BASICS OF ANESTHESIA

3 PHASES OR SURGERY 2. Availability and completeness

of anesthetic and emergency
Pre-operative
medicine, fluids and
Phase
anesthetic accessories.
Starts when the
patient decided Care focuses on:
to have the preparing and Surgical Patient
surgery and teaching the 1. Patient Profile - to confirm that
ends when patient you have the right patient.
patient is
transferred to OR
2. Informed consent - contains
Intraoperative surgical procedure, laterality,
Phase anesthesia,
Starts when Care focuses on: surgeon/anesthesiologist, date
patient is on OR Providing a safe of operation.
Table and ends environment
when he is during surgery A. Ensure that the patient
transferred to
understands the procedure
PACU
and the risk and
Postoperative complications.
Phase Care focuses on:
Starts when Preventing B. Validity of Consent - A patient
patient is in PACU complications is in her sound mind when she
and ends when and relieving signs the consent; that means
no longer needs pain
she is in her legal age (>18yo),
surgery
PATIENT ADMISSION IN THE OR mentally capacitated, and
not under the influence of
Pre-operative Check alcohol or any substance. In
the event that the patient
Operating Room Suite
cannot sign the consent, her
1. Completeness of the significant other must sign for
equipment needed and her.
checking if it’s in good working
condition (anesthesia
3. Medical history - check
machine, pulse oximetry, IV
patient’s current illness and
stand)
medication (herbal meds- may
interfere with anesthetic, The figure above shows the surgical
agents/anticoagulants - must safety checklist developed by the
discontinue for 7-10days prior to World Health Organization (WHO) in
surgery since it may increase 2008 to promote teamwork and
bleeding tendencies communication between the
intraoperatively, check for surgical team in ensuring patient
ALLERGIES surgical safety. The Sign In is part of
the preoperative check done by the
3. PE -check surgical site marking
circulating nurse and
anesthesiologist.
4. Lab reports/X-ray - availability
of blood products
5. Preop meds - prophylactic
WHAT IS ANAESTHESIA?
antibiotics
ANAESTHESIA is an artificially
6. No wig, contact lenses, nail induced state of partial or
polish and jewelry, dentures total loss of feeling or
sensation, especially to pain. It
7. Maintenance of NPO includes loss of protective
reflexes.
8. Changing of client into
hospital gown ANAESTHESIOLOGY is the
practice of medicine that
9. Removal of body hair on the deals with the management
surgical site, if prescribed; of procedures for rendering a
patient insensible to
10. Checking patency/Admin of pain during surgical
IVF to client. procedures and with the
support of life functions under
PRE-OPERATIVE CHECK
the stress of anesthetic and
surgical manipulations. Berry &
Kohn (2003)

 Before we understand how

anesthesia’s affects or acts in
our body, we need to learn
first the normal pathway of the
 pain impulse transmission. in the nociceptors and when
Based on the gate theory of we replace it with another non
pain transmission, the pain stimulus, the transmission
nociceptors (pain receptors) in for pain stimulus closes and
our skin detect the pain the gate for non-pain stimulus
stimulus as it comes in contact opens and that is the one
with our skin. The pain stimulus being transmitted and
will travel from the primary interpreted in our brain.
neurons (nociceptors) and will
be transmitted to the  But how about anesthesia? To
secondary neurons that are all block the pain stimulus,
waiting in the substantia anesthesia is being inducted in
gelatinosa, where the three different parts of the
transmission occurs. pain transmission. Anesthesia
may be inducted locally,
 Located mainly in the spinal wherein local anesthesia is
cord, the transmission then injected in the skin to block
proceeds to the secondary the pain receptors in our skin.
neurons and travels through The second type is when an
the spinothalamic tract going anesthesia is inducted in the
to thalamus and transmitted to spine where the transmission
the tertiary neurons going to occurs, blocking the nerves
the specific part of the brain that supplies the particular
(cortex) for interpretation. region of the body which is the
lower body. This type is called
regional anesthesia. And the
 But what happens when the final type or way of blocking
pain transmission is blocked? stimulus is by inducting
According to gate theory, general anesthesia to the
when the pain stimulus patient wherein the agents
contacts our skin, say our would shut down the central
thumb was hit by a hammer, nervous system. The effect of
for us to lessen the pain, we this type of anesthesia is
tend to rub our thumb to directly in the brain.
replace the pain sensation
with another kind of stimulus.
As the photo above shows,
when the pain stimulus travels
FACTORS TO BE CONSIDERED WHEN The disadvantages includes
GIVING ANESTHESIA increased anxiety to patient
since the patient is awake
 Type, location, and duration of
during the whole procedure,
surgery
and increased doses may
 Technical challenges of the
cause toxicity
procedure
The following are the common
 Patient’s age and physical
local and regional anesthetic
condition
agents used in the hospital.
 Patient’s previous anesthetic
history
 Anesthesiologist’s personal
preference, expertise, and
clinical judgement

LOCAL ANESTHESIA

It is the injection of anesthetic

agents directly to the planned
incision site.

It is often combined with

regional block anesthesia.
REGIONAL ANESTHESIA

The advantages are simple, It is the second type of

economical, fast recovery of anesthesia that is injected
the patient and it is ideal for around the nerves to
anesthetize the region
short minor procedures.
supplied by these nerves
which is from the abdomen to
Local anesthetic agents may the lower parts of the body. In
be used in combination with this type, the patient remains
EPINEPHRINE. conscious. There are two types
It is a vasoconstrictor that of regional anesthesia, the
prevents rapid absorption and spinal anesthesia and epidural
anesthesia.
prolongs local action of the
anesthetic agents. It also
prevents seizures.
 2. Epidural Anesthesia
 Given to patients who will
undergo surgeries in the
lower parts of their body for
more than 2 hours but does
not exceed 4-5hrs such as
ORIF of Tibia/Fibula, some
Urology Cases,
Hysterectomy, and etc.
 Doses can be increased
through the epidural
catheter inserted in the
epidural space. This type of
anesthesia is also common
to patients in labor to
reduce their labor pains
during normal spontaneous
delivery.

2 TYPES OF REGIONAL
ANESTHESIA

1. Spinal Anesthesia
 Given to patients who will
undergo surgeries in the
lower parts of the body that
do not exceed 2 hours such
as cesarean section,  The above photo shows the
complicated wound different positions of
debridement, patients done during
appendectomy, etc. induction of regional
anesthesia.
 GENERAL ANESTHESIA

 Using the sitting position It is the induction of anesthetic

during spinal anesthesia, agents that causes severe
the nurse provides a foot CNS depression;
stool and a pillow on the
stomach of the patient It may be given through
while bending forward. The inhalation, intravenous or
spinal anesthetics given is usually combined.
only one time through the
syringe while in the epidural In this type of anesthesia, the
anesthesia, there is an patients are not arousable,
epidural catheter being and have no ventilatory
placed so the function in which the patient
anesthesiologist can top up needs assistance to maintain
anesthetic agents through patent airway.
this port.
The cardiovascular function
may also be impaired.
 In lateral decubitus
position, the patient In general anesthesia, there
assumes the C position or four levels or stages of
sometimes called the sedation that occurs during
shrimp position. The nurse induction.
holds the head and the
legs of the patient to allow
proper positioning while
instructing the patient not
to move.
THREE DIFFERENT ADMINISTRATION INDUCTION OF GENERAL ANESTHESIA
TECHNIQUES FOR GENERAL
1. Transfer patient to OR table;
ANESTHETHICS
provide privacy
2. Provide restraint to patient
(lower leg, both arms)
THE INHALATION TYPE
3. Attachment of vital signs
monitoring devices (BP app,
1. MASK INHALATION: It uses
pulse oximetry, ECG leads)
anesthetic gas or volatile liquid
4. Make patient comfortable
vapor. The mask should be
5. Pre-oxygenation
securely worn.
6. Loss of consciousness (light to
moderate sedation induced)
2. LARYNGEAL MASK: It is a
7. Intubation
flexible tube with an inflatable
 CN remain at the patient’s
silicone ring. Laryngeal masks
side during induction to
do not protect against
provide physical protection
regurgitation and aspiration.
and emotional support
Also, it can easily be
 Assist the anesthesiologist as
dislodged.
needed
 Laryngoscope
3. ENDOTRACHEAL
A. ET tube - balloon tested and
ADMINISTRATION:
lubricated prior to intubation
The anesthetic gas or vapor is
(may/may not use guide wire)
inhaled directly into the
B. Apply cricoid pressure as
trachea through a nasal or
needed upon insertion of
oral silicone tube. It is inserted
anesthesiologist
through the vocal cords by
C. Adjustment of ET level by
direct laryngoscopy.
anesthesiologist (document
- The size of ET tube for a normal
the ET level later- 20-21)
size adult is 6.5 - 7.0mm, while
D. Removal of guidewire;
7.5 -8.0mm is used for large size
injecting 8-10 cc of Air in the
adults.
balloon to anchor
E. Securing ET with adhesive
tape

8. Closely observe the monitors.

 GENERAL ANESTHETICS

1. Inhalation Agents cause CNS

depression, respiratory
depression, myocardial
depression. When
 The figure shows the discontinued, inhalation
preparation of the intubation anesthetic agents are
trolley/tray. eliminated through the lungs.

 During intubation, it is
important that the nurse
prepares all the things she will
need for emergency cases.
She needs to prepare at least NURSING RESPONSIBILITIES
3 different sizes of ET, check
the working condition of 1. Provide humidified
laryngoscopes, make sure the supplemental oxygen during
light is working, different sizes the recovery phase as
of oral and nasal airway, and ordered.
suction tubing, to suction oral
2. Monitor for respiratory
and endotracheal secretions.
depression, CNS depression
and
arrhythmias postoperatively.

MALIGNANT HYPERTHERMIA is
a rare life threatening
 The photo shows the proper complication that occurs
way of securing the ET tube during surgery characterized
with adhesive tape. by increase in heat production
leading to hypermetabolism`
SIGNS AND SYMPTOMS OF  Administer 100% oxygen,
MALIGNANT HYPERTHERMIA
 Call for help,
a. Muscle rigidity
 Administer dantrolene sodium,
b. Hypercapnia and hypoxemia
according to facility policy
c. Tachycardia
 Institute cooling measures
d. Ventricular arrhythmia
 Correct acidosis as indicated
e. Temperature elevation
(disorder’s hallmark)  Administer diuretics

f. Tachypnea  Monitor vital signs

g. Respiratory and metabolic  Transfer to critical care unit for

acidosis additional dantrolene therapy
h. Hyperkalemia

i. Myoglobinemia and
myoglobinuria

NURSING INTERVENTIONS

 Assessment of risk factors

preoperatively

a. Personal or family history of the

condition

b. History of skeletal muscle or

neuromuscular disorder
NURSING RESPONSIBILITY
c. Muscle cramps or muscle
rigidity with stress or exercise 1. Monitor for respiratory
depression, CNS depression
and
arrhythmias postoperatively.
 If malignant hyperthermia
occurs, 2. Be sure to keep emergency
equipment and medicine at
 Anesthesia must be hand.
discontinued immediately.
NURSING RESPONSIBILITY

1. Prior to extubation, be sure to assess respiratory function and muscle

strength.

2. Some antibiotics may prolong action (aminoglycosides, vancomycin,

tetracycline, bacitracin)