reflexes
o Urine output - END: loss of most reflexes is present and
there is depression of vital functions
Four Levels of Sedation - Client is UNCONSCIOUS, relaxed muscles,
1. Minimal Sedation blink and gag reflexes are absent
- Drug induced state during the client cant
respond normally to verbal command Nursing interventions:
- Begin preparation for surgery only when
2. Moderate Sedation anesthetist indicates stage 3 has been
- May be administered thru IV reached and client is breathing well, with
- Depressed level of consciousness that does stable VS
not impair the client’s ability to maintain
patent airway Stage 4: Medullary Depression
- START: functions are excessively depressed
3. Deep Sedation - END: Indicates respiratory and circulatory
- Client can not be easily aroused and failure
respond purposefully after the repeated - The client is not breathing; the heartbeat
stimulation may or may not be present

Four Levels of Anesthesia Nursing intervention

Stage 1: Beginning Anesthesia (Onset) - If arrest occurs, respond immediately to
Stage 2: Excitement assist in establishing airway
Stage 3: Surgical Anesthesia - Provide cardiac arrest tray; drugs, syringes,
Stage 4: Medullary Depression long needles;
- Assist surgeon with closed or open cardiac
Stage 1: Beginning of Anesthesia massage
- START: during anesthetic administration
- END: during LOC TYPES OF GENERAL ANESTHESIA
- Client may be drowsy/ dizzy with possible 1. Intravenous Anesthesia
auditory or visual hallucinations 2. Inhalation Anesthesia

Nursing Interventions: Intravenous Anesthesia

- Close the door - Rapid induction
- Avoid unnecessary noises or motions when - Unconsciousness occur 30 sec after the
anesthesia begins administration
- Stand by to assist client - Promotes rapid transition from conscious to
surgical anesthesia stage
- Prepare client for a smooth transition to the
surgical anesthesia stage since IV
anesthetics has calming effects
- Ex. Thiopental sodium and ketamine
DRUG Induction and Comments Spinal Anesthesia
Recovery - Used for surgical procedures involving the
Thiopental Rapid onset and Standard induction agent,
rapid recovery cardiovascular lower half of the body
(bolus dose) slow depression, avoid in - Any procedure performed below the level
recovery following porphoryia of the diaphragm (e.g. hysterectomy,
IV infusion appendectomy)
Ketamine Moderately rapid CV stimulation, inc
onset and recovery cerebral blood flow,
- Anesthetic technique of choice for older
emergence reactions adults
impair recovery - Benefits
Fentanyl Slow onset and Used in balanced o Relative safety
recovery, naloxone anesthesia and conscious
o Excellent lower-body relaxation
reversal available sedation, marked
analgesia o Absence of the effect of
Midazolam Slow onset and Used in balanced unconsciousness
recovery flumazenil anesthesia and conscious o Does not require emptying of the
sedation, cardiovascular
stomach
stability, marked amnesia
Propofol Rapid onset and Used in induction and for - Achieved by injecting local anesthetics into
rapid recovery maintenance, the subarachnoid space
hypotension, useful
antiemetic action Epidural Anesthesia
Etomidate Rapid onset and CV stability, dec
moderately fast steroidogenesis, - Epidural block is achieved by introduction of
recovery involuntary muscle an anesthetic agent into the epidural space
movements (entered by a needle at a thoracic, lumbar,
sacral or caudal interspace)
Inhalation Anesthesia - Provide a blockage of the autonomic nerves
- A mixture of volatile liquid or gas and and hypotension can result
oxygen is used - Respiratory muscles are affected,
- Ease of administration and elimination respiratory depression or paralysis may
through the respiratory system occur if the level of block is too high
- Usually used to maintain the client in stage Caudal Anesthesia
3 anesthesia following induction - Produced by injection of the local
- Mixture is given through mask or an ET tube anesthetic into the caudal or sacral canal.
(ET tube is inserted once the client is This is a variation of epidural anesthesia.
paralyzed and unconscious) This method is commonly used with
- Commonly used inhalation anesthetics are obstetric clients
halothane and isoflurane
- Nitrous oxide Topical Anesthesia
- Agents may be applied directly on the area
Inhaled anesthetics to be desensitized
1. Nitrous Oxide - May come in a form of a solution, an
2. Desflourane ointment, cream or powder
3. Sevoflurane - A short-acting anesthesia that can block
4. Isoflurane peripheral nerve endings in the mucous
5. Enflurance membranes of the vagina, rectum,
6. Halothane nasopharynx, and mouth
7. Methoxyflurane
Local Infiltration Anesthesia
Types of Regional Anesthesia - Involves the injection of an anesthetic agent
1. Spinal Anesthesia into the skin and subcutaneous tissue of the
2. Epidural Anesthesia area to be anesthetized
3. Topical Anesthesia - Lidocaine (xylocaine)
4. Local Infiltration Anesthesia - Block only the peripheral nerves around the
5. Filed Block Anesthesia area of incision
6. Peripheral Nerve Block Anesthesia
Filled Block Anesthesia B. Trendelenburg
- Injected and infiltrated into the area - Permits displacement of intestines into
proximal to the planned incision upper abdomen
- Block forms a barrier between the incision - Often used during surgery of lower
and the nervous system abdomen or pelvis
C. Lithotomy
Peripheral Nerve Block Anesthesia - Exposes perineal and rectal areas
- Anesthetizes nerve or nerve plexus rather - Vaginal repair, D&C, rectal surgery
than all the local nerves anesthetized by a D. Prone
filed block - Cervical spine
- Commonly used drugs lidocaine, - Posterior fossa craniotomy
bupivacaine and mepivacaine - Back, rectal and posterior leg
E. Lateral
Complications and Discomforts of Anesthesia - Kidney, chest or hip surgery
1. Hypoventilation – inadequate ventilatory F. Jack Knife
support after paralysis of respiratory G. Reverse Trendelenburg
muscles - Rectal procedures
2. Oral Trauma H. Functional Ongcologic & Technical
3. Malignant Hyperthermia – uncontrolled procedure
skeletal muscle contraction
4. Hypotension – d/t preoperative Surgical Incisions
hypovolemia or untoward 1. Kocher’s incision
5. Cardiac Dysrhythmia – d/t preexisting CV 2. Midline incision
compromise, electrolyte imbalance or 3. Gridion muscle splitting
untoward selection to anesthesia 4. Battle incision
6. Hypothermia – d/t exposure to cool 5. Lanz incision
ambient OR environment and loss of 6. Paramedian
thermoregulation capacity from anesthesia 7. Transverse
7. Peripheral nerve damage – d/t improper 8. Rutherfold Morrison incision
positioning of pt or use of restraint 9. Pfannestiel
8. Nausea & Vomiting
9. Headache 2. Provide Equipment Safety
- Counting of needles, sponges and
Maintaining Safety and Preventing Injury instruments are performed by the
1. Position the Client circulating nurse and the scrub nurse must
Consider client’s be done;
- Site of operation a. The initial incision
- Age b. During the surgery
- Size of client c. Immediately before the incision is
- Type of anesthetic used closed
- Pain normally experienced by the client on - A final correct count is announced to the
movement surgeon and charted on the intraoperative
Position must: chart
- Not hinder respiration/circulation
- Nor apply excessive pressure to skin 3. Maintain Surgical Asepsis
surfaces - Ensure the sterility of supplies and
- Not Limit surgical exposure equipment
- Ensure all members of surgical team use
Surgical Positions sterile technique to minimize postop
A. Dorsal Recumbent (supine) infections
- Commonly used for CAB, hernia repair, - Be an advocate in maintaining sterile
mastectomy, bowel resection surgical environment
4. Assisting w/ wound closure
- Anticipate the type of closure needed and
obtain the supplies necessary for wound
closure
- If a surgical drain is used, assess whether
the drainage is flowing freely through the
system
- Monitoring of the drain’s patency and the
characteristic of the drainage is continued
when the client is transferred out of the
operative area

5. Monitoring
- Monitor body temperature and watch out
for signs of hypothermia
- Offer a blanket to the client immediately
upon transfer to the operating room bed
- Report the lowest core body temperature
to the postoperative nurse when
transferring the client after surgery
- Thermal blankets may be provided
- IV solutions can be warmed to assist
maintaining warm body temperature
- Monitor for malignant hyperthermia, a
genetic disorder characterized by
uncontrolled skeletal muscle contraction
leading to potentially fatal hyperthermia
o This condition can occur 30 min of
anesthesia induction or several
hours after surgery
o Initial manifestation is increased
end-tidal CO2 jaw muscle rigidity,
cardiac dysrhythmias, and a
hypermetabolic state caused by
anesthetic agents (succinylcholine)
- Monitor for respiratory and cardiac arrest.
Although an arrest is a rare occurrence,
everyone inside the operating room should
know where the crash kart is kept so
immediate management could be
administered
- Monitor for uncontrolled hemorrhage and
secondary allergic reactions from drugs and
latex