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General anesthesia


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General anesthesia

  1. 1. General Anesthesia
  2. 2. Definition• The state produced when a patient receives medications for amnesia, analgesia, muscle paralysis, and sedation.
  3. 3. Clinical Constellation▫ Unarousable even secondary to painful stimuli.▫ Unable to remember what happened (amnesia).▫ Unable to maintain adequate airway protection and/or spontaneous ventilation as a result of muscle paralysis.▫ Cardiovascular changes secondary to stimulant/depressant effects of anesthetic agents.
  4. 4. Advantages  Reduces intra-operative patient awareness and recall.  Allows proper muscle relaxation for prolonged periods of time.  Facilitates complete control of the airway, breathing, and circulation.  Can be used in cases of sensitivity to local anesthetic agent.  Can be administered without moving the patient from the supine position.  Can be adapted easily to procedures of unpredictable duration or extent.  Can be administered rapidly and is reversible.•
  5. 5. Disadvantages Requires increased complexity of care and associated costs. Requires some degree of preoperative patient preparation. Can induce physiologic fluctuations that require active intervention. Associated with less serious complications such as nausea or vomiting, sore throat, headache, shivering, and delayed return to normal mental functioning. Associated with malignant hyperthermia
  6. 6. Process of Anesthesia▫ Premedication- to have the patient arrive in the operating room in calm, relaxed frame of mind.▫ Induction-most critical part of the anesthesia process.  D-A-M-M-I-S▫ Maintenance phase-anesthesia begins to wear off
  7. 7. Anesthetics thiopental (pentotal)▫ Therapeutic Class- General Anesthetic▫ Pharmacologic Class- Intravenous induction agent▫ Administration Alert- Pregnancy Category C▫ Pharmacokinetics-  Onset- 30-60 sec  Peak- 10-30 min  Half-life- 12 min  Duration- 20-30 min
  8. 8. thiopental (pentothal) action and uses▫ Use for medical procedures and to rapidly induce unconsciousness prior to administering inhale anesthetic.▫ Classified as an ultrashort-acting barbiturate, has a very low analgesic properties.
  9. 9. thiopental (pentothal) adverse effects▫ Can produce severe respiratory depression (Respiratory), apnea, airway obstruction▫ Depress the myocardium and causes dysrhythmias (Cardiovascular), hypotension▫ Causes hallucination, confusion, and excitability▫ Headache, nausea, vomiting
  10. 10. thiopental (pentothal) contraindication▫ Liver disease, Addisons disease, Myxedema▫ Severe heart disease▫ Severe hypotension▫ Severe breathing disorder▫ History of porphyria.
  11. 11. thiopental (pentothal) interactions and treatment▫ Drug-drug- potentiates respiratory and CNS depression▫ Herbal/food- kava and valerian potentiates sedation.▫ TX-Discontinue the drug and assist ventilation until respiration return to normal
  12. 12. succinylcholine (anectine)▫ Therapeutic Class- skeletal muscle paralytic agent; neuromuscular blocker▫ Pharmacologic Class- Depolarizing blocker; acetylcholine receptor blocking agent▫ Pregnancy Alert- Pregnancy category C▫ Pharmacokinetics  Onset- .5-1 min IV, 2-3 min IM  Peak- unknown  Half-life- unknown  Duration- 2-3 min IV, 10-30 min IM
  13. 13. succinylcholine (anectine) action and uses• Short-term muscle relaxation in anesthesia and intensive care, usually for facilitation of endotracheal intubation. ▫ Acts on cholinergic receptor sites at neuromuscular junctions. ▫ Reduces the amount of general anesthetic needed for the procedures.
  14. 14. succinylcholine (anectine) adverse effects▫ Can cause complete paralysis of the diaphragm and intercostal muscles (Muscular)▫ Bradycardia and respiratory depression (Respiratory)▫ Rapid onset of extremely high fever with muscle rigidity.▫ Hyperkalemia
  15. 15. succinylcholine (anectine) interactions▫ Drug-drug- additive skeletal muscle blockade will occur - clindamycin, aminoglycosides, furesemide, lkithium, quinidine or lidocaine▫ Halothane or nitrous oxide- bradycardia, dysrhythmias, sinus arrest, apnea, and malignant hyperthermia
  16. 16. succinylcholine (anectine) contraindications▫ Severe burns, trauma, neuromuscular diseases, or glaucoma▫ Pt. with history of malignant hyperthermia▫ Pulmonary, renal, cardiovascular, metabolic, hepatic dysfunction
  18. 18. ▫ Preoperative Phase: decision for surgical intervention is made to when the patient is transferred to the operating room table.▫ Intaroperative Phase: transferred to the operating room table to when he or she is admitted to the postanesthesia care unit.▫ Postoperative Phase: admission of the patient to the postanesthesia care unit and ends after follow-up evaluation in the clinical setting or home.
  19. 19. Preoperative Nursing Management:I- Patient Education:* Teaching deep breathing and coughing exercises.* Encouraging mobility and active body movement. e.g Turning(change position),foot and leg exercise.* Explaining pain management.* Teaching cognitive coping strategies.
  20. 20. Preoperative Nursing Management:• Managing nutrition and fluids. − A fasting period of 8hours or more is recommended• Preparing the bowel for surgery. − Enema• Preparing the skin. −The goal of preoperative skin preparation is to decrease• bacteria without injuring the skin.
  21. 21. Immediate preoperative nursing intervention:* Administering preanesthetic medication.* Maintaining the preoperative record. e.g. Final checklist, consent form, identification.
  22. 22. Post - SurgeryI-Assessing the patient: Frequent assessment of the patient oxygen saturation, pulse volume and regularity, depth and nature of respiration, skin color ,depth of consciousness.
  23. 23. II- Maintaining a patent airway: − The nurse applies oxygen, and assesses respiratory rate and depth, oxygen saturation.III- Maintaining cardiovascular stability: − The nurse assesses the patient’s mental status, vital signs, cardiac rhythm, skin temperature, color and urine output. − Central venous pressure, arterial lines and pulmonary artery pressure.IV- Relieving pain and anxiety:− Opioid analgesic.V- Assessing and managing the surgical site: − The surgical site is observed for bleeding, type and integrity of dressing and drains.
  24. 24. VI- Assessing and managing gastrointestinal function: − Nausea and vomiting are common after anesthesia. − Check of peristalsis movement.VII- Assessing and managing voluntary voiding: − Urine retention after surgery can occur for a verity of reasons. -Opioids and anesthesia interfere with the perception of bladder fullness. - Abdominal, pelvic ,hip may increase the like hood of retention secondary to pain.VIII- Encourage activity: − Most surgical are encouraged to be out of bed as soon as possible.