General Anesthesia

Definition•The state produced when a patient receives medications for amnesia, analgesia, muscle paralysis, and sedation.

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.

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.•  

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

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

Anestheticsthiopental (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

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.

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

thiopental (pentothal)contraindication

▫Liver disease, Addison's disease, Myxedema

▫Severe heart disease▫Severe hypotension▫Severe breathing disorder▫History of porphyria.

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

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

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.

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

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

succinylcholine (anectine)contraindications

▫Severe burns, trauma, neuromuscular diseases, or glaucoma

▫Pt. with history of malignant hyperthermia

▫Pulmonary, renal, cardiovascular, metabolic, hepatic dysfunction

PRE AND POST NURSING MANAGEMENT

▫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.

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.

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.

Immediate preoperative nursing intervention:

* Administering preanesthetic medication.

* Maintaining the preoperative record. e.g. Final checklist, consent form,

identification.

Post - Surgery

I-Assessing the patient: Frequent assessment of the patient

oxygen saturation, pulse volume and regularity, depth and nature of respiration, skin color ,depth of consciousness.

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.

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.