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 Wheter the procedure is an
emergency
TYPES OF ANESTHESIA  Options for management of pain after
surgery
ANESTHESIA  How long it has been since the client
- the one that control pain during the ate, had any liquids, or any drugs
surgery.  Client position jeeded for the surgical
- is an induced state of partial or total loss procedure
of sensation, occuring with or without loss
of conscience TYPES OF ANESTHESIA
- defined as the absence of normal
sensation. This also includes loss of
protective reflexes.

Anesthesia provides:
 Amnesia
 Analgesia
 Muscular relaxation

 A physician anesthesiologist _- the one

who perform anesthesia
- it can be invasive procedure - pasensya na kayo ni ss ko lang ppt ni
- they are the one who manage the pain maam hindi ko rin mabasa sa sobrang
during the surgery and after the surgery labo hahahaa
- can be comprises of physician in training or
fellow or resident or it can be Certified  Local Anesthesia – numbs small
Nurse anesthasis or CRNA section of the body. The medicine is
 Nurse Anesthatis – who assist in giving given temporarily in order to stop
anesthesia the sense of pain inthe particular
area or the body.
PURPOSES OF ANESTHESIA Ex: Dental extraction or skin biopsy
- To produce muscle relaxation - topical
- to produce analgesia - infaltration
- to produce artificial sleep or to cause loss of
consciousness  Regional Anesthesia – these are
- to block transmission of nerve impulses the one that blockting in the larger
- to suppress reflexes part of the body such as the lymphs
or everything below your chest.
Selection of anestheis is influeced by The patient may be concious during
the follow: the procedure or have sedation in
 Type and duratuon of the procedure addition to regional anesthesia.
 Area of the body having surgery - it is injected in order to block pain
 Safety issues to reduce injury, such as around the major nerves or in
airway management spinal cord
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- Peripheral anesthesia
- Epidural – in order to ease the pain of GENERAL ANESTHESIA
childbirth or during CS or spinal hip or - is a reversible loss of consciousness
knee surgery or arm block for hand induced by ihibating neuronal impulse in
surgery. It will no cause the patient several areas of the central nervous
conciousness and the brain and heart are system (made up of brain and spinal cord,
not affcted to any extend so that the and this is the body processing center.)
patient will remain awake and there is a - general anesthetics are agents that block
little danger of the strenght of the heart the pain stimulus at the cortex
beat being diminize.
- Spinal – that can minimize the sense of PROCEDURES S ATATE OF THE:
pain. It is the moat common technique or  Analgesia
procedure involving the lower body and it  Amnesia
also help to avoid complication associated  Unconsciousness characterized by
with general anesthesia loss of reflexes and muscle tone
- Intravenous regional

 General Anesthesia – treatment

that make the patient unconsious in
sensitive to pain or other stimuli.
Used in more invasive surgical
procedure or in head, chest or
abdominal. Patient will expereince
complete loss of consiousness and
perception.
- total inhalation anesthesia STAGES OF GENERAL ANESTHESIA
- balance anesthesia
-total intrvenous intramascular  STAGE 1 (analgesia and sedation,
anesthesia relaxation):
 Itong mga nasa general ay in a form 1. begins with induction and ends with
oh inhalant anesthesia, injectable loss of consciousness
anesthesia or anesthetic aja (idk) 2. client feels drowsy and dizzy nad has a
reduced sensation to pain and is amnesic
Sedation- it relaxes the patient to the 3. hearing is exage
point in a way there is a more naturalistic
but it can be easily to arouse or awaken. NURSING INTERVENTION
Ex light or moderate sedation: Cardiac 1. Close the operating room doors, dim
catheterization, colonoscopy the lights and control traffic in the
Deep sedation: - provided by anesthesia operating room.
professional because breathing may be 2. Position the client securely with
affected with stronger anesthatic safety belts
medication. May expereince more sleep
and completely unconscious nad not liekly
to remember the procedure.
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3. The jaw is relaxed and there is
quite, regular breathing
4. The client cannot hear
5. Sensations are lost

NURSING INTERVENTIONS
1. Assist the anesthesiologist with
intubation
- Providing assistance helps promote
smooth intubation and prevent
injury.
 STAGE 2(Excitement, delirium)
- characterized by struggling, shouting,
laughing, singing or crying --- maybe
prevented in anesthetic is administred
smoothly and quickly
- client may have irregular breathing, 2. Place the patient into operative
increased muscle tone and involuntary position
movement of the extremeties during this - Performing procedures as soon as
stage
possible promotes time
- Laryngospasm or vomiting may occur management to minimize total
- Pupils dilate but cintract if exposed to anesthesia time for the client.
light

NURSING INTERVENTION

1. Avoid auditory and physical stimuli 3. Prepare the patient skin over the
2. Protect the extremeties operative site as directed.
3. Assits the anesthesiologist or CRNA
with suctioning as needed
 STAGE 4 (Danger, paralyzed)
4. Stay with client
1. Begins with depression of vital
 STAGE 2 (Operative anesthesia, function and ends with
surgical anesthesia) respiration failure, cardiac arrest
1. Begins with generalized muscle and possible death
relaxation and ends with loss of 2. Respiratory muscles are
reflexes and depression of vital
paralyzed; apnea occurs
function.
3. Pupils are fixed and dilated
2. Pupils are small but contract when
exposed to light. Respiration are
NURSING INTERVENTION
regular, the pulse rate and volume
are normal, and the skin is pink or 1. Prepare for and assits in treatment
of cardiac and or pulmonary arrest.
slightly flushed
- teamwork and preparedness help
decrease njuries and complications
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and promote the possibility of a - Medula contains the cardiac,
desired outcome for the client. respiratory, vomiting anf vasomotor
centers.
2. Document occurrence in the client - important in respiration, cardiac center,
chart. vasomotor and relfexes.
- document everything when the
patient is experiencing
depression on the vital function.

DEPTH OF ANESTHESIA
- CNS depression which is caused by
accumulation of the anesthesia drug in the
brain (cortex, subcortex, midbrain, spinal
cord, medullary centers. )
Cortex – involves in higher process of
human brain includes the memory,
thinking, learning, reasoning, problem
solving, emotions, consciouness and
function related to senses. (review lang itezz sabi ni maam sa mga
Subcortex – located beneath the cortex, nadiscuss sa taas)
process more primitive function such as
emotions process in the amidlla. SIGNS AND STAGES OF ANESTHESIA
Midbrain – mecensepalon (not sure sa - Somewhat related to the response from
spelling). Diethyl Ether);
- serve important function in motor
movement particularly movement in the 1. Analgesia, Mild CNS depression.
eye and in the auditory and visula Suitable for surgical procedures
processing, any damage to midbrain can not requiring muscle relaxation. All
result a wide variety movemnt idorsders, anesthetics do not produce
difficulty in hearning and vision and anelgesia.
sometimes trouble in memory. 2. Delirium: An excited state
Spinal cord – sense motor comands from resulting from corticol motor
the brain to the body. This is the one that depression. This can be avoided
sends sensory information from the body with rapidly potent anesthetics.
to the brain and coordinate reflexes. The This stage extend from the lass of
one that carry nerve signal. Nerve signal consciouness in stage 1 to surgical
helps to feel sensation and move muscles. anesthesia in stage 3.
Any damage in spinal cord can affect 3. Surgical Anesthesia: Furhter
movement and fucntion. subdivided into stages
Medullary center – cardiovascular and representative of increasing
respiratory system link together into a muscle relaxation, the final stage is
united system that control your heart rate, dissappearance of muscle tone.
breathing and BP, and this is the one 4. Respiratory paralysis: Generally
manage the automatic processes. not desirable.
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person trained adminstration of
Administration of General general anasthesia.
Anesthesia - Stored at room temperature of
about 15 – 30 degree centegry.
INHALATION - Most common effect that patient
a. Gaseous Agent – nitrous oxude is may experience is vomiting,
the most common used agent and is shivering and upset stomach.
usually given with oxygen. It is
colorless, odorless gas that  Sevoflurane – volatile anesthetics
provides analgesia. that provide hipnosis, amnesia,
b. Volatile agents – liquids agents analgesia and autonomic blockage
vaporized for inhalation. O2 is the during surgical and procedural
carrier flowing over or bubbling intervnetion.
through the liquid in the vaporizer - can cause loss of conscoiuness
system on the anesthesia machine.
 Desflurane – used to cause of loss
of consciouness before or during
surgery in adult. Used in
maintenance anesthesia in adult
and children after receiving other
naesthetic before or during sugery.

 Holathane – used in induction and

maintenance of general anesthesia.
Inhalational Anaesthetics - it reduces the BP, frequenly
decrese the pulse rate and
 Nitrous oxide-weak – odorless, depresssess respiration.
colorless and non flamable gas. It is - advantage is it non flamability
support convasion to the same and favorable solubility
conent as oxygen. This is a least characteristics and has rapid
potent inhalation anesthetics and induction and capacity to provide
this is clinically use as a safe muscle relaxation.
anesthetic and appreciated for anti - causes minimal chages in heart
anxiety effects. Slow down the rate, and it acts in the brain and
brain and the body response and causes unconsciouness.
the effect of the drugs varies on the - used to put the patient sleep and
amount of how much has been maintain level of unsciousness
inhaled. Can cause feeling our during entire operation.
euphoria, relaxation and calmness,
giggles and laughter. Hypnotic drugs-intravenous
 Isoflurane – it induces muscles
relaxation and reduces pain  Gold standard - thiopentone –
sensitivity by altering tissue medicine use as an anesthetics.
exciettability. Administred only by Use alone or with other
medications.
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- Belong to class of drugs called - the common side effects include
barbitorate. hypotension, pauses of breathing
- safe and effective in childern and (lasting 30-60 seconds), burning
the most coomon side effects is sensation at the injection site and
coughing, hicupps, sneezing, sometimes the patient might have
slowed breathing, cardiac rushes and expereincing itching,
arrythmia, slowed heart rate, iregular heart beat (arrythmia) or
prolonged sleepiness and expereincing slow heart beat.
recovery and, shivering.  Etomidate
Penthotal sodium - administer by means  Benzodiasepimes
of iv route. Individual response to the drug  Ketamie – used to indious loss of
is so varried that there can be no fixed consciouness or relieve pain.
dosage that drug should be titrated against - rapid active general anesthetic
patient requirement as govern by age, sex and used for induction of
and body wegiht. anesthesia diagnostic and surgical
- Younger patient recuired relatively procedure.
larger dosage than middle aged and - the most common side effect is
elderly person. drowsiness, double vission,
- when giving penthotal the doctor may confusion, nausea and vomiting,
agve pre medication like the atropin. dizziness and feeling of
Atropin sulfate is to decrease the broncial uneasiness.
secretions.
- sometime we give test dose before giving INTRAVENOUS INJECTION
pentothal. It is advisable to inject a small - administered through a vein. The patient
test dose 25 – 75 mg in order to assess the feel a simple, pleasant and rapid induction.
tolerance and sensitivity and observe the Unconsciousness generally occurs about
patient reaction for at least 60 seconds and 30 seconds to 1 minute after the initial IV
is unexpectedly deep anesthesia develop administration.
or respiratory depression occurs,
conusder this possibility the patient may 1. Barbiturates – it acts rapidly,
be sensitive to pentothal. causing unconsciousness within 30
 Propofol – given intrvenously. seconds.
Used to sedate the patient and Ex: Thiopental NA (Penthotal NA)
administred as a bolus or as 2. Ketamine (Ketalar) – ketamine is
infussion or some combination of dissociative anesthetic agents.
the two. Rpids onset of the trancelike,
- The action involves positive analgesic sate occur, Often used for
modulation of inhibatory fucntion of diagnostic and short surgical
the nuerotransmiter, your gamma procedures.
aminobutyric acid. This is a non 3. Propofol (Diporivan) – is a short
barbitorate sedative and used in acting anaesthetic agents. Hypnosis
hopsital setting by trined anesthathist occurs in legs than 1 minute from
for the induction and maintenance of the time of injection. The drug is
general anesthesia. eliminated rapidly and the client
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beccomes responsive withing 8
minutes after the infusion ends. ANALGESIA - OPIATES
 Gold standard – morphine
ADJUNCTS TO GENERAL ANESTHETIC  Deribatives – diamorphine codeine
AGENTS  Synthethic agents
 Pethidine
 SEDATIVES  Fentanyl / alfentanil – short acting
- common drug in the class include  Remidentanil – ultra short acting
midazolan (Dormicum) and
diazeoan (Valium). All have MUSCLE RELAXATION
hypnotic, sedative, muscle relaxant  Aids intubation
and amnesic effects.  Helps surgeon / surgery
 Surgery og long duratiom
 Opoid analgesics (Narcotics)  Reduces maintenance dose of
- common opoid analgesic enhance anaesthethics agents
anesthesia include morphone
sulfate, meperidine, fentanyl and MALIGNANT HYPERTHERMIA
sufentanil.  Rare but extreme emergency
 Occurs most often with inhalants
 Neuromuscular Blocking Agents  Genetic predisposition
– are used to relax the jaw and vocal  Uncontrolled acceleration of
cords immediately after induction muscle metabolism and increased
so that the endotracheal tube can BMR
be placed. This is used to provide  Life threatening elevated
continued muscle relaxation. temperature. Hyperkalemia,
Ex: Succinylcholine acidosis
Emergency treatment of Malignant
ANALGESIA Hyperthermia
 Good analgesia = good anesthesia  Stop surgical
 Hypnotic sparing effects procedure/anestheisa if possible
 Opiates  Hyperventilate with 100% oxygen
 Local anaethethics  Administer DANTROLENE
 NSAIDS intravenously
 Paracetamol  Undertake body cooling measures:
Iced NS intravenously, cooling
Potential Complications of General blanket.
Anesthesia
 Overdose
 Unrecognized hypoventilation
 Complications of intubation
 Anaphylaxis
 Hypothermia
 Injury r/t positioning, burns
 Malignant hyperthermia
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LOCAL ANESTHESIA
 Inejction of a solution containing TYPES OF LOCAL ANESTHESIA
anesthetic into the tissue at the
planned incision site. 1. Topical Anesthesia
 Briefly disrupts sensory nerve
 Topical agents are applied
impulse transmission form a specific
directly to the area of skin or
body area or region.
mucous membrane surfaced to
ADVANTAGES be anesthetized.
2. Local Infiltration
 Simples, economical, and non-
explosive  Is the injection of an anesthetic
 Equipment needed is minimal agent directly into the tissue
 Post operative recovery is brief around an incision, wound or
 Undesirable effects of GA are lesion.
avoided SPINAL ANESTHESIA
 ideal for short and superficial
surgical procedures
ADVANTAGES DISADVANTAGES
 Mental status  Necessary extra
monitoring expertise
 Shorter  Possible patient
recovery pain

INDICATIONS CONTRAINDICATIONS
 Surgical  Coagulopathy
procedures  Uncorrected
 for spinal anesthesia this how we will below the hypovolemia
position our client (side lying and it is diaphragm
somewhat position like fetal position)  Patient with
 if mataba ang patient pinapaposition sila cardiac or
like sitting position respiratory
disease
LOCAL ANESTHESIA
ADVANTAGES DISADVANTAGES
Involved Medications
 Client remains  Client remains  Lidocaine
conscious conscious  Bupivacaine
 Cost effective  Potential for local  Tetracaine
 Minimal recovery tissue irritation
time  Potential for Patient Assessment
 Vasoconstrictive sudden systemic  Continuous heart rate, rhythm, and
agents decrease reaction such as pulse oximetry monitoring
bleeding hypotension  Level of anesthesia
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 Motor function and sensation
return monitoring
REGIONAL ANESTHESIA TYPES
COMPLICATIONS
 Hypotension
 FIELD BLOCK – injected around the
 Bradycardia
operative field
 Urine retention
 NERVE BLOCK – into or around a
 Postural puncture headache nerve or nerve group
 Back pain  SPINAL – into subarachnoid space
SPINAL ANALGESIA  EPIDURAL – into epidural space

Administration of Reginal
Indications Anesthesia
 Postoperative pain from major  Spinal Anesthesia – produces a
surgery nerve block in the subarachnoid
space by introducing a local
Involved Medications anesthetic at the lumbar level,
 Lipid-soluble drugs usually between L4 and L5.
 Preservative-free morphine  Autonomic nerve fibers are the first
Monitoring recovery affected and the last to recover.
 Respiratory depression
 Urine depression
 Pruritus
 Nausea and vomiting
REGIONAL ANESTHESIA
 A form of local anesthesia in which
an anesthetic agent is injected
around the nerves so that the area
supplied by the nerves is
anesthetized. PERIPHERAL NERVE BLOCKS
 The patient receiving RA is awake
and aware of his surroundings  Blockade of brachial plexus, lumbar
unless medications are given to plexus and specific peripheral
produce mild sensation or to nerves via injection of local
relieve anxiety. anesthetic solutions into tissues
surrounding individual peripheral
nerves or nerve plexuses.

 Local anesthetic deposited near the

vicinity of the nerve diffuses from
the outer surface (mantle) to the
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center (core) of the nerve along a
concentration gradient.
LOWER LIMB BLOCKS
 Proximal structure: mantle
 Lumbar plexus block
 Distal structure: core
 Illiofascial block
 Obturator block
 Sciatic block
 Ankle block
Advantages of this region blocks
Advantages  Eliminates the need for expensive
 Reduced physical stress equipment and drugs
 Avoids airway manipulation and  Relatively safe method of anesthesia
complication associated with  Provides excellent method of
endotracheal intubation anesthesia
 Indwelling catheters may be placed  Does not cloud the patient’s
for prolonged and analgesia consciousness or alertness
 Provides surgical anesthesia and  Useful for patients with respiratory
postoperative analgesia or cardiac problems

Requirements REGIONAL ANESTHESIA

 Cooperative patient Advantages Disadvantages
 Skilled anesthesiologist
 Patient remains  Patient remains
 Surgeon accustomed to operating conscious conscious
on awake patients  No respiratory  Circulatory
depression or depression/statis
HEAD AND NECK
irritation  Potential
 Intracranial block – neurosurgery  Enhanced pain trauma/infection
and scalp surgeries management at site of
 Eye blocks post-operative injection
 Face blocks  Edema – potential
for spinal
 Ophthalmic nerve block
headache
 Maxillary nerve block
 Mandibular nerve blocks
 Cervical plexus blocks COMPLICATIONS
 Hypotension
UPPER LIMB BLOCKS
 Headache
 Interscalene block  Post op paralysis
 Supraclavicular blocks
 Nausea and vomiting
 Infraclavicular blocks
 Urine retention
 Axillary block
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 Others: Labor analgesia and
interventional pain modalities.

EPIDURAL ANESTHESIA (EA)

 A commonly used conduction block
by injecting a local anesthetic into
the epidural space that surrounds COMPLICATIONS
the dura matter of the spinal cord  Similar to that of spinal anesthesia
 Block sensory, motor, and  Total spinal anesthesia
autonomic functions  Local anesthetic toxicity
 Have much higher doses  Spinal/epidural hematoma
 All the complications in the SA can  Concerns regarding catheter
be observed except headache placement and removal in patient
 Injection of a certain amount of local on anticoagulation
anesthetic (with or without  Epidural abscess
opiates) into the lumbar or thoracic
epidural space TECHNIQUES FOR EA
 A catheter is inserted after the  Patient position
epidural space has been located  Landmarks identified
with a needle  Aseptic preparation
 Controlled local anesthetic  Local infiltration of LA at
delivery injection site
 Redosing of anesthesia for  Epidural puncture with Tuohy
long procedures needle
 Post – operative analgesia  Epidural space identified: LORT:
with local anesthetics and hanging drop technique
opiates.  Note: =/- of CSF, blood paresthesia
 Epidural catheter threaded into
Indications
space
 Abdominal
 Test for inadvertent
 Thoracic
intravascular and intrathecal
 Lower extremities procedures
placement of catheter
Advantages  Epidural injection of LA
 Hip surgery – decrease blood loss
and incidence of deep venous
thrombosis
 Thoracic surgery – superior pain
control, less sedation, better
pulmonary function
 Rapid recovery of GI function
 Early ambulation
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Level of Anesthesia required for

procedures

Admitting the patient to the Post –

anesthesia Care unit (PACU)
 Transferring of the patient from the
OR to the PACU is the responsibility
LOCAL CONDUCTION BLOCKS of the anesthesiologist
 During the transport the
anesthesiologist remains at the
 Brachial plexus block – produces head part of the patient and a
anesthesia of the arm surgical team member remains at
 Para vertebral anesthesia – the opposite side
produces anesthesia of the nerves  Transporting the patient involves
supplying the chest, abdominal the special consideration of the
wall and extremities incision site, potential vascular
 Transsacral (caudal) block – changes and exposure.
produces anesthesia of the
perineum and occasionally the NURSING ASSESSMENT IN PACU
lower abdomen  Vital signs – presence of artificial
airway, O2 saturation, BB, pulse
and temperature
 Level of consciousness (LOC) –
ability to follow command,
pupillary response
 Urinary output (I&O)
 Skin integrity
 Pain
 Condition of surgical wound
 Presence of IV lines
 Position of patient – (If ang patient
under spinal anesthesia, position
the client flat on bed for 6-8 hours
and bawal itaas taas ang ulo kasi
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mag vomit ang patient that can 2. Maintains optimal respiratory
cause severe headache) function
3. Does not develop DVT
POST ANESTHESIA CARE UNIT
4. Exercise and ambulates as
(PACU)
prescribed
 Also called the recovery room or
a. Alternated periods or
post-anesthesia recovery room
rest and activity
 Kept clean, quiet, free of b. Progressively increases
unnecessary equipment, with
ambulation
indirect lighting, and well
c. Resumes normal
ventilated to help patients
activities with
decrease anxiety and promote
prescribed time frame
comfort
5. Wounds health without
 Should be equipped with necessary complications
facilities 6. Resumes oral intake and normal
PHASES OF POST-ANESTHESIA CARE bowel functions
a. Reports absence of N
 Phase I PACU – used during the and v
immediate recovery phase, b. Takes at least 75% of
intensive nursing care is provided usual diet
 Phase II PACU – the patient is c. Is free of abdominal
prepared for self-care or care in the distress and gas pains
hospital or an extended care setting d. Exhibits normal bowel
 Phase III PACU – patient is elimination pattern
prepared for discharge 7. Acquired knowledge and skills
necessary to manage therapeutic
Measures used to determine regimen
readiness for discharge in the PACU 8. Experience no complications and
 Stable V/S has normal vitals
 Orientation to person, place, events
Common complications post-
and time
anesthesia
 Uncompromised pulmonary fxn
 Nausea/vomiting – 5%
 Adequate O2 saturation
 Unexpected alteration in mental
 UO at least 30ml/hr
state – 5%
 N and V absent or under control
 Requirements for upper airway
 Minimal pain
support – 3.6%
EVALUTATION  Hypotension – 3%
EXPECTED OUTCOME:  Dysrhythmias – 2%
 Hypertension, myocardial ischemia,
1. Indicates that pain is decreased
or a major cardiovascular
intensely
complication - <1%
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Checklist for evaluating patients NAUSEA & VOMITING

Before departing the OR and After
arriving in the PACU
 Airway patency
 Breathing (rate and depth)
 Arterial oxygenation (pulse
oximeter)
 Blood pressure
 Heart rate, ECG
 Level of SAB and EPIDURAL
 Level of consciousness AIRWAY OBSTRUCTION

COMMON PROBLEMS IN PACU

DELAYED AND AWAKENING

HYPOXEMIA
AGITATION AND DELIRIUM

HYPERTENSION/HYPOTENSION
PAIN
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HYPOTHERMIA ALDRETE SCORING SYSTEM

POST OPERATIVE PAIN

 ACUTE pain is experienced
immediately after surgery (up to 7
days)
 CHRONIC pain lasts more than 3
months after the injury
ROUTINE DISCHARGE CRITERIA
FROM PACU
 Vital signs satisfactory and stable
 Return to postoperative metal state
 Adequate pain control
 Immediate treatment of any
complications
 Adequate function of all drains,
tubes, catheters
 Surgical bleeding controlled or
treated
 Post-operative orders reviewed and
implemented
 Laboratory studies needed
immediately obtained and results
reviewed