overview of anesthesia. the four stages of anesthesia stage i: relaxation biologic response:...
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Overview of Overview of AnesthesiaAnesthesia
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The Four Stages of The Four Stages of AnesthesiaAnesthesia
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.
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The Four Stages of The Four Stages of AnesthesiaAnesthesia
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.
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The Four Stages of The Four Stages of AnesthesiaAnesthesia
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.
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The Four Stages of The Four Stages of AnesthesiaAnesthesia
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.
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Common Inhalation AgentsCommon 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.
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Common Inhalation AgentsCommon Inhalation Agents
Forane:
Disadvantage: • Pungent odor• Produces more coughing• expensive
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Common Inhalation AgentsCommon Inhalation Agents
Halothane:
Advantage: • Rarely irritates the brynx• Does not increase respiratory secretions
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Common Inhalation AgentsCommon Inhalation Agents
Halothane:
Disadvantage: • Cases of hepatitis have been reported
after administration• Should not be administered to patients
with abnormal liver fx.
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Common Inhalation AgentsCommon Inhalation Agents
Ethrane:
Advantage: • Rapid induction• Rapid recovery with minimal after effects
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Common Inhalation AgentsCommon 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.
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Common Inhalation AgentsCommon Inhalation Agents
Desflurane:
Advantage: • Allows much faster induction and
emergence• Offers good cardiovascular stability
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Common Inhalation AgentsCommon Inhalation Agents
Desflurane:
Disadvantage: • Strong odor
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Common Inhalation AgentsCommon Inhalation Agents
N2O • Inorganic gas of slight potency,• supports combustions when
combined with oxygen. • Only gas still in use for
anesthesia
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Common Inhalation AgentsCommon Inhalation Agents
N2O Advantage: rapid uptake and elimination
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Common Inhalation AgentsCommon Inhalation Agents
N2O Disadvantage: • no muscle relaxation, • possible excitement or
laryngospasm, • hypoxia a hazard
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Common Inhalation AgentsCommon Inhalation Agents
N2O Use: because it lacks potency, N2O is
rarely used alone, but as an adjunct to barbiturates, narcotics, and other drugs.
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Intravenous Anesthetic Intravenous Anesthetic AgentsAgents
Because removal of drug from
circulation is impossible, safety in use is related to
metabolism.
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Intravenous Anesthetic Intravenous Anesthetic AgentsAgents
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.
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Intravenous Anesthetic Intravenous Anesthetic AgentsAgents
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.
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Intravenous Anesthetic Intravenous Anesthetic AgentsAgents
High Dose Narcotics:
Following high dose narcotic anesthesia patients are:– awake, – pain free, – with adequate, though not good
ventilation
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Intravenous Anesthetic Intravenous Anesthetic AgentsAgents
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.
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Intravenous Anesthetic Intravenous Anesthetic AgentsAgents
High Dose Narcotics:Clinical signs of narcotic toxicity:• Pinpoint pupils• Depressed respirations• Reduced consciousness
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Intravenous Anesthetic Intravenous Anesthetic AgentsAgents
High Dose Narcotics:Narcotic antagonist given to reverse
narcotic-induced hypoventilation.
Narcan
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Intravenous Anesthetic Intravenous Anesthetic AgentsAgents
Nondepolarizing Neuromuscular blockers:
Act on enzymes to prevent muscle contraction.
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Intravenous Anesthetic Intravenous Anesthetic AgentsAgents
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.
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Regional AnesthesiaRegional Anesthesia
Spinal AnesthesiaAgent is injected into the cerebrospinal fluid
(CSF) in the subarachnoid space using a lumbar interspace in the vertebral column.
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Regional AnesthesiaRegional Anesthesia
Spinal AnesthesiaLevel 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
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Regional AnesthesiaRegional Anesthesia
EpiduralAgent 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.
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Regional AnesthesiaRegional Anesthesia
Peripheral BlockBier 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.
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Regional AnesthesiaRegional 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.