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)-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=Moderate Sedation/Analgesia=Intravenous Intravenous Conscious Sedation (IVCSConscious Sedation (IVCS)) - A form of anesthesia that may be produced intravenously. A depressed level of consciousness that does not impair the pt’s 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 AnesthesiaLMA-Laryngeal Mask AnesthesiaMask Inhalation Anesthesia

 

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

II. Excitement Phaseincludes 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 pt’s 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 pt’s 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. Emergencethe 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 pt’s breathing is stable and when extubation is deemed safe by the anesthesiologist.

•Assess pt’s 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 client’s 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 Anesthesia2. Excitement3. Surgical Anesthesia4. 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 RelaxantsMuscle Relaxants  Nondepolarizing Neuromuscular blockersNondepolarizing Neuromuscular blockersMivacurium chloride (Mivacron)=Short-Mivacurium chloride (Mivacron)=Short-actingactingAtracurium besylate (Tracrium)=Intermediate Atracurium besylate (Tracrium)=Intermediate actingactingPancuronium bromide (Pavulon)=Long ActingPancuronium bromide (Pavulon)=Long Acting  Deploarizing Neuromuscular blockersDeploarizing Neuromuscular blockersSuccinylcholine chloride (Anectine)= short-Succinylcholine chloride (Anectine)= short-actingactingDecamethonium (Syncurine)=short durationDecamethonium (Syncurine)=short duration

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

•Technique which render only a specific Technique which render only a specific anatomical region of the body anatomical region of the body insensitive to paininsensitive to pain•Provides a pain free state with good Provides a pain free state with good condition for certain operative condition for certain operative procedure without producing loss of procedure without producing loss of consciousnessconsciousness•Factors affecting effectivity; Factors affecting effectivity; 1.1. Amount Amount of anestheticof anesthetic administeredadministered, , 2.2. Specific Specific gravity of fluid increased than CSF, gravity of fluid increased than CSF, 3.3. Positioning (controlled by Positioning (controlled by anesthesiologist)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 sub-arachnoid 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 thoraco-lumbar 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 intra-abdominal 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.•Dextran-prolongs localized anesthetic effects.

•Assess pt’s LOC and Neuro V/SAssess pt’s LOC and Neuro V/S•Instruct the procedures, positioning and Instruct the procedures, positioning and attachments to be placed on the clientattachments to be placed on the client•For central nerve blocks (SAB, Epidural block) For central nerve blocks (SAB, Epidural block) assist in positioning client in a fetal position assist in positioning client in a fetal position safely safely (pregnant mothers are placed in a Left (pregnant mothers are placed in a Left Lateral Position)Lateral Position) or sitting. or sitting.•Assess for existing neurological and sensory Assess for existing neurological and sensory deficits (paralysis, numbness)deficits (paralysis, numbness)•Assess baseline V/S to anticipate management Assess baseline V/S to anticipate management of systemic effects (hypotension, seizure, of systemic effects (hypotension, seizure, respiratory depression)respiratory depression)•Assess for hypersensitivity to anesthetic agents Assess for hypersensitivity to anesthetic agents and history of allergies from drugs or foodsand history of allergies from drugs or foods•Assess and ensure complete & functional Assess and ensure complete & functional equipments to be utilizedequipments 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