2. Definition
• The state produced when a
patient receives medications for
amnesia, analgesia, muscle
paralysis, and sedation.
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. 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. 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. 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. 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. 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. 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. thiopental (pentothal)
contraindication
▫ Liver disease, Addison's disease, Myxedema
▫ Severe heart disease
▫ Severe hypotension
▫ Severe breathing disorder
▫ History of porphyria.
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. 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. 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. 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. 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. succinylcholine (anectine)
contraindications
▫ Severe burns, trauma, neuromuscular
diseases, or glaucoma
▫ Pt. with history of malignant hyperthermia
▫ Pulmonary, renal, cardiovascular, metabolic,
hepatic dysfunction
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. 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. 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. Immediate preoperative nursing
intervention:
* Administering preanesthetic medication.
* Maintaining the preoperative record.
e.g. Final checklist, consent form,
identification.
22. 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.
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. 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.
