ANESTHESIA
MARIAN MENDOZA RN MAM
ANESTHESIA
DEFINITION
• ANESTHESIA- a temporary state that causes
unconsciousness, loss of memory, lack of pain and muscle
relaxation
• Anesthesia or anaesthesia is a state of
controlled, temporary loss of sensation or
awareness that is induced for medical purposes.
• It may include some or all of analgesia (relief
from or prevention of pain), paralysis (muscle
relaxation), amnesia (loss of memory), and
unconsciousness.
• An individual under the effects of anesthetic
drugs is referred to as being anesthetized.
ANESTHESIA
• loss of feeling or sensation, especially loss of the
sensation of pain with loss of protective reflexes.
• A reflex is an involuntary ... Other examples of
protective reflexes are blinking when something flies
toward your eyes or raising your arm if a ball is thrown
your way.
• Artificially induced state or partial or total loss
sensation, with or without loss of consciousness
• Anesthesia produces muscle relaxation , blocks
transmission of nerve impulses and suppresses reflexes
TYPES OF ANESTHESIA
Local anesthesia
General anesthesia
Regional anesthesia
Conscious sedation
TYPES OF ANESTHESIA
• GENERAL ANESTHESIA
• Involves the client being put into a
medication-induced state in which the patient
will not respond to pain and includes changes
in breathing and circulation
• Under general anesthetic, patient is in a state
of carefully controlled unconsciousness
Example; halothane, nitrous oxide+ oxygen
General Anesthesia
- Pain is controlled by general insensibility .
Basic Elements:
• Loss of Consciousness
• Analgesia (insensibility to pain)
• Hypnosis (artificial sleep)
• Relaxation (rendering a part of body less
tense)
TYPES OF ANESTHESIA
REGIONAL ANESTHESIA
• Involves the injection of local anesthetic
around major nerves bundles
• Once local anesthetic is injected in the desired
region, patient may experience numbness and
tingling in the area supplied by the nerves and
it may become difficult or impossible to move
that part of the body
Regional Anesthesia
• Anesthesia that produces a loss of painful
sensation in only one region of the body and
does not result in unconsciousness.
• when only one area of the body, like an arm or
a leg, needs to be anesthetized in order to
perform an operation.
Types of Anesthesia
Local / Regional
• Loss of sensation in a specific body part or
region.
• Pain is controlled without loss of
consciousness.
• The anesthetic drug is injected around a
specific nerve or group of nerves to
interrupt pain impulses.
Types of Anesthesia
LOCAL ANESTHESIA
• Involves the injection of local anesthetic into
the tissues near the surgical site
• It is usally used for minor surgery such as toe
nail repair, skin lesion or a cut to remove
something (biopsy)
• Example: Lidocaine, lignocaine
Methods of Administration
A. Inhalation
- It is the most common method .
- The anesthesia vapor of a volatile
liquid or anesthetic gas is inhaled
and carried to the blood stream by
passing across the alveolar
membrane into the general
circulation and onto the tissue.
Inhalation
Examples:
• Halothane
(Flouthane)
• Nitrous oxide
(N20)
• Enflurance
(Ethane)
• Sevoflurane
• Isoflurane
Laryngeal Mask
General anesthesia
Mask Endotracheal tube
Methods of Administration
B. Intravenous
- Injected directly
into circulation
usually via a
peripheral vein.
Intravenous
Examples:
• Pentothal sodium (barbiturates)
• Fentanyl (opioid narcotic)
• Demerol (opioid narcotic)
• Nalbuphine Hcl (narcotic)
Techniques
A. Topical Anesthesia
- Applied directly into the skin mucous
membrane, open skin surfaces, wounds
and burns.
Examples:
• Lidocaine (Xylocaine)
• Benzocaine
Techniques
B. Local Anesthesia
(Infiltration)
- Injection of the anesthetic
agent intracutaneously and
subcutaneously into tissues
to block peripheral nerve
stimuli at their origin.
Example:
Lidocaine
Techniques
C. Regional Application
C1. Nerve Block
- Loss of sensation produced by
injecting the anesthetic drug around a
specific nerve to interrupt sensory, motor or
sympathetic transmission of impulses.
• Major Block – involves multiple nerves (e.g.
Brachial plexus-arm)
• Minor Block – facial nerve
Posterior Tibial Nerve Block
Common nerve blocks
• Trigeminal nerve blocks (face)
• Ophthalmic nerve block (eyelids and scalp)
• Supraorbital nerve block (forehead)
• Maxillary nerve block (upper jaw)
• Sphenopalatine nerve block (nose and palate)
• Cervical epidural, thoracic epidural, and lumbar epidural
block (neck and back)
• Cervical plexus block and cervical para-vertebral block
(shoulder and upper neck)
• Brachial plexus block, elbow block, and wrist block
(shoulder/arm/hand, elbow, and wrist)
• Subarachnoid block and celiac plexus block (abdomen and
pelvis)
Techniques
C.2. Intravenous Block (Bier Block)
- Used most often for procedures involving the arm, wrist and
hand.
- An occlusion tourniquet is applied to the
extremity to prevent infiltration and
absorption of the injected IV agent
beyond the involved extremity.
TYPES OF ANESTHESIA
REGIONAL ANESTHESIA
• Spinal anesthetic
• A type of regional anesthetic used to give total
numbness lasting about 3 hours to lower part
of the body so that surgery can be safely
carried out in this area
• Examples: lidocaine, lignocaine, bupivacaine,
tetracaine
Techniques
Spinal Anesthesia
- Loss of sensation below the level of
the diaphragm produced by the injection
of the anesthetic drug into the
subarachnoid space without LOC.
- Lumbar puncture – between L4 and L5.
Spinal Anesthesia
Spinal Anesthesia
Categories:
1. Low Spinal Anesthesia (saddle or caudal)
-perineal or rectal surgery.
2. Mild
- below the level of the umbilicus- T10
- used for hernia repairs or appendectomy.
3. High
- reaching the nipple – T4
- for cesarean section
Complications:
- postural dependent spinal anesthesia.
Uses:
- Abdominal surgery, pelvic surgery and
urologic procedures.
Spinal Anesthesia
Position:
- Client is usually in lateral position.
• Patients back is at the edge of the OR table,
parallel to it.
• Knees are flexed onto the abdomen and
head is flex to knees.
• Hips and shoulder are vertical to table to
prevent rotation of the spine.
Type of regional anesthesia
Regional anesthesia
Epidural anesthesia
• Usually used to numb
the lower half of the
body and good for
pain relief for
example , during
labor and childbirth
Techniques
Epidural Anesthesia
- Injection is made into space surrounding
dura matter within the spinal cord.
Uses:
• Anorectal, vaginal and perineal procedures.
• More commonly used for OB patients as a
continuous technique to control pain labor and
delivery during and after CS.
• FHT Monitored because patient is insensitive to
uterine contractions.
Epidural Anesthesia
Epidural Anesthesia
Examples
A. Bupivacaine HCL
B. Lidocaine HCL
C. Mepivacaine HCL
D. Chloroprocaine
• Epidural narcotic analgesia may provide sustained
post operative relief or control of pain in patients
with intractable or prolonged pain as from
muscle spasm or terminal malignancy .
• Example : Morphine Sulfate, Fentanyl
TYPE OF ANESTHESIA
Conscious sedation
• Defined as aa medication-induced state that
reduces the patient’s level of consciousness
during which the patient may respond
purposefully to verbal commands or light
touch
• Drug used : midazolam, fentanyl, morphine
SIDE EFFECTS
Common side effects that can occur after having a general
anesthesia and some regional anesthesia include;
• Vomiting
• Infection
• Dizziness and feeling faint
• Feeling cold or shivering
• Headache
• Itchiness
• Difficulty passing urine
• Aches and pain
• Sore or hoarse throat
• Dry mouth
COMPLICATION
• An allergic reaction to an
anesthetic medication
eg: Lignocaine
• Permanent nerve
damage- which can cause
numbness or paralysis
• Cardiac arrest
• Death
Stages of Anesthesia
Stage 1- Stage of analgesia / amnesia
Characterized by loss of response to verbal
commands and loss of consciousness
Patient is drowsy, dizzy, and may experience
auditory or visual hallucination.
Normal CR, BP, slow RR, but increase in
depth.
Pain is progressively abolished
Stages of Anesthesia
Stage 2- Stage of Excitement
Begins with Loss of Consciousness
and extends through loss of eyelid reflexes.
Irregular and large in volume -RR,
increased HR, increased BP, pupils widely
dilated.
Muscle tone increased- jaw may be tight
Stages of Anesthesia
Stage 3- Stage of Surgical Anesthesia
Surgery usually begins at this stage.
Client is motionless with regular
shallow RR .
(-) Blinking & gag reflex, (-) corneal
reflex.
Client is unconscious
Stages of Anesthesia
Stage 4- Stage of medullary depression /
Danger Stage
Characterized by profound depth of
anesthesia.
Caused by overdose .
Patient is not breathing, no heartbeat at all.
(-) reflex, weak thready pulse, decrease BP,
widely dilated pupils, flaccid respiration.
May lead to respiratory and cardiac arrest
SIGNS and Nursing INTERVENTIONS
[Link], dizzy, visual and auditory hallucination
• Nursing care- close door, quite environment,
stay by to assist the client
2. Client may struggle, nrsg action – assist
anesthesiologist, provide quite environment
3. No gag reflex, no blink,
4. No breathing, no heart beat – N. I. -provide
cardiac arrest tray, and airway
Commonly used abbreviations
GETA – General Endotracheal tube Anesthesia
CSEA – Combined Spinal Epidural Anesthesia
SAB – Sub-arachnoid Block
GA – General Anesthesia
PNB – Peripheral Nerve Block
GIVA – General Intravenous Anesthesia
LMA – Laryngeal Mask Anesthesia
