Slide 1

[Audio] MEDICAL SURGICAL NURSING I Introduction to types of aneasthesia. 1.

[Audio] Learning Outcomes. 1. Define anesthesia. 2. State the different types of anesthesia. 3. Describe the nurses role before, during and after administration of analgesia. 2.

[Audio] Anesthesia Greek word →Anesthesis (negative sensation) Definition Is used to produced unconsciousness , analgesia, reflex loss and muscle relaxation during a surgical procedure. ( lgnatavicius & Workman,2002) 3.

[Audio] Anesthesia Analgesia: Absence of pain in response to a stimulus that is normally painful. Anesthesia: Absence of all sensory modalities (Benzon, 2005). 4.

[Audio] Basic Principles of Anesthesia "Triad of General Anesthesia" need for unconsciousness need for analgesia need for muscle relaxation 5.

[Audio] Type of anesthesia ANESTHESIA GENERAL REGIONAL ANESTHESIA ANESTHESIA TOPICAL LOCAL INFILTRATION NERVE BLOCK BRACHIAL PLEXUS 6 FIELD BLOCK SPINAL EPIDURAL.

[Audio] Type of anesthesia 1. General anesthesia. Total absence of all sensation with the patient unconscious. 2. Local/ regional anesthesia Absence of pain in a particular region, body with the patient conscious. 7.

[Audio] Factors affecting choices of anesthesia 1. Patients factors Age – old/ young Old - the functional capacity of organs declines. Young – the organ at minimal functioning level. Physical condition of the patient - obese Medical history - - concurrent Illness - cardiac disease, DM, HTN, asthma, COPD - list of medications - - allergies , allergics to anaesthetic drugs. Social history – tobacco, alcohol, drug use 8.

[Audio] Factors affecting choices of anesthesia 2. Type, location and duration of the surgery Eg: open heart surgery need longer hours of an operation Degree of technical difficulty of the surgery. Eg: micro surgery/transplant 9.

[Audio] Factors affecting choices of cont anesthesia 3. Previous anesthetic history Eg: allergics to anaesthetic drugs. Personal preference, expertise and judgement of the anesthetist. Eg: in special cases the anesthetist been call from other hospital(visiting anest) patient's preference. Eg: personel request by client 10.

[Audio] General anesthesia Purpose Analgesia — loss of response to pain Amnesia — loss of memory Immobility — loss of motor reflexes Hypnosis — loss of consciousness Skeletal muscle relaxation 11.

[Audio] Stages of general anesthesia Stage I: Analgesia Description: The patient begins to lose consciousness but remains responsive. This stage is characterized by analgesia (pain relief) without loss of awareness. Characteristics: Decreased pain sensation. Patient may still be able to respond to commands. 12 Amnesia may begin to develop..

[Audio] Stages of general anesthesia 2. Stage II: Excitement (Delirium) Description: This stage involves loss of consciousness and may include involuntary movements and vocalizations. It is often considered an undesirable stage due to potential agitation. Characteristics: Increased heart rate and blood pressure. Reflexes may be exaggerated. Possible hallucinations or delirium. 13.

[Audio] Stages of general anesthesia 3. Stage III: Surgical Anesthesia Description: The desired stage for surgery, where the patient is fully unconscious and does not respond to surgical stimuli. Characteristics: Further loss of consciousness. Muscle relaxation and loss of reflexes. Stable vital signs (heart rate, blood pressure). 14.

[Audio] Stages of general anesthesia 3. Stage III: Surgical Anesthesia Divided into four planes, with the third plane being ideal for most surgeries: Plane 1: Loss of eyelash reflex. Plane 2: Loss of corneal reflex. Plane 3: Intercostal muscle paralysis; suitable for surgery. Plane 4: Deep anesthesia; can lead to respiratory failure. 15.

[Audio] Types of general anesthesia Types Description Example Extremely rapid induction Thiopental Intravenous anesthesia Ketamine Fentanyl Inhalation anesthesia Ether, chloroform, halothane Nitrous oxide Mixture of volatile liquids or gas and oxygen Non volatile Rectal anesthesia Instilled into the rectum Methohexital sodium 16.

[Audio] General anesthesia (cont..) Muscle relaxant Administered intravenously Given mainly – To facilitate intubation – Relax the muscle – To administer smaller dose of potent general anesthesia Example: – Suxamethonium – Atracurium – Vecuronium 17.

[Audio] General anesthesia (cont..) The anesthetics that reduce the client consciousness, inhibit the client from breathing adequately. The anesthesiologist must assist the patients breathing during the course of the surgery by placing a small breathing tube (endotracheal tube or Laryngeal Mask Airway - LMA) into trachea after the client is anesthetized. 18.

[Audio] Laryngeal Mask Airway 19 ETT. 19 ETT Laryngeal Mask Airway.

20.

[Audio] General anesthesia (cont..) The endotracheal tube or LMA is most often removed while the patient is waking up. Certain short procedures not involving surgery in the abdomen or chest may be performed without the use of an endotracheal tube. 21.

[Audio] Side effect of GA Post-operative nausea and vomiting - triggered by factors such as the medication, motion and the type of surgery. Sore throat - ETT cause sore throat after it's removed. Postoperative delirium - Confusion when regaining consciousness after surgery (older patients) 22.

[Audio] Side effect of GA Aches, pains and backache - Position during surgery Chills and shivering - body temperature dropped during surgery Difficulty urinating - bladder dysfunction that interferes with the nerve impulses from the brain to the bladder. 23.

[Audio] LOCAL/ REGIONAL ANESTHESIA 24. 24 LOCAL/ REGIONAL ANESTHESIA.

[Audio] Local/ regional anesthesia Medication instilled around the nerve → block transmission of nerve impulse in that particular area. Produce analgesia, relaxation and reduced reflex. Patient still awake and conscious during 25 the procedure but NO PAIN AND CANNOT MOVE..

[Audio] Local/ regional anesthesia (cont..) May be use when : –General anesthesia is contraindicated because the present of adverse reaction to anesthesia. –A choice. –Pain management postoperatively enhance by regional anesthesia. 26.

[Audio] Various Type of Regional Anesthesia. 1. Topical anesthesia Involves used of anesthetic agent applied directly to the surface of the area to be anesthetized. Ointment/spray / gel Used in respiratory intubation and diagnostic procedure (laryngoscopy, bronchoscopy). Onset action 1 minute and duration 20-30 minute. 27.

[Audio] Topical anesthesia 28. Topical anesthesia 28.

[Audio] Topical anesthesia Bronchoscopy Laryngoscopy 29.

[Audio] Various Type of Regional Anesthesia. 2. Local infiltration Injection into the skin and subcutaneous tissue to the area to be incised. block nerve conduction at site of administration, thereby producing temporary loss of sensation in a limited area. 30.

[Audio] Local infiltration 31. Local infiltration 31.

[Audio] Various Type of Regional Anesthesia. 3. Field block Local anesthetic is deposited toward larger nerve terminal branches. Treatment is done away from the site of local anesthetic injection. By surrounding an area with anesthetic, the nerves proximal to the injection site are anesthetized but the tissue to be repaired is not infiltrated. 32.

[Audio] 3. Field block 33. 3. Field block 33.

[Audio] Various Type of Regional Anesthesia. 4. Peripheral nerve block Injecting a local anesthetic near the nerve, or nerves, that control sensation and movement to a specific part of the body. It will temporarily numb the area. 34.

35.

[Audio] Various Type of Regional Anesthesia. 5. Spinal anesthesia Anaesthesia of the lower half of the body; caused by injecting an anaesthetic beneath the arachnoids membrane that surrounds the spinal cord The drug absorbed into the nerve fiber and produced analgesia with relaxation. Effective for lower abdominal and pelvic procedure Eg: Lower segment Cesarian section (LSCS) Incision and Drainage. 36.

[Audio] Spinal anesthesia 37. Spinal anesthesia 37.

[Audio] Spinal anesthesia 38. Spinal anesthesia 38.

[Audio] Various Type of Regional Anesthesia. 5. Epidural anesthesia Local anaesthetic is injected to epidural space Less adverse effect. Very effective. Eg: LSCS 39.

[Audio] Epidural anesthesia 40. Epidural anesthesia 40.

[Audio] Risk of Spinal and Epidural anesthesia Hypotension - the client need to be hydrated prior to anesthesia. Headache -due to a leak of cerebrospinal fluid from the needle hole in the dura. Backache - due to ligament strain due to profound muscle relaxation or surgical positioning. 41.

[Audio] Risk of Spinal and Epidural anesthesia Other complications (rare)  infection, nerve damage(including paralysis, loss of bladder and bowel function, loss of sexual function), allergic reactions, seizures. 42.

[Audio] Various Type of Regional Anesthesia. 6. Caudal anesthesia Injection of local anesthetic into the caudal canal. Block of the sacral and lumbar nerve roots. It is useful as a supplement to general anesthesia and for provision of postoperative analgesia. Popular in pediatric patients. 43.

[Audio] Caudal anesthesia 44. 44 Caudal anesthesia.

[Audio] Caudal anesthesia 45. Caudal anesthesia 45.

[Audio] Local / regional anesthesia Types Description Topical Apply directly to the area E.g. ointment, gel, cream Local infiltration Injection into the skin and subcutaneous tissue to the area to be incised Field block The area to the proximal to the incision is injected with local anesthetic Peripheral nerve block Anesthetizes individual nerve E.g. A finger (digital nerve block) 46.

[Audio] Local / regional anesthesia Types Description Spinal Injecting anesthetics into subarachnoid space E.g. for appendectomy Epidural Injecting anesthetic agent into the epidural space Caudal Injecting anesthetic into caudal or sacral canal. 47.

[Audio] Nurses role before, during and after received analgesia. 48.