Classification of Stage of General Anesthesia, Nsg Common position & Nsg.
on position & Nsg. Common anesthesia agents used, adv, Major complication of
Anesthesia , adv, Mgt., rationale considerations during disadvantage, Nsg. consideration, anesthesia per organ system,
disadvantage, Nsg int. , induction of anesthesia and rationale, desired effects Nsg. Mgt. rationale
rationale post-op phase
A. General Anesthesia ONSET INHALATION ANESTHETIC RESPIRATORY
POSITIONS IN INDUCTION OF AGENTS COMPLICATIONS
Duration : ANESTHESIA
Loss of all sensation
FROM Induction stage TO Respiratory
and consciousness. Loss of consciousness Spinal Anesthesia Nitrous Oxide
obstruction
Protective reflexes bispectral state of 100 The patient is supine
with safety strap in place. Advantages :
such as are lost Nsg. Management :
Nsg Mgt : Following induction, the The incidence of nausea and
- supplemental oxygen
Close suites door airway is maintained by vomiting is minimal.
while corrective
Advantages :
keep room quiet insertion of endotracheal Adverse effect can be quickly
measures are
Because the client is tube if the patient’s reversed.
stand by to assist initiate undertaken. Jaw
cricoid pressure as requested position for surgery is to Excellent procedure that does
unconscious rather thrust, head-tilt, oral or
be other than supine not produce severe pain.
then awake and Continuous pulse nasal airways
(e.g. side-lying) or
anxious, respiration oximetry (SpO2) lithotomy. Disadvantages : Rationale :
and cardiac function Left lateral decubitus can cause bowel distention - incomplete anesthetic
Rationale : can cause displacement of
position recovery,
are readily regulated. prevent movement of air that
Sitting position tympanoplasty grafts and laryngospasm, airway
The anesthesia can can alter the sterility of the increase ICP
Lateral position edema, wound
be adjusted to the induction site cannot be used during
Prone position hematoma, and vocal
unnecessary noises are not laparoscopy
length of the cord paralysis. Airway
therapeutic to patient there is no muscle relaxation can
Nsg. Consideration : obstruction in
operation and the reduce the risk of the cause possible laryngospasm
Always ask permission unconscious patients is
client’s age and aspiration of stomach from the patient when hypoxia is a hazard and has a most commonly due to
physical status. contents during induction changing position depressant effect on myocardial the tongue falling back
allows for early detection Explain the rationale why contractility against the posterior
of a fall in a is that there is a need to pharynx
Disadvantages : Nsg. Considerations :
patient's hemoglobin change position
It depresses the Provide full-support to monitor heart rate, chest pain,
saturation with oxygen
respiratory and the patient hypertension and stroke Hypoxemia
Strap the patient when check respiratory rate before
circulatory systems. EXCITEMENT induction
needed Nsg. Management :
Some clients - oxygen therapy with or
Duration : Rationale : without positive airway
become more
FROM Loss of Effects of nitrous oxide can pressure
anxious about a consciousness TO cause alteration of HR, BP etc.
general anesthetic Relaxation bispectral state 70 NO2 can cause respiratory Rationale :
that about the - 50 irregularities - Increased
surgery itself. Often intrapulmonary
Nsg Mgt : shunting relative to
this is because they Secure patient properly closing capacity is the
fear losing the remain at the side of the most common cause of
capacity to control patient quietly but ready to
assist anesthesiologist as hypoxemia following
their own bodies. needed general anesthesia
Desired effects :
Nsg. interventions : Rationale : warm sensations Laryngospasm and
Ensure safety to At this stage respiration and A feeling of well-being, euphoria laryngeal edema
patient heart rate may become and/or floating. During heavier
sedation, hearing may dissolve Nsg. Management :
Monitor VS irregular. In addition, there
into a constant, electronic-like - treatment includes
may be uncontrolled 100% oxygen, anterior
throbbing
Rationale : movements, vomiting, At a deeper level of sedation mandibular
breath holding, and again, sleepiness, difficulty to displacement and
General anesthesia
pupillary dilation thus keep one's eyes open or speak administer humidified
can alter the monitor the patient oxygen by mask,
("dream") can occur
patient’s properly to avoid risking inhalation of racemic
consciousness which the patient Halothane (Fluothane) epinephrine, repeated
To provide close every 20 minutes,
endanger the patient hydrocortisone IV may
monitoring of the patient Advantages :
from fall and other nonflammable, potent, versatile, be considered.
mechanical accident chemically stable and rapid Reintubation with a
has a smooth induction smaller tube may be
SURGICAL ANESTHESIA
makes possible of high O2 helpful
B. Regional
Duration : concentration for adequate
Anesthesia ventilation Rationale :
FROM Surgical Anesthesia
permits early intubation because - a forceful involuntary
stage of Relaxation TO Loss
of minimal larygeal irritation spasm of the laryngeal
Temporary of reflexes;
musculature caused by
Depression of vital functions ventricular arrythmias are rare
interruption of the sensory stimulation of
bispectral state 40. useful for patients with bronchial
transmission of the superior laryngeal
asthma because it reduces
nerve
nerve impulses to Nsg Mgt : bronchodilation
and from a specific Position patient and prep skin not irritating on respiratory tract
Hypoventilation
only when anesthesiologist
area or region of the indicates this stage in Disadvantages :
Nsg. Management :
body. The client loss reached potentially toxic to liver - should be directed at
sensation in an area depressant to respiration and the underlying cause.
Rationale : cardiovascular system causing Marked hypoventilation
of the body but
Because when the stage is hypotention, bradycardia and may require controlled
remains conscious reached, the respiration etc. sometimes cardiac arrest ventilation until
returns to normal which can cause hypothermia contributory factors are
Advantages : enable the patient to cope complete elimination takes some identified and
with the change of position time corrected
patients remain
conscious Nsg. Considerations : Rationale :
maintain his own report unusual reaction - most commonly
DANGER assess respiratory and cardiac caused by residual
airway
system depressant effects of
aspiration of gastric Duration : take VS before induction anesthetic agents on
contents is avoided FROM Danger Stage: vital monitor PR, RR , temp and BP respiratory drive or
smooth recovery functions too depressed TO persistent
Respiratory failure; possible neuromuscular
requiring less skilled cardiac arrest bispectral state blockade
nursing care 0.
Aspiration
Disadvantages : Nsg Mgt : pneumonia
practice and skill is Prepare for cardiopulmonary Rationale :
require for best result resuscitation indicates allergies Nsg. Management :
analgesia may not assist immediately in to prevent further complications - Administer 100%
of tachycardia and bradycardia oxygen the oropharynx
be always effective establishing airway, must be suctioned and
obtain baseline data
to other patients provide cardiac arrest the patient placed in
toxicity may occur if tray, drugs, syringes, the recovery position
long needles, assist Desired effects :
local anesthetic is Rationale :
Pain is controlled
given intravenously surgeon with closed or - During general
Unconsciousness
open cardiac massage. anesthesia the pt loses
Enflurane (Ethrane) its reflexes causing a
Nsg Interventions : possible risk for
Rationale :
ensure safety There is a sudden respiratory Advantages : aspiration
provide supportive cessation has a rapid induction and
functions This stage is prone to cardiac recovery with minimal
collapse and even respiratory aftereffects
collapse pharyngeal and laryngeal CARDIOVASCULAR
Rationale : reflexes are obtunded easily, COMPLICATIONS
the patient is risk salivation is not stimulated, and
bronchomotor tone is not Hypotension
for fall and
affected
accident cardiac rate and rhythm are Nsg. Management :
To prevent anxiety remain stable - fluid challenge;
pharmacologic
about the muscle relaxation is produced
treatment includes
anesthesized part inotropic agents
Disadvantages :
of the body (dopamine,
has a pungent odor
dobutamine,
respiration and blood pressure epinephrine) and alpha
B.1 Topical (surface) are progressively depressed receptor agonists
Anesthesia severe renal disease is a (phenylephrine)
contraindication to use
- Is applied directly to the skin
and mucous membranes, Nsg. Considerations : Rationale :
open skin surfaces, wounds, obtain VS before induction - hypoxemia,
assess for any renal diseases hypovolemia,
and burns
monitor VS, observe possible decreased myocardial
respiratory depression contractility
B.2 Local Anesthesia (myocardial ischemia,
- is injected into a specific Rationale : pulmonary edema),
obtain baseline data decreased systemic
area and is used for minor
drug is contraindicated to patient vascular resistance,
surgical procedures such as with renal disease cardiac dysrhythmias,
suturing a small wound or prevent vital sign-related pulmonary embolus,
performing a biopsy complications pneumothorax, cardiac
tamponade
Hypertension
B.3 Nerve Block
- Is a technique in which the Desired effects : Nsg. Management :
anesthetic agent is injected rapid excitement - correction of the
analgesia initiating cause;
into and around a nerve or
various medications
small nerve group that can be used to treat
supplies sensation to a small Isoflurane (Forane) hypertension including
area of the body beta blockers, calcium
Advantages : channel blockers,
less cardiac depression nitroprusside or
B.4 Intravenous block (Bier increase cardiac output nitroglycerin
block) has a CNS excitatory effect
rapid induction and emergence Rationale :
- Is used most often for - enhanced SNS activity
with a minimal aftereffects
procedures involving the arm, (pain, bladder
low organ toxicity
wrist and hand distension),
provide superb muscle relaxation
preoperative
can be used to patients with hypertension,
B.5 Spinal anesthesia asthma and patients with COPD hypervolemia,
(Subarachnoid block) hypoxemia, increased
Disadvantages : intracranial pressure,
- It requires a lumbar puncture it is expensive and vasopressors
through one of the reduces respiratory minute
interspaces between lumbar volume
can cause respiratory acidosis Arrhythmias
disc 2 (L2) and the sacrum
cerebral vascular resistance is
decreased , cerebral blood flow Nsg. Management :
(S1). An anesthetic agent is increases and ICP rises - Treatment of the
injected into the secretions are weakly stimulated causes
subarachnoid space Nsg. Considerations :
surrounding the spinal cord obtain spirometry test
check respiratory rate and
B.6 Epidural (peridural) patency Rationale :
prevent position that increases - hypoxemia,
anesthesia ICP hypercarbia,
- Is an injection of an obtain BP hypovolemia, pain,
anesthetic agent into the electrolyte and acid-
Rationale : base imbalance,
epidural space, the area myocardial ischemia,
assess for lung capacity
inside the spinal column but to provide efficient airway increased ICP, digitalis
outside the dura mater toxicity, hypothermia,
Desired effects : anticholinesterases
Muscle relaxation and malignant
hyperthermia
analgesia
NEUROLOGICAL
COMPLICATIONS
Desflurane (Suprane)
Delayed recovery
Advantages :
has rapid emergence and Nsg. Management
recovery from anesthesia - detect and treat the
resist biotransformation and cause
degradation, and produced few
urinary metabolites Rationale :
- Metabolic and
electrolyte causes,
Disadvantages : cerebral depression by
has a pungent odor that may be drugs, cerebral
irritating during induction hypoperfusion
may lower blood pressure
elevated heart rate
Perioperative
Nsg. Considerations : neuropathy
check blood pressure and heart
rate before induction Nsg. Management :
- Prevent formation of
Rationale : streae
the drug can greatly alter the HR
and BP Rationale :
- Stretch (traction)
Desired effects : Compression,
prevent myocardial ischemia Metabolic causes
rapid emergence and recovery and Direct surgical
from anesthesia trauma
analgesia
Sevoflurane (Ultane)
Advantages :
Can be used as an inhalant for
adults and pediatric patients.
Rapidly eliminated by the lungs
Disadvantages :
Can cause glycosuria and
proteinuria when used for long
procedures at low flow rates
Nsg. Considerations :
Note for any deviation of
anesthesia
Rationale :
Adverse effect is most cmmon
Desired effects :
patency of airway
absence of hypoxia
INTRAVENOUS ANESTHETIC
AGENTS
Propofol (Diprivan)
Advantages :
Is rapidly distributed,
metabolized, and eliminated
Emergence is very rapid with a
few post-operative side effects
Disadvantages :
Produces cardio-respiratory
depression
Causes hypotension
The solution supports rapid
growth of microorganisms if
infusion pump or syringes
become contaminated
Pain on the injection site in the
small vein is present
Nsg. Considerations :
Assess respiratory and cardiac
capacity
Check blood pressure before
induction
Maintain sterility and avoid
contamination during induction
Rationale :
Drug can compromise heart and
lungs
This drug can alter Blood
pressure
Induction site can be infected if it
become unsterile
Desired effects :
Maintained anesthesia effect
Ketamine Hydrochloride (Ketalar,
Ketaject)
Advantages :
Has a rapid induction
Respiration is not depressed
unless the drug is administered
too rapidly or in too large dose
May elevate blood pressure
Disadvantages :
Physiologic manifestations may
be present during emergence
Nsg. Considerations :
Provide safety during emergence
Check VS
Rationale :
Drug can cause hallucination
which tends to cause accidents
Obtain baseline data
Desired effects :
Comfortably detached from all
bodily sensations