Sheila Carmela L.

Colon, RN,MAN

An=without, esthesia =awareness or feeling. A branch of medicine that is concerned with the administration of medication or anesthetic agents to relieve pain and support physiologic functions during a surgical procedure. State of narcosis (severe CNS depression produced by pharmacologic agents). Loss of sensation and protective reflexes (Absence of pain)

the properties of general anesthesia (i.e. hypnosis, analgesia, & muscle relaxation) are produced in varying degrees, by a combination of agents. Each agent has a specific purpose. This is often referred to as neuroleptanesthesia.

FACTORS IN THE SELECTION AND DOSAGE OF ANESTHESIA: Type and duration of the procedure. Area of the body having surgery. Safety issues to reduce injury, such as airway management. Whether the procedure is emergency. Options for management of pain after surgery.

Mild Sedation (Minimal/Light sedation)-a drug induced state during which the pt can still respond normally to verbal commands although cognitive function and coordination may be impaired but ventilatory and cardiovascular functions are not affected. Moderate Sedation/Analgesia=Intravenous Conscious Sedation (IVCS) - A form of anesthesia that may be produced intravenously. A depressed level of consciousness that does not impair the pts ability to maintain a patent airway and to respond appropriately to physical stimulation and verbal communication. Its goal is a calm, tranquil, amnesic, & pain-free pt.

Deep Sedation/Analgesia a drug induced depression of consciousness during which pts cannot be easily aroused but respond purposely after repeated or painful stimulation. Full Anesthesia a drug-induced state of loss of consciousness during which pts cannot be arouse even by painful stimulation. The ability to independently maintain ventilatory function is often impaired.

 Refers to a drug-induced state in which analgesia,

amnesia, muscle relaxation and unconsciousness occur May be administered by oral, rectal, & parenteral routes, with the inhalation & intravenous routes most commonly used.
GETA- General Endotracheal Tube Anesthesia LMA-Laryngeal Mask Anesthesia Mask Inhalation Anesthesia

I. Induction Phase involves putting the pt safely into a state of unconsciousness; includes the following sequence: preoxygenation, loss of consciousness, intubation

Assess pts LOC and determine understanding of the anesthesia procedure (explain in awake intubation) Identify problems or risk factors that might occur during the intubation (Mallampati-difficult intubation, trauma to oral structure, bleeding in the oropharynx) Assess for hypersensitivity to anesthetic agents Remain at the pt side to provide safety & emotional support Assist in the needs of anesthesia provider, initiate cricoid pressure (Sellick maneuver) if indicated. Closely observe pts breathing and oxygenation through monitors attached (Pulse oximeter, ECG, Cardiac monitors, BP monitor) Refer abnormal observations immediately and appropriately (Cyanosis). Avoid making unnecessary noise that might stimulate client. Ensure that emergency equipments are readily available for use Document findings and actions rendered

II. Excitement Phase includes from the loss of consciousness to relaxation, light hypnosis, & excitement with loss of breathing, movements of extremities, crying, to shouting in response to external stimuli.

Assess pts baseline V/S Assess and ensure functional equipments Remain at the pt side to provide safety & emotional support Provide restraints and pads to avoid injury Assist in the needs of anesthesia provider in positioning and
restraining the pt Ask for assistance in positioning a restless & an overweight pt Monitor breathing and oxygenation through monitors attached (Pulse oximeter, ECG, Cardiac monitors, BP monitor) Decrease environmental stimuli; avoid making unnecessary noise that might stimulate client, provide dim lights and a warm room temp.

III. Maintenance Phase

Involves the achievement of balance anesthesia during the course of the surgical procedure to maintain oxygenation, unconsciousness, analgesia, muscle relaxation, & control of autonomic reflexes

Assess pts V/S conscientiously Assess for Hypoxia, Hypercarbia, Dysrhythmia, and Fluid balance Determine factors that would aggravate respiratory obstruction

and or depression Ensure adequate lung expansion in positioning Be alert for hypotension and hypothermia Monitor BP, Temperature and I&O and record Prevent hypothermia thru providing blankets or warming devices applied with precaution and as indicated by anesthesiologist Observe strict asepsis and sterility in intervening near the sterile field Ensure safety in positioning the pt thru obtaining assistance and applying pads underneath pressure points Prepare emergency supplies or equipments that might be needed for the pt (emergency drugs, emesis basin) Document and report findings and actions

IV. Emergence the anesthesia provider attempts to have the pt as nearly awake as possible and achieve resumption of protective reflexes specially reflexes that aid in respiration, involves administration of agents that reverse the effects of drugs that depressed neuromuscular blockades until pts breathing is stable and when extubation is deemed safe by the anesthesiologist.

Assess pts LOC and reorient with date, time, location and place Identify problems, risk factors, deviations from baseline data (compare pre-op assessment to current data; analyze, document and report findings and deviations) Assess for cyanosis, hypoxia, dysrhythmias, severe

hypotension, and hypothermia Monitor clients V/S every 15 minutes Provide blankets for warmth Maintain safety precautions (restraints & side rails) Monitor I & O Assess for spontaneous respirations before extubation as per indicated by the anesthesiologist as safe. Document and report findings and actions

1. Beginning Anesthesia

2. Excitement
3. Surgical Anesthesia 4. Medullary Depression

INTRAVENOUS AGENTS: Anxiolytics/Sedative Hypnotics Barbiturates- Thiopental, Phenobarbital= Pentothal Propofol=Diprivan Benzodiazipines--Diazepam, Lorazepam, Midazolam= Valium, Ativan Opiates/Narcotic Analgesic Meperidine HCL=Demerol Morphine Sulfate=Astrmorph KetamineHCL= Ketalar, Ketaject Fentanyl=Sublamaze Nalbuphine=Nubaine Butorphanol=Stadol

INHALANT AGENTS: Nitrous Oxide Halothane=Flouthane Enflurane=Ethrane Isoflurane=Forane Desflurane=Supane Sevoflurane=Sevorane, Ultane

Muscle Relaxants

Nondepolarizing Neuromuscular blockers Mivacurium chloride (Mivacron)=Short-acting Atracurium besylate (Tracrium)=Intermediate acting Pancuronium bromide (Pavulon)=Long Acting
Deploarizing Neuromuscular blockers Succinylcholine chloride (Anectine)= short-acting Decamethonium (Syncurine)=short duration

Narcotic Reversal (Antagonists) Neostigmine methylsulfate (Prostigmin) Edrophonium Chloride (Tensillon) Anti-Cholinergics/Antimuscarinic Atropine Sulfate Methscopolamine bromide

Technique which render only a specific

anatomical region of the body insensitive to pain Provides a pain free state with good condition for certain operative procedure without producing loss of consciousness Factors affecting effectivity; 1. Amount of anesthetic administered, 2. Specific gravity of fluid increased than CSF, 3. Positioning (controlled by anesthesiologist)

Spinal Anesthesia
(Spinal block, Sub-arachnoid block, intrathecal lock) Accomplished through a lumbar tap or lumbar puncture and injecting an anesthetic solution into the subarachnoid space with CSF that coats the end part of the spinal cord and nerve roots Epidural Anesthesia(peridural, extradural anesthesia) Accomplished through a lumbar tap or lumbar puncture and injecting an anesthetic solution into the epidural

space Thoracic and Lumbar Block- injecting at the thoracolumbar junction of the peridural spaces Caudal Block- injecting in the extradural space of the sacral area

Topical Anesthesia- direct application of anesthetics to mucous membranes, serous surface and an open wound to effect analgesia & depression of sensation and reflexes. Cryoanesthesia- cooling or freezing of a localized area to block local nerve conduction of painful impulses Simple Local Infiltration (peripheral nerve block)injection of a local anesthetic agent intracutaneously and

subcutaneously into tissues at and around the incisional site to block peripheral nerve stimuli at their origin. Regional Injections/ Blocks- a local anesthetic agent is injected around a specific nerve or group of nerves (plexus) to depress the entire sensory nervous system of a limited, localized part of the body.

Paravertebral Block-to block sensation some in parts of the jaw Brachial Plexus/Axillary Block- entire arm Intercostal block- for superficial intraabdominal procedures Median, radial, ulnar Nerve Block- for the elbow or wrist Hand and Digital Block- for digits/phalanges Penile block- used for circumcision Bier Block Field Block

Amino Amides:
Lidocaine Hcl (Xylocaine)

most widely used for LA/peripheral nerve block Bupivacaine (Sensorcaine)4 times more potent than lidocaine-Spinal Anes. Amino Esther:
Tetracaine HCL (Pontocaine) - Longer duration of

effect than Amides (for Spinal Anes.)

Epinephrine (Adrenalin)-

a cathecolamine, potent stimulant that causes vasoconstriction to slow circulatory uptake and absorption thus prolonging localized anesthesia effect. Used to counteract cardiovascular depressive effect of anesthesia. Sodium bicarbonate lowers the ph of the solution causing it to cross the cell membrane more readily and decreases pain during injection. Dextranprolongs localized anesthetic effects.

Assess pts LOC and Neuro V/S Instruct the procedures, positioning and attachments to be placed on the client For central nerve blocks (SAB, Epidural block) assist in positioning client in a fetal position safely (pregnant mothers are placed in a Left Lateral Position) or sitting. Assess for existing neurological and sensory deficits (paralysis, numbness) Assess baseline V/S to anticipate management of systemic effects (hypotension, seizure, respiratory

depression) Assess for hypersensitivity to anesthetic agents and history of allergies from drugs or foods Assess and ensure complete & functional equipments to be utilized

Remain at the pt side to provide safety & emotional support Provide restraints and pads to avoid injury Assist in the needs of anesthesia provider Ask for assistance in positioning the pt prn Prepare equipments needed in anesthesia induction. Observe surgical asepsis in preparing local anesthesia Monitor breathing and oxygenation through monitors attached (Pulse oximeter, ECG, Cardiac monitors, CVP,BP monitor) Document and report findings and actions provided