Anesthesia

Anesthesia is the state of narcosis, analgesia, relaxation and loss of reflex the client is not arousable even to painful stimuli DEFINITION OF TERMS ANESTHESIOLOGISTphysician trained to deliver anesthesia and to monitor patient during surgery ANESTHETISThealth care professional, such as a nurse anesthetist, who is trained to deliver anesthesia and to monitor the patients condition during surgery ANESTHETIC- the substance such as a chemical gas, used to induced anesthesia Effects of Anesthesia 1. To produce muscle relaxation 2. Analgesia 3. Loss of memory 4. Artificial sleep (unconsciousness) 5. Relieves fear and anxiety Factors considered in choice of Anesthesia Physical condition Age Presence of co-existing disease Type, site, duration of surgery Anesthesiologists preference Patients preference Stages of Anesthesia 1. Beginning 2. Excitement 3. Surgical

4. Medullary

1. BEGINNING (ONSET/INDUCTION) from anesthetic administration to loss of consciousness Assessment: Drowsy or dizzy Experience auditory/visual hallucination Intervention: Close OR doors Keep room quiet Standby person to assist if necessary 2. EXCITEMENT (DELIRIUM) Loss of consciousness to loss of eyelid reflexes ASSESSMENT Increase in ANS activity Irregular breathing, shouting, struggling PR is rapid; RR irregular PUPILS: dilate and constrict if exposed to light INTERVENTIONS: Strap the thighs. Secure hand on armboard Do not apply restraint on operative site 3. SURGICAL Loss of eyelid reflexes to loss of most reflexes Depression of vital function Surgical procedure is started ASSESSMENT: Unconscious Muscles are relaxed VS normal

PUPILS: Small but contract when exposed to light. INTERVENTIONS: Assist in positioning the patient. Begin prep long upon the signal of the anesthesiologist

4. MEDULLARY (DANGER) Vital function too depressed until respiratory and circulatory failure Due to overdose of anesthesia Resuscitation must be done. ASSESSMENT: Not breathing May or may not have a heartbeat RR- Shallow Weak pulse and thready PUPILS: widely dilated and no longer contract when exposed to light Cyanotic death INTERVENTION: Establish an airway Provide emergency equipment/material Assist in CPR

General anesthesia Loss of all sensation and consciousness Regional or Local anesthesia Loss of sensation in ONE area with consciousness present

Types of anesthesia

1. Minimal sedation anxiolysis drug induced state in which a patient can respond normally in verbal commands cognitive function and coordination may be impaired 2.Moderate sedation sedation conscious

Type of Sedation

depressed level of consciousness that does not impair ability to maintain a patent airway Pt. respond purposefully to verbal commands alone or accompanied by light tactile stimulation. Midazolam/Diazepam 3. Deep Sedation analgesia a drug induced state in which a patient cannot be easily aroused but can respond purposefully after repeated painful stimulation inhaled or intravenous Volatile anesthetic (halothane, Isoflurane) Gas anesthetic (Nitrous oxide)

Anesthesia is adjusted to the length of the operation and the clients age and physical status DISADVANTAGE: Depresses the respiratory and circulatory system Administered by: 1. IV INFUSION 2. INHALATION Mask Nasal Oral Tracheal IV (INTRAVENOUS) Commonly used as an induction agent before a more patent type is given Unconsciousness occurs about 30 seconds after initial IV administration 3. Brief duration of action INTRAVENOUS ANESTHETIC AGENTS: 1. TRANQUILIZERS AND SEDATIVE HYPNOTICS (Benzodiazepines) a. Midazolam (Dormicum) b. Diazepam (Valium) c. Chlordiazepoxide (Librium) d. Droperidol (Inapsine) e. Lorazepam (Ativan) 2. OPIOIDS (Narcotics) a. Morphine b. Meperidine HCl (Demerol) 3. NEUROLEPANALGESICS a. Fentanyl (Sublimaze) b. Sufentanil 4. DISSOCIATIVE AGENTS a. Ketamine (Ketaralac; Ketajact) 5. BARBITURATES

a. Thiopental Na (Pentothal) b. Methohexital Na (Brevital) 6. NONBARBITURATES HYPNOTICS a. Etomidate (Amidate) b. Propofol (Diprivan)

Inhalation

A mixture of anesthetic liquid in volatized form or gases with oxygen BY MASK or ENDOTRACHEAL TUBE

1. 2. 3. 4. 5.

GENERAL ANESTHESIA
Blocks the pain stimulus at the cortex Total loss of consciousness and sensation Produces amnesia, analgesia, hypnosis and relaxation ADVANTAGES: Respiration and cardiac function are readily regulated since client is unconscious.

Positioning IV line Monitoring Strap Rapid acting drugs Thiopental (Pentothal) Propofol (Diprovan) Methohexital (Brevital) 6. O2 and Gas via mask 7. Muscle relaxant ADULT: Succiniylcholine chloride (Anectine) PEDIA: Rocuronium (Zemuron) Atracurium (Tracrium) Vecuronium (Norcuron) 8. INTUBATION KEY POINTS DURING INDUCTION! 1. Circulator should remain 2. Gentle and rapid approach 3. Avoid stimulation of the patient (mandatory) noise avoidance

GA Induction procedure

4. Do not touch patient until anesthesiologist says it is safe to do so 5. Precaution: ECG, defib, chest stet, BP 6. Positioning: if obese elevate head to avoid pressure (protect diaphragm) 7. If hypotensive- flat 8. Children: circulator- to be less frightening stay close to the child

INHALATION AGENTS:

ANESTHETIC

1. FIELD BLOCK areas proximal to the incision site is injected and infiltrated a barrier (WALL IN) 2. PERIPHERAL NERVE BLOCK anesthetizes individual nerves or nerve plexuses rather than all the nerves anesthetized by a field block ALONG SPINAL CORD: Blocks impulses along the spinal cord and nerve roots and may occur either in the subarachnoid or epidural space 1. SPINAL produces a nerve block in the subarachnoid space 2. EPIDURAL injection of local anesthetic into the spinal canal in the space surrounding the dura mater 3. CAUDAL (TRANS-SACRAL) produces anesthesia of the perineum and occasionally, the lower abdomen

5. Tetracaine (Pontocaine) REGIONAL ANESTHETIC AGENTS: 1. Procaine (Novocaine) 2. Tetracaine (Pontocaine) 3. Lidocaine (Xylocaine) 4. Bupivacaine (Marcaine)

1. VOLATILE LIQUIDS: a. Halothane (Fluothane) b. Methoxyflurane (Penthrane) c. Enflutane (Ethrane) d. Isoflurane (Forane) e. Sevoflurane (Ultrane) f. Desflurane (Suprane) 2. GASES: a. Nitrous oxide

REGIONAL ANESTHESIA
Produces loss of sensation in only one region of the body and does not cause loss of consciousness Blocks pain stimulus at its: 1. Origin 2. Along afferent neurons 3. Along the spinal cord Block pain stimulus at its ORIGIN 1. TOPICAL directly applied into the area to be desensitized with the use of a solution 2. LOCAL INFILTRATION BLOCK blocks only peripheral nerves around the area of incision ALONG AFFERENT NEURONS

LOCAL ANESTHETIC AGENTS: 1. Lidocaine (Xylocaine) Mepivacaine (Carbocaine) 2. Bupivacaine (Marcaine) 3. Etidocaine (Duranest) 4. Procaine (Novocaine)

and

1. CARDIAC ARREST 2. RESPIRATORY DEPRESSION a. Excessive mucus b. CNS depression c. Bronchospasm/ laryngospasm 3. HYPOTENSION AND SHOCK 4. LOSS OF PROTECTIVE RESPONSE TO PAIN 5. VOMITING AND ASPIRATIONS Complications/ Discomforts of Regional Anesthesia: HYPOTENSION PREVENTION: Infuse 500-800 mL of IV if not prone to CHF INTERVENTION: Oxygen administration Vasoconstrictive drugs Trendelenburg position 10-20 mins after induction NAUSEA AND VOMITING INTERVENTION: Oxygen administration Give ephedrine, anti-emetics IVF Complications/ Discomforts of Regional Anesthesia: HEADACHE excessive loss of CSF due to: a. Loss of large spinal fluid b. Poor hydration PREVENTION: Use of small needle

Major Complications of General Anesthesia:

 Administer IV before and after induction Flat on bed for 6 to 8 hours INTERVENTION: Apply tight abdominal binder IV administration Analgesic RESPIRATORY PARALYSIS happens when drug reaches upper thoracic and cervical cord in large amount or in heavy doses PREVENTION: Avoid extreme trendelenburg position before level of anesthesia sets INTERVENTION: Artificial airway NEUROLOGIC COMPLICATIONS post operative paralysis due to: a. Unsterile needles, syringes and anesthetic medications b. Pre-existing disease of the CNS which cause the paralysis rather than the anesthesia itself PREVENTION: Strict aseptic technique and careful neurologic examination to ascertain existing neurologic diseases

Potential adverse effects of anesthesia

Myocardial depression, bradycardia Nausea and vomiting anaphylaxis CNS agitation, seizures, respiratory arrest Oversedation or under sedation Agitation and disorientation Hypothermia Hypotension Malignant hyperthermia Allergic reactions and drug toxicity or reactions Cardiac dysrhythmias Trauma: laryngeal, oral, nerve, and skin, including burns Thrombosis

Intraoperative Complications:
1. 2. 3. 4. 5. 6. 7.

(ANESTHESIA)

Hypoventilation Oral trauma Hypotension Cardiac dysrhythmia Hypothermia Peripheral nerve damage Malignant hyperpyrexia