Mr. Renato D.

Lacanilao, RN, MAN

ANESTHESIA
Lecturer
 THE SURGICAL EXPERIENCES
• SEDATION & ANESTHESIA
• Anesthesia
– Greek word anaisthesis, meaning “no sensation”
– a partial or complete loss of sensation, with or without loss of
consciousness as a result of the administration of an anesthetic
agent.
• Analgesia
– lessening of or creating insensibility to pain.
• Anesthetic
– an agent that produces anesthesia; subdivided into general an
regional, according to their actions
 Levels of Sedation & Anesthesia

1. Minimal Sedation
– uses sedatives & anxiolytics that allows the patient to
remain responsive & breath independently.
– Indications are for minor surgeries or as a supplement to
local or regional anesthesia
– Advantages for the patient include anxiety relief, amnesia,
analgesia, comfort & safety
2. Moderate Sedation (Conscious sedation)
– a form of anesthesia that maybe produced intravenously
– A depressed level of consciousness that does not impair the patient’s ability
to maintain a patent airway & to respond appropriately to physical
stimulation & verbal command.
– Goal: a calm tranquil amnesic patient who, when sedation is combined with
analgesic agents, is relatively pain free during the procedure to be able to
maintain protective reflexes.
– Can be administered by an anesthesiologist, anesthetist, moderate sedation is
referred to as monitored anesthesia care.
– Midazolam (Versed) or Diazepam (Valium) is used frequently for IV
sedation.
– Patient’s receiving this form of anesthesia is never left alone, and is closely
monitored for respiratory, cardiovascular & CNS depression (pulse oximetry,
ECG, V/S monitoring)
– Maybe used alone or in the combination with local, regional, or spinal
anesthesia.
3. Deep Sedation
– A drug induced state during which patient cannot be easily aroused
but can respond purposely after repeated stimulation.
– The difference between deep sedation& anesthesia is that the
anesthetized patient is not arousable.
– Deep sedation & anesthesia are achieved when an anesthetic agent is
inhaled or administered intravenously.
– Inhaled anesthetic agents includes Volatile liquid agents & gases
– Volatile liquid anesthetic produced anesthesia when vapor are
inhaled.
– Gas anesthetic are administered by inhalation & are always
combined with oxygen
– When anesthetic administration is discontinued, the vapor & the gas
is eliminated through the lungs.
4. Anesthesia
– Is a state of narcosis (severe central nervous system
depression produced by pharmacologic agents), analgesia,
relaxation, and reflex loss.
– Patients under general anesthesia are not arousable even to
painful stimuli.
– The loss of the ability to maintain ventilatory function &
require assistance in maintaining a patent airway.
– Cardiovascular function may also be impaired.
 General Categories of Anesthesia

I. General Anesthesia
– is the depression of the CNS by administration of drugs or
inhalation agents, resulting in loss of consciousness, sensory
perception and motor function
– Patients are not arousable even with painful stimuli. CP
functions are often impaired.
– Produces total loss of consciousness, analgesia and muscle
relaxation
 Methods of General Anesthesia administration
1. Intravenous
– Agents that produce anesthesia in large doses through
sedative-hypnotic analgesic action.
– Agents are administered as a bolus or continuous drip
infusion directly into the systemic circulation for rapid
effects.
– It is used primarily as an induction agent or can use as
maintenance of anesthesia.
– Thiopental (Pentothal Na) agent of choice
– The medication maybe administered for introduction often
used along with inhalation anesthetics but maybe used
alone
– Can also be used to produce moderate sedation.
– Duration of action is brief and the patient awakens with little
nausea & vomiting
– IV anesthetics are non explosives, require little equipment &
are easy t administer
– Advantage: Onset of anesthesia is pleasant; preferred by
patents who have experienced various methods.
– Disadvantage: Thiopental: Powerful respiratory depressant
effect.
– Sneezing, coughing & laryngospasm are sometimes noted w/
its use.
• 2. Inhalation
• Gases and oxygen are administered into the systemic circulation
through the alveolar membranes of the lungs, with diffusion to
the pulmonary circulation and finally to the brain.
• Halothane (Flouthane), Isoflurane (Forane), Sevoflurane
(Ultane), Enflurane (Ethrane), Desflurane (Suprane)
• Liquid anesthetic maybe administered by mixing the vapors with
oxygen or nitrous oxide-oxygen & then having the patient
inhale the mixture through tube or a mask, or through a
laryngeal mask.
– ET tube can be inserted either through the nose or mouth.
 2 types of Inhalation Anesthesia
1. Volatile Agents - liquid that are easily vaporized &
produce anesthesia when inhaled like Ether (Diethyl
Ether), Trichloroethylene, Chloroform, halothane,
enflurane, methoxylflurane, and isoflurane
2. Gaseous Agents
• Nitrous Oxide or laughing gas – a colorless odorless
nonexposive gas that has been referred to as a “carrier of
gases.” It is the most commonly used gas anesthetic.
When inhaled, the gas anesthetic enters the blood though
the pulmonary capillaries & act on cerebral centers to
produce loss of consciousness & sedation.
• Ethylene, Cyclopropane
3. Rectal (Pediatrics)
• Metohexital Na, Anectine, Penthotal Na 5-10%
 II. Regional Anesthesia
• Referring to a technique that temporary interrupts the transmission
of nerve impulses to and from a specific area or region.
• Reduce all painful sensations in one region of the body without
inducing unconsciousness.
• Patent is awake & aware of his/her surrounding when regional or
spinal anesthesia is given – unless medication is given to produce
mild sedation or to relieve anxiety
• Nurse must avoid careless conversation, unnecessary noise &
unpleasant odors – may produce a negative view of the surgical
experience
• A quiet environment is therapeutic
• Diagnosis must not be stated aloud if the patient is not to know it at
all this time
 Methods of Administration for Regional Anesthesia
1. Epidural anesthesia
– Anesthetic injected extradurally to produce anesthesia below level
of diaphragm, used in obstetrics.
– Is achieved by injecting local anesthetic into the spinal canal in the space
surrounding the dura mater.
– Also blocks the sensory motor & automatic functions but it is
differentiated fro the spinal anesthesia by the injection site& the amount
used
– Epidural dose are much higher because it does not make direct contact
with the cord or nerve roots.
– Advantage: Absence of headache that occasionally results from
subarachnoid injection
 2. Spinal anesthesia
– anesthetic introduced into subarachnoid space of spinal cord producing anesthesia
below the level of diaphragm.
– A type of extensive conduction nerve block that is produced when local anesthetic is
introduced into the subarachnoid space at the lumbar level, usually between L4 & L5.
– Produces anesthesia at the lower extremities, perineum, & lower abdomen for a
lumbar puncture procedure, the patient usually lies on the side in a knee chest
position
– Agents used: Procaine hydrochloride (Novocaine), Tetracaine (Pontocaine), Lidocaine
(Xylocaine), and Bupivacaine (Marcaine, Sensorcaine)
– Few minutes after the introduction of the spinal anesthetic, anesthesia & paralysis
affect the toes & perineum them gradually legs & the abdomen.
– Nausea, vomiting & pain may occur during surgery when spinal anesthesia is used –
occurs due to manipulation of various structures in the abdominal cavity.
– Headache may be an after effect of the spinal anesthesia, several factors involved: size
of spinal needle used, leakage of the fluid from the subarachnoid space through the
puncture site, and the patient’s hydration status.
– Keep patient lying flat quiet & well hydrated.
 3. Local Infiltration Anesthesia
– Infiltration anesthesia is the injection f the solution containing the local anesthetic into
the tissues at the planned incision site
– Is often combined with a local regional block by injecting the nerves immediately
supplying the area
– Advantages:
• It is simple, economical & non explosive
• Equipment needed is minimal
• Postoperative surgery is brief
• Undesirable effects of general anesthesia is avoided
• It is deal for short &superficial surgical procedure
– often administered in combination with epinephrine
– Anesthesia of choice in any surgical procedure in which it can be used.
– Action is almost immediate, so surgery may begin as soon as injection is complete.
– Anesthesia last 45 minutes to 1 hour, depending on the anesthetic the use & the use of
epinephrine.
 Other types of Nerve Blocks include:
– Brachial Plexus block – produces anesthesia of the arm
– Para vertebral anesthesia – produces anesthesia of the nerves supplying the
chest, abdominal wall & extremities
– Transsacral (Caudal)block – produces anesthesia of the perineum &
occasionally the lower abdomen, commonly used in obstetrics.
– Topical – cream, spray, drops, or ointment applied externally, directly to area
to be anesthetized.
– Field Block – area surrounding the surgical site injected with anesthetic
– Nerve Block – injection into nerve plexus to anesthetize part of body
– Local infiltration block – injected into subcutaneous tissue of surgical area
– Saddle block – similar to spinal, but anesthetized area is more limited,
commonly used in obstetrics
– Bier blocks – used most often for procedures involving the arm, wrist, and
hand
– IV Regional
 STAGES OF
ANESTHESIA
 STAGES OF ANESTHESIA

• Stage 1: Beginning Anesthesia/Onset/Induction

– Extends from the administration of anesthesia to the time of Loss of
consciousness.
– As the patients breathes I the anesthetic mixture, warmth, dizziness & a
feeling of detachment maybe experienced.
– The patient may have a ringing, roaring, or buzzing in the ears & though
still conscious may seem to have the inability to move extremities.
– During the stages noises seem to be exaggerated; even low voices or
minor sound seem loud & unreal.
– Nurse avoids making unnecessary noises or motions when anesthesia
begins.
 Stage 2: Excitement/Delirium
– Extends from the time of loss of consciousness to the time of
loss of lid reflex.
– Characterized variously by struggling, shouting, talking, singing,
laughing or crying – avoided if anesthetic is administered
quickly & smoothly.
– Pupils dilate but contract if exposed to light, pulse rate is rapid
& respiration maybe irregular.
– Restraint patient for possibility of uncontrolled movements.
 Stage 3: Surgical Anesthesia
– Extends from the loss of lid reflex to the loss of most reflexes. Surgical
procedure is started.
– Reached by continued administration of the anesthetic vapor or gas.
– Pupils are small but contract when exposed to light.
– Respirations are irregular, the pulse rate and volume are normal, and the
skin is pink or slightly flushed.
– With proper administration of the anesthetic, this stage maybe
maintained four hours in several planes.
 Stage 4: Medullary Depression/Stage of Danger

• It is characterized by respiratory/cardiac depression or arrest. It is due to

overdose of Anesthesia. Resuscitation must be done.
• This stage is reached when too much anesthesia is administered.
• Respiration becomes shallow, pulse is weak & thready, & pupils become
widely dilated & no longer contract when exposed to light.
• Cyanosis develops, ad without prompt attention/intervention death rapidly
follows – anesthetic is discontinued immediately & respiratory & circulatory
support is initiated to prevent death.
• Stimulants (rarely used) maybe administered; narcotic antagonist can be
used if over dosage is due to opiods.
 Potential Intra Operative Complications

Nausea & Vomiting or Regurgitation

– turn to side if gagging occurs, head of the table is lowered,
and a basin is provided for the vomitus
– an antiemetic is administered preoperatively or intra
operatively to counteract possible aspiration
Anaphylaxis
– Is a life threatening allergic action that causes vasodilation,
hypotension & bronchial constriction.
.
Hypoxia & other Respiratory Complication
– Inadequate ventilation, occlusion of the airway, inadvertent
intubations of the esophagus, and hypoxia are significant
potential problems of general anesthesia.
– Factors that can contribute to inadequate ventilation that can
compromise gas exchange:
• Respiratory depression caused by anesthetic agent
• Aspiration of respiratory tract secretions of vomitus
• Asphyxia caused by foreign bodies in the mouth
• Spasm of the vocal cords
• Relaxation of the tongue
– peripheral perfusion is checked frequently, and pulse oximetry
values are monitored
Hypothermia
– a condition where glucose metabolism s reduced & a resultant
metabolic acidosis developed & are indicated by a core body
temperature below normal 36.6 lower)
Malignant Hyperthermia
– An inherited muscle disorder chemically induced by anesthetic
agents.
– Mortality rate more than 50%
Desseminated Intravascular Coagulopathy
– a life threatening condition characterized by thrombus
formation & depletion of select coagulation proteins.