TYPES AND STAGES OF ANESTHESIAWITH THEIR NURSING

RESPONSIBILITIES

Types of Anesthesia
1.

General Anesthesia
- a state of analgesia and complete loss of consciousnessas a direct result of anesthesia
agents.

Intravenous Administration
(barbiturates, benzodiazepines, non-barbiturate hypnotics, dissociative agents, and
opioid agents)- Used as an induction agent before the client is induced withinhalation
agents- Advantage: The onset of anesthesia is pleasant; no buzzing, roaring,or dizziness
during and after administrationNursing Responsibilities1.

a method of oxygen administration should always be available.2.

monitor the vital signs to determine any deviations orcomplications.

Inhaled Anesthesia-
This includes volatile liquid agents and gases.Volatile liquid anesthetics produce
anesthesia when their vapors areinhaled.

- Used to progress client from stage II to stage III anesthesiaNursing Responsibilities1.

Monitor vital signs frequently2.

Observe for possible respiratory depression3.

Monitor for malignant hyperthermia4.

Monitor for dysrhythmias5.

Make sure to attach ground pad to decrease risk for fires

Rectal-
Although most general anesthetics can be used by themselvesin producing loss of
consciousness, some are often used together. Thisallows for more effective anesthesia in
certain patients.
STAGES OF GENERAL ANESTHESIAStage 1: Beginning Anesthesia
- As the patient breathes in the anesthetic mixture,warmth, dizziness, and a feeling of
detachment may be experienced. The patientmay have a ringing, roaring, or buzzing in
the ears and, although still conscious, maysense an inability to move the extremities
easily. During this stage, noises areexaggerated.Nursing Responsibilities1.

The environment must be calm and quiet; devoid of any extraneousnoise that could
result in uncontrolled patient movement
Stage II: Excitement -
It is characterized by struggling, shouting, talking, singing,laughing, or crying; this is
often avoided if the anesthetic is administered smoothlyand quickly.

The pupils dilate, but they contract if exposed to light; the pulse rate israpid, and
respirations may be irregular.

Nursing Responsibilities1.

Because of the possibility of uncontrolled movements of the patientduring this stage, the
anesthesiologist or anesthetist must always beassisted by someone ready to help restrain
the patient.2.

A strap may be in place across the patient’s thighs, and the hands may
be secured to an armboard.3.

The patient should not be touched except for purposes of restraint butrestraints should
not be applied over the operative site.4.

Manipulation increases circulation to the operative site and therebyincreases the

potential for bleeding, so nurses should be really carefulwhile restraining the patient.
Stage III: Surgical Anesthesia-
Surgical anesthesia is reached by continuedadministration of the anesthetic vapor or
gas. The patient in unconscious and liesquietly on the table. The pupils are small but
contract when exposed to light.Respirations are regular, the pulse rate and volume
are normal, and the skin is pinkor slightly flushed.

Nursing Responsibilities1.

Maintain patient’s airway

2.

Prevent complications from happening such as anaphylaxis,hypothermia, malignant

hyperthermia, DIC, and do therecorresponding nursing responsibilities3.

Prevent stage 4 anesthesia from occurring

Stage IV: Medullary depression-
Reached when too much anesthesia has beenadministered. Respirations become
shallow; pulse is weak and thread, and thepupils become widely dilated and no longer
contract when exposed to light.Cyanosis develops and, without prompt intervention,
death rapidly follows.

Nursing Responsibilities1.

Prepare emergency cart2.

Always be ready for doctor’s orders

3.

Regional Anesthesia4.

An anesthetic agent is injected around nerves so that the regionsupplied by these nerves
is anesthetized. The patient receivingregional anesthesia is awake and aware of his or
her surroundings.
2.

Regional AnesthesiaTYPES OF REGIONAL ANESTHESIA

Topical

–
application of the agent directly to the skin, mucous membranes, oropen surface.
Eutectic mixture of local anesthetics (EMLA cream), acombination of lidocaine and
prilocaine, can be applied to the skin to producelocalized dermal anesthesia. EMLA
should be applied to the site 30 to 60minutes before painful procedures.

Local Infiltration
–
injection of the agent into the tissues through which thesurgical incision will pass.

Field block

Nerve block
–
Regional (peripheral) nerve block is achieved by theinjection of a local anesthetic into
or around a specific nerve or groupof nerves. Nerve blocks may be used to provide
intraoperativeanesthesia and postoperative analgesia and for the diagnosis
andtreatment of chronic pain.

- Examples of common regional nerve blocks include brachial plexus,intercostals, and

retrobulbar blocks.

Intravenous Regional
–
Intravenous regional nerve block (Bierblock) is the IV injection of a local anesthetic into
an extremityfollowing mechanical exsanguinations using a compression bandageand a
tourniquet.-A fully functioning tourniquet is a necessity. Function and status ofthe
tourniquet should be checked and documented immediatelybefore use. This type of
block provides not only analgesia, but also theability to work in a bloodless field.

Spinal
–
Spinal anesthesia is an extensive conduction nerve block thatis produced when a local
anesthetic agent is introduced into thesubarachnoid space at the lumbar level,
usually between L4 and L5. Itproduces anesthesia of the lower extremities, perineum,
and lowerabdomen.

Epidural block
–
Involves injection of a local anesthetic into theepidural (extradural) space via either a
thoracic or lumbar approach.Epidural anesthesia is commonly used for obstetrics,
vascularprocedures involving the lower extremities, and hip and kneereplacement
surgeries.- One advantage of epidural (extradural) injection is a decreasedincidence of
headache.

Acupuncture

–
activates A-
δ and C aff
erent fibers in muscle, causing signalsto be transmitted to the spinal cord, which then
results in a local release ofdynorphin and enkephalins.-These afferent pathways
propagate to the midbrain, triggering a sequence ofexcitatory and inhibitory mediators
in the spinal cord