Classification of Stage of General Anesthesia, Nsg Common position & Nsg.

on position & Nsg. Common anesthesia agents used, adv, Major complication of
Anesthesia , adv, Mgt., rationale considerations during disadvantage, Nsg. consideration, anesthesia per organ system,
disadvantage, Nsg int. , induction of anesthesia and rationale, desired effects Nsg. Mgt. rationale
rationale post-op phase

A. General Anesthesia ONSET INHALATION ANESTHETIC RESPIRATORY

POSITIONS IN INDUCTION OF AGENTS COMPLICATIONS
Duration : ANESTHESIA
 Loss of all sensation
 FROM Induction stage TO  Respiratory
and consciousness. Loss of consciousness Spinal Anesthesia Nitrous Oxide
obstruction
Protective reflexes bispectral state of 100  The patient is supine
with safety strap in place. Advantages :
such as are lost Nsg. Management :
Nsg Mgt : Following induction, the  The incidence of nausea and
- supplemental oxygen
 Close suites door airway is maintained by vomiting is minimal.
while corrective
Advantages :
 keep room quiet insertion of endotracheal  Adverse effect can be quickly
measures are
 Because the client is tube if the patient’s reversed.
 stand by to assist initiate undertaken. Jaw
cricoid pressure as requested position for surgery is to  Excellent procedure that does
unconscious rather thrust, head-tilt, oral or
be other than supine not produce severe pain.
then awake and  Continuous pulse nasal airways
(e.g. side-lying) or
anxious, respiration oximetry (SpO2) lithotomy. Disadvantages : Rationale :
and cardiac function  Left lateral decubitus  can cause bowel distention - incomplete anesthetic
Rationale :  can cause displacement of
position recovery,
are readily regulated.  prevent movement of air that
 Sitting position tympanoplasty grafts and laryngospasm, airway
 The anesthesia can can alter the sterility of the increase ICP
 Lateral position edema, wound
be adjusted to the induction site  cannot be used during
 Prone position hematoma, and vocal
 unnecessary noises are not laparoscopy
length of the cord paralysis. Airway
therapeutic to patient  there is no muscle relaxation can
Nsg. Consideration : obstruction in
operation and the  reduce the risk of the cause possible laryngospasm
 Always ask permission unconscious patients is
client’s age and aspiration of stomach from the patient when  hypoxia is a hazard and has a most commonly due to
physical status. contents during induction changing position depressant effect on myocardial the tongue falling back
 allows for early detection  Explain the rationale why contractility against the posterior
of a fall in a is that there is a need to pharynx
Disadvantages : Nsg. Considerations :
patient's hemoglobin change position
 It depresses the  Provide full-support to  monitor heart rate, chest pain,
 saturation with oxygen
respiratory and the patient hypertension and stroke  Hypoxemia
 Strap the patient when  check respiratory rate before
circulatory systems. EXCITEMENT induction
needed Nsg. Management :
 Some clients - oxygen therapy with or
Duration : Rationale : without positive airway
become more
 FROM Loss of  Effects of nitrous oxide can pressure
anxious about a consciousness TO cause alteration of HR, BP etc.
general anesthetic Relaxation bispectral state 70  NO2 can cause respiratory Rationale :
that about the - 50 irregularities - Increased
surgery itself. Often intrapulmonary
Nsg Mgt : shunting relative to
this is because they  Secure patient properly closing capacity is the
 fear losing the  remain at the side of the most common cause of
capacity to control patient quietly but ready to
assist anesthesiologist as hypoxemia following
their own bodies. needed general anesthesia
 Desired effects :
Nsg. interventions : Rationale :  warm sensations  Laryngospasm and
 Ensure safety to  At this stage respiration and  A feeling of well-being, euphoria laryngeal edema
patient heart rate may become and/or floating. During heavier
sedation, hearing may dissolve Nsg. Management :
 Monitor VS irregular. In addition, there
into a constant, electronic-like - treatment includes
may be uncontrolled 100% oxygen, anterior
throbbing
Rationale : movements, vomiting,  At a deeper level of sedation mandibular
breath holding, and again, sleepiness, difficulty to displacement and
 General anesthesia
pupillary dilation thus keep one's eyes open or speak administer humidified
can alter the monitor the patient oxygen by mask,
("dream") can occur
patient’s properly to avoid risking inhalation of racemic
consciousness which the patient Halothane (Fluothane) epinephrine, repeated
 To provide close every 20 minutes,
endanger the patient hydrocortisone IV may
monitoring of the patient Advantages :
from fall and other  nonflammable, potent, versatile, be considered.
mechanical accident chemically stable and rapid Reintubation with a
 has a smooth induction smaller tube may be
SURGICAL ANESTHESIA
 makes possible of high O2 helpful
B. Regional
Duration : concentration for adequate
Anesthesia ventilation Rationale :
 FROM Surgical Anesthesia
 permits early intubation because - a forceful involuntary
stage of Relaxation TO Loss
of minimal larygeal irritation spasm of the laryngeal
 Temporary of reflexes;
musculature caused by
 Depression of vital functions  ventricular arrythmias are rare
interruption of the sensory stimulation of
bispectral state 40.  useful for patients with bronchial
transmission of the superior laryngeal
asthma because it reduces
nerve
nerve impulses to Nsg Mgt : bronchodilation
and from a specific  Position patient and prep skin  not irritating on respiratory tract
 Hypoventilation
only when anesthesiologist
area or region of the indicates this stage in Disadvantages :
Nsg. Management :
body. The client loss reached  potentially toxic to liver - should be directed at
sensation in an area  depressant to respiration and the underlying cause.
Rationale : cardiovascular system causing Marked hypoventilation
of the body but
 Because when the stage is hypotention, bradycardia and may require controlled
remains conscious reached, the respiration etc. sometimes cardiac arrest ventilation until
returns to normal which  can cause hypothermia contributory factors are
Advantages : enable the patient to cope  complete elimination takes some identified and
with the change of position time corrected
 patients remain
conscious Nsg. Considerations : Rationale :
 maintain his own  report unusual reaction - most commonly
DANGER  assess respiratory and cardiac caused by residual
airway
system depressant effects of
 aspiration of gastric Duration :  take VS before induction anesthetic agents on
contents is avoided  FROM Danger Stage: vital  monitor PR, RR , temp and BP respiratory drive or
 smooth recovery functions too depressed TO persistent
Respiratory failure; possible neuromuscular
requiring less skilled cardiac arrest bispectral state blockade
nursing care 0.

Disadvantages :
 practice and skill is
require for best result
 analgesia may not
be always effective
to other patients
 toxicity may occur if
local anesthetic is
given intravenously
Nsg Interventions :
 ensure safety
 provide supportive
functions
Rationale :
  the patient is risk
for fall and
accident
 To prevent anxiety
about the
anesthesized part
of the body
B.1 Topical (surface)
Anesthesia
- Is applied directly to the skin
and mucous membranes,
open skin surfaces, wounds,
and burns
B.2 Local Anesthesia
- is injected into a specific
area and is used for minor
surgical procedures such as
suturing a small wound or
performing a biopsy
Nsg Mgt :
 Prepare for cardiopulmonary
resuscitation
 assist immediately in
establishing airway,
provide cardiac arrest
tray, drugs, syringes,
long needles, assist
surgeon with closed or
open cardiac massage.
Rationale :
 There is a sudden respiratory
cessation
 This stage is prone to cardiac
collapse and even respiratory
collapse
 Aspiration
pneumonia
Rationale :
 indicates allergies Nsg. Management :
 to prevent further complications - Administer 100%
of tachycardia and bradycardia oxygen the oropharynx
must be suctioned and
 obtain baseline data
the patient placed in
the recovery position
Desired effects :
Rationale :
 Pain is controlled
- During general
 Unconsciousness
anesthesia the pt loses
Enflurane (Ethrane) its reflexes causing a
possible risk for
Advantages : aspiration
 has a rapid induction and
recovery with minimal
aftereffects
 pharyngeal and laryngeal CARDIOVASCULAR
reflexes are obtunded easily, COMPLICATIONS
salivation is not stimulated, and
bronchomotor tone is not  Hypotension
affected
 cardiac rate and rhythm are Nsg. Management :
remain stable - fluid challenge;
pharmacologic
 muscle relaxation is produced
treatment includes
inotropic agents
Disadvantages :
(dopamine,
 has a pungent odor
dobutamine,
 respiration and blood pressure epinephrine) and alpha
are progressively depressed receptor agonists
 severe renal disease is a (phenylephrine)
contraindication to use
Nsg. Considerations : Rationale :
 obtain VS before induction - hypoxemia,
 assess for any renal diseases hypovolemia,
 monitor VS, observe possible decreased myocardial
respiratory depression contractility
(myocardial ischemia,
Rationale : pulmonary edema),
 obtain baseline data decreased systemic
 drug is contraindicated to patient vascular resistance,
with renal disease cardiac dysrhythmias,
 prevent vital sign-related pulmonary embolus,
complications pneumothorax, cardiac
tamponade

B.3 Nerve Block
- Is a technique in which the
anesthetic agent is injected
into and around a nerve or
small nerve group that
supplies sensation to a small
area of the body
B.4 Intravenous block (Bier
block)
- Is used most often for
procedures involving the arm,
wrist and hand
B.5 Spinal anesthesia
(Subarachnoid block)
- It requires a lumbar puncture
through one of the
interspaces between lumbar
disc 2 (L2) and the sacrum
(S1). An anesthetic agent is
injected into the
subarachnoid  space
surrounding the spinal cord
B.6 Epidural (peridural)
anesthesia
- Is an injection of an
anesthetic agent into the
epidural space, the area
inside the spinal column but
outside the dura mater
 Hypertension
Desired effects : Nsg. Management :
 rapid excitement  - correction of the
 analgesia initiating cause;
various medications
can be used to treat
Isoflurane (Forane) hypertension including
beta blockers, calcium
Advantages : channel blockers,
 less cardiac depression nitroprusside or
 increase cardiac output nitroglycerin
 has a CNS excitatory effect
 rapid induction and emergence Rationale :
- enhanced SNS activity
with a minimal aftereffects
(pain, bladder
 low organ toxicity
distension),
 provide superb muscle relaxation
preoperative
 can be used to patients with hypertension,
asthma and patients with COPD hypervolemia,
hypoxemia, increased
Disadvantages : intracranial pressure,
 it is expensive and vasopressors
 reduces respiratory minute
volume
 can cause respiratory acidosis  Arrhythmias
 cerebral vascular resistance is
decreased , cerebral blood flow Nsg. Management :
increases and ICP rises - Treatment of the
 secretions are weakly stimulated causes
Nsg. Considerations :
 obtain spirometry test
 check respiratory rate and
patency Rationale :
 prevent position that increases - hypoxemia,
ICP hypercarbia,
 obtain BP hypovolemia, pain,
electrolyte and acid-
Rationale : base imbalance,
myocardial ischemia,
 assess for lung capacity
 to provide efficient airway increased ICP, digitalis
toxicity, hypothermia,
Desired effects : anticholinesterases
 Muscle relaxation and malignant
hyperthermia
 analgesia
 NEUROLOGICAL
COMPLICATIONS
Desflurane (Suprane)
 Delayed recovery
Advantages :
 has rapid emergence and Nsg. Management
recovery from anesthesia - detect and treat the
 resist biotransformation and cause
degradation, and produced few
urinary metabolites Rationale :
- Metabolic and
electrolyte causes,
Disadvantages : cerebral depression by
 has a pungent odor that may be drugs, cerebral
irritating during induction hypoperfusion
 may lower blood pressure
 elevated heart rate
 Perioperative
Nsg. Considerations : neuropathy
 check blood pressure and heart
rate before induction Nsg. Management :
- Prevent formation of
Rationale : streae
 the drug can greatly alter the HR
and BP Rationale :
- Stretch (traction)
Desired effects : Compression,
 prevent myocardial ischemia Metabolic causes
 rapid emergence and recovery and Direct surgical
from anesthesia trauma
 analgesia

Sevoflurane (Ultane)

Advantages :
 Can be used as an inhalant for
adults and pediatric patients.
 Rapidly eliminated by the lungs

Disadvantages :
 Can cause glycosuria and
proteinuria when used for long
procedures at low flow rates

Nsg. Considerations :
 Note for any deviation of
anesthesia
Rationale :
 Adverse effect is most cmmon

Desired effects :
 patency of airway
 absence of hypoxia

INTRAVENOUS ANESTHETIC
AGENTS

Propofol (Diprivan)

Advantages :
 Is rapidly distributed,
metabolized, and eliminated
 Emergence is very rapid with a
few post-operative side effects

Disadvantages :
 Produces cardio-respiratory
depression
 Causes hypotension
 The solution supports rapid
growth of microorganisms if
infusion pump or syringes
become contaminated
 Pain on the injection site in the
small vein is present

Nsg. Considerations :
 Assess respiratory and cardiac
capacity
 Check blood pressure before
induction
 Maintain sterility and avoid
contamination during induction

Rationale :
 Drug can compromise heart and
lungs
 This drug can alter Blood
pressure
  Induction site can be infected if it
become unsterile

Desired effects :
 Maintained anesthesia effect

Ketamine Hydrochloride (Ketalar,

Ketaject)

Advantages :
 Has a rapid induction
 Respiration is not depressed
unless the drug is administered
too rapidly or in too large dose
 May elevate blood pressure

Disadvantages :
 Physiologic manifestations may
be present during emergence

Nsg. Considerations :
 Provide safety during emergence
 Check VS

Rationale :
 Drug can cause hallucination
which tends to cause accidents
 Obtain baseline data

Desired effects :
 Comfortably detached from all
bodily sensations