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Anesthesia

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					Overview of
Anesthesia
           The Four Stages of
               Anesthesia
Stage I:   Relaxation

 • Biologic Response:       Amnesia, Analgesia

 • Pt Reaction:    Feels drowsy and dizzy.
   Exaggerated hearing. Decreased sensation of pain.
    May appear inebriated.

  • Nsg Actions:     Close OR doors. Check for
   proper positioning of safety devices. Have suction
   available and working. Keep noise in room at a
   minimum. Provide emotional support for the pt
   by remaining at his side.
          The Four Stages of
              Anesthesia
Stage II:   Excitement

 • Biologic Response:         Delirium

 • Pt Reaction:      Irregular breathing. Increased
   muscle tone and involuntary motor activity; may
   move all extremities. May vomit, hold breath,
   struggle (pt very susceptible to external stimuli
   such as a loud noise or being touched)
 • Nsg Actions:       Avoid stimulating the patient.
   Be available to protect extremities or to restrain
   the pt. Be available to assist anesthesiologist
   with suctioning.
          The Four Stages of
              Anesthesia
Stage III:   Operative or surgical anesthesia

• Biologic Response:       Partial to complete sensory
  loss. Progression to complete intercostal paralysis.

 • Pt Reaction:       Quiet. Regular thoraco-abdominal
   breathing. Jaw relaxed. Auditory and pain sensation
   lost. Moderate to maximum decrease in muscle
   tone. Eyelid reflex is absent.
  • Nsg Actions: Be available to assist
    anesthesiologist with intubation. Validate with
    anesthesiologist appro. Time for skin scrub and
    positioning of pt. Check position of pt’s feet to
    ascertain they are not crossed.
           The Four Stages of
               Anesthesia
Stage IV:     Danger

 • Biologic Response:          Medullary paralysis and
     respiratory distress.
 •   Pt Reaction: Resp. muscles paralyzed. Pupils
     fixed and dilated. Pulse rapid and thready.
     Respirations cease.
  • Nsg Actions:        Be available to assist in tx. Of
     cardiac or respiratory arrest. Provide emergency
     rug box and defibrillation. Document
     administration of drugs.
Common Inhalation Agents
                Forane:
Advantage:
• lowers resp.,
• good muscle relaxation,
• low incidence of renal or hepatic damage.
• Offers good cardiovascular stability.
• May be given to pt’s with minimal renal
  failure.
Common Inhalation Agents
               Forane:
Disadvantage:
• Pungent odor
• Produces more coughing
• expensive
 Common Inhalation Agents
              Halothane:
Advantage:
• Rarely irritates the brynx
• Does not increase respiratory secretions
Common Inhalation Agents
              Halothane:
Disadvantage:
• Cases of hepatitis have been reported
  after administration
• Should not be administered to patients
  with abnormal liver fx.
 Common Inhalation Agents
                Ethrane:
Advantage:
• Rapid induction
• Rapid recovery with minimal after effects
 Common Inhalation Agents
                Ethrane:
Disadvantage:
• Respiration and blood pressure are
  progressively depressed with deepening
  anesthesia
• Severe renal failure is a contraindication
  to use.
• Seizure activity asso. with use. Not to be
  administered to pt with history of seizures.
 Common Inhalation Agents
              Desflurane:
Advantage:
• Allows much faster induction and
  emergence
• Offers good cardiovascular stability
Common Inhalation Agents
            Desflurane:
Disadvantage:
• Strong odor
Common Inhalation Agents
               N2O
• Inorganic gas of slight potency,
• supports combustions when
  combined with oxygen.
• Only gas still in use for
  anesthesia
Common Inhalation Agents
              N2O
Advantage:
rapid uptake and elimination
Common Inhalation Agents
               N2O
Disadvantage:
• no muscle relaxation,
• possible excitement or
  laryngospasm,
• hypoxia a hazard
Common Inhalation Agents
               N2O
Use:
because it lacks potency, N2O is
 rarely used alone, but as an
 adjunct to barbiturates,
 narcotics, and other drugs.
   Intravenous Anesthetic
           Agents

Because removal of
      drug from
    circulation is
 impossible, safety
 in use is related to
     metabolism.
    Intravenous Anesthetic
            Agents
             Barbituates:
     Sodium Pentothal, Brevital

Important Facts:
• Do not produce relief from pain, only
  marked sedation, amnesia, hypnosis.
• Repeated administration has
  accumulative, prolonged effect.
• Extravasation can cause thrombophlebitis,
  nerve injury, tissue necrosis.
    Intravenous Anesthetic
            Agents
               Diprivan:
          Sedative, hypnotic

Important Facts:
• Used for rapid induction and maintenance
  of anesthesia for short periods of time.
• Used for general anesthesia for
  ambulatory surgery patients.
   Intravenous Anesthetic
           Agents
      High Dose Narcotics:

Following high dose narcotic
 anesthesia patients are:
  – awake,
  – pain free,
  – with adequate, though not good
    ventilation
   Intravenous Anesthetic
           Agents
      High Dose Narcotics:
Opiods:
    Fentanyl (Sublimase): 70 times
 more potent than Morphine.
    Sufenta: 5 times more potent
 than Fentanyl, 625 times more
 potent than Morphine.
    Demerol: causes myocardial
 depression and tachycardia, 1000
 times less potent than Fentanyl.
    Intravenous Anesthetic
            Agents

       High Dose Narcotics:
Clinical signs of narcotic toxicity:
• Pinpoint pupils
• Depressed respirations
• Reduced consciousness
   Intravenous Anesthetic
           Agents

      High Dose Narcotics:
Narcotic antagonist given to reverse
 narcotic-induced hypoventilation.


              Narcan
   Intravenous Anesthetic
           Agents

       Nondepolarizing
    Neuromuscular blockers:
Act on enzymes to prevent muscle
 contraction.
     Intravenous Anesthetic
             Agents

          Nondepolarizing
        Neuromuscular blockers:
1.   Curare: poison arrows made by South
     American Indians. Caused respiratory
     paralysis.
2.   Pavulon: 5 times more potent than Curare.
3.   Norcuron: shorter duration of action, more
     potent than Pavulon.
4.   Tracrium: intermediate action about 30
     minutes. Advantage to liver and renal disease
     pt because metabolizes more quickly.
      Regional Anesthesia

          Spinal Anesthesia
Agent is injected into the cerebrospinal fluid
   (CSF) in the subarachnoid space using a
   lumbar interspace in the vertebral
   column.
        Regional Anesthesia

           Spinal Anesthesia
Level of anesthesia depends on:
•   Position during and immediately after injection
•   Cerebrospinal fluid measure
•   Site and rate of injection
•   Volume, dosage, specific gravity of solution
•   Inclusion of vasoconstrictor will prolong effects
•   Spinal curvature
•   Interspace chosen
•   Coughing and straining
      Regional Anesthesia

                Epidural
Agent is injected into the space between the
   ligamenta flava and the dura.
   Anesthesia is prolonged while drug is
   absorbed from CSF into the blood
   stream.
       Regional Anesthesia
              Peripheral Block
Bier Block or Intravenous Regional Block
Document:
•   Tourniquet application
•   Pressure setting
•   Inflation time
•   Deflation time
•   Surgeon should be notified of tourniquet time
    every 30 min.
•   Deflation done intermittent to avoid toxic blood
    level and seizures.
       Regional Anesthesia
    Monitored Anesthesia Care
•   Physician administers local anesthesia
•   Anesthesia personnel monitor pt
•   If nursing personnel monitor pt, must be
    RN other than circulating nurse.
•   Abnormalities reported to surgeon.
•   Documentation:
     1. monitoring of medications and their dose, route,
        time of administration, effects
     2. pt’s LOC should be monitored and recorded.

				
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posted:1/14/2013
language:English
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