Three phases of general anesthesia Induction Receive anesthetic agent via

Three phases of general anesthesia induction receive

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***If patient has a history of Malignant Hyperthermia (MH) inhalation agents need to be avoided. Three phases of general anesthesia Induction Receive anesthetic agent via inhalation or IV Airway patency is achieved & maintained with: Endotracheal intubation Newer devices LMA- Laryngeal mask airway Esophageal-tracheal Combitube Maintenance Patient is positioned Skin is prepped Surgery is performed During this period the anesthesiologist maintains depth of anesthesia and monitors Heart rate Blood pressure Respiratory rate Temperature O2 and CO2 levels Emergence Anesthesia withdrawn or reversed pharmacologically Extubated once the patient is able to reestablish voluntary breathing Critical to ensure airway patency during this period because extubation may cause bronchospasm or laryngospasm Regional Anesthesia (p.65) Effects: Analgesia Relaxation Reduces reflexes Patient is conscious/awake during procedure but does not feel pain No intubation needed
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Types: Local Nerve Infiltration Limited area of the body Technique used for: Skin or muscle biopsy Small wound is sutured Injection at a local nerve site to suppress sensation Meds used Lidocaine Bupivacaine Tetracaine Nerve Block Specific larger area of the body (ex: extremity) Injection at nerve trunk Epidural Block Local anesthetic agent injected into the epidural space (outside the dura mater of the spinal cord) Technique used for surgeries of the: Arms & shoulders Thorax Abdomen Pelvis Lower extremities Epidural catheter can be left in place for Postoperative pain relief Chronic pain management Safe and effective pain relief for patients of all ages Less adverse effects than general anesthesia Spinal Anesthesia Similar to epidural but anesthetic medication is given on a single injection Effective for approx. 90 minutes Technique used for surgeries of the: Lower abdomen Perineum Lower extremities Side effects of epidural & spinal anesthesia Leakage of CSF (cerebral spinal fluid) into epidural space Reduced CSF pressure and postoperative headache Treatment: Hydration Caffeine Analgesics Epidural blood patch Hypotension Monitor BP If critical hypotension occurs…alert anesthesia provider Expected interventions- increase IV fluids administer vasoactive meds Conscious Sedation – Type of medications used, nursing role Effects : Analgesia Amnesia Moderate sedation Types of meds used: Combo of IV meds with
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Opioids Morphine sulfate Fentanyl (Sublimaze) Or Sedatives Diazepam (Valium) Midazolam (Versed) Reversal agents Naloxone Hydrochloride (Narcan) Flumazenil (Romazicon) Advantages: Patient is able to independently maintain airway Allows patient to respond to verbal and physical stimulation Disadvantages : (common adverse side effects) Venous thrombosis Phlebitis Local irritation Confusion Drowsiness Hypotension Apnea Nurses Role Make sure there is a signed Informed Consent Keep patient IV site Monitor Oxygen
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  • Fall '08
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  • vital signs, pain relief, NURSING ROLE

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