Anesthesia
Anesthesia
Anesthesia
An induced state of partial or total loss of sensation, occurring with or without loss of consciousness
Purposes of Anesthesia
To produce muscle relaxation To produce analgesia To produce artificial sleep or to cause loss of consciousness To block transmission of nerve impulses To suppress reflexes
GENERAL ANESTHESIA
Reversible loss of consciousness induced by inhibiting neuronal impulses in several areas of the CNS patients are not arousable , not even in painful stimuli
LARYNGOSCOPE
Stage 4 (Danger)
Begins with depression of vital function and ends with respiratory failure, cardiac arrrest, and possible death Respiratory muscles are paralyzed; apnea occurs
Gaseous Agent nitrous oxide is the most common used agent and is usually given with oxygen. It is colorless, odorless gas that provides analgesia Volatile agents liquid agents vaporized for inhalation. O2 is the carrier, flowing over or bubbling through the liquid in the vaporizer system on the anesthesia machine
Intravenous injection
administered through a vein. The patient feels a simple, pleasant and rapid induction.
Types of IV Injection
Barbiturates it acts rapidly, causing unconsciouness within 30 seconds. Ketamine (Ketalar) ketamine is a dissociative anesthetic agent Propofol (Diporivan) is a short acting anesthetic agent. Hypnosis occurs in less than 1 minute from the time of injection.
Balanced Anesthesia
A combination of IV drugs and inhalation agents used to obtain specific effects A combination is used to provide hypnosis, analgesia, amnesia, muscle relaxation and reduce reflexes with minimal disturbance of physiologic function
REGIONAL ANESTHESIA
Briefly disrupts sensory nerve impulse transmission from a specific body area or region
Systems affected
Motor fibers Sympathetic fibers Sensory fibers
Local Anesthesia
Delivered topically and by local infiltration
Topical Anesthesia
Applied directly to the area of skin or mucous membrane surface to be anesthetized This method often used for respiratory intubation and for diagnostic procedures such as bronchoscopy or cystoscopy
Regional Anesthesia
may be used when
General anesthesia cannot be used because of medical problems The client has had adverse reactions to general anesthesia The client has a preference and a choice is possible Pain management after surgery is enhanced by regional anesthesia
Field block
Occurs with a serried of injections around the operative field. Injecting around a specific nerve or group of nerves depresses sensation at a local area
Nerve block
Occurs with injection of the local anesthetic agent into or around a nerve or group of nerves in the involved area. Lidocaine and Bupivacaine
Spinal anesthesia
Occurs by injecting an anesthetic agent into the cerebrospinal fluid in the subarachnoid space at the lumbar level Position: Knee-chest Can cause temporary partial or complete respiratory paralysis
Spinal anesthesia
Usually causes headache as an after effect due to:
Spinal needle used Leakage of CS fluid from the subarachnoid space through the puncture site Hydration status of patient
Epidural anesthesia
The anesthetic agent is injected into the epidural space and the spinal cord areas are never entered. Doses are much higher compared to spinal anesthesia since the agent does not make direct contact with the spinal cord and nerve roots Used for:
Anorectal, vaginal, perineal, hip, and lower extremity surgeries.
Advantages:
Decreased cardiac and pulmonary complications No headaches compared to SA Use of the epidural catheter for pain control after surgery
Disadvantage:
Greater technical challenge of introducing the agent into the epidural rather than the subarachnoid space.
Moderate Sedation
Previously referred to as conscious sedation
Onset: immediately after induction of anesthesia, several hours into the procedure or even after anesthetic has been terminated
Management of MH
Stop all anesthetic agents and succinylcholine Intubate Ventilate client with 100% oxygen using highest possible flow rate Administer dantrolene sodium (dantrium) IV at a dose of 2 3 mg/kg If possible, terminate surgery.
Management of MH
Assess: ABG and serum chemistries for metabolic acidosis and hyperkalemia Use active cooling techniques:
Administer iced saline (0.9% NaCl) IV at a rate of 15 mL/kg every 15 minutes for 3 doses Apply cooling blanket over torso Wrap of rub extremities with cold, wet towels or ice wrapped towels Lavage the stomach, bladder, rectum and open body cavities (if appropriate) with sterile iced normal saline
Management of MH
Monitor core body temperature Monitor cardiac rhythm Insert foley catheter Administer IV fluids at a rate and volume sufficient to maintain urine output above 2mL/kg/hr Monitor urine for presence of blood or myoglobin
Type
Advantages
Most controllable method Induction and reversal accomplished with pulmonary ventilation Few side effects
Disadvantages
Must be used in combination with other agents for painful or prolonged procedures Limited muscle relaxant effects Postoperative nausea and shivering common Explosive Must be metabolized and excreted from the body for complete reversal Contraindicated in presence of hepatic or renal disease Increased cardiac and respiratory depression Retained fat cells Drug interactions can occur Pharmacologic effects on the body may be unpredictable
General Inhalation
Intravenous
Rapid and pleasant induction Low incidence of post operative nausea and vomiting Requires little equipment
Balanced
Minimal disturbance to physiologic function Minimal side effects Can be used with older and high-risk clients
Type
Regional or Local
Advantages
Gag and cough reflexes stay intact Allows participation and cooperation by the client Less disruption of physical and emotional body functions Decreased chance of sensitivity to the agent Decreased intraoperative stress
Disadvantages
Difficult to administer to an uncooperative or upset client No way to control after administration Absorbs rapidly into the blood and causes cardiac depression or overdose Increased nervous sytem stimulation Not practical for extensive procedures because of the amount of drug that would be required to maintain anesthesia