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ANAESTHESIA

SUBMITTED BY-
Taniya Masih
2nd yr, B.Sc (HONS.) Nursing
57
DEFINITION
• Anaesthesia is a state of narcosis.
• It is the use of medicine to prevent the
feeling of pain or other sensation
during surgery or other procedure
that might be painful.
TYPES
General Regional Local

Epidural Spinal Local conduction


blocks

Brachial Paraventral transsacral


plexus block (caudal) block
GENERAL ANAESTHESIA
• General anaesthesia are not arousal, not
even to painful. They lose the ability to
maintaining a patent airway
cardiovascular functions may be
impairment as well.
STAGES OF GENERAL ANAESTHESIA

• Beginning anaesthesia;
 as the patient breathes in the
anaesthetic mixture, warmth, dizziness,
and a feeling of reattachment may be
experienced.
During this stage, noises are
exaggerated, even low voices or minor
sound seem loud and unreal.
• Excitement;
Characterised by struggling, shouting,
talking, singing, laughing or crying is
often avoided if the anaesthetic agent is
administered smoothly & quickly.
Pupils dilated, pulse rate is rapid &
respiration may be irregular.
The possibility of uncotrolled
movement of the patient during this
stage.
• Surgical anaesthesia;
It is reached by continued administration
of the anaesthetic vapour or gas.
Respiration are regular, the pulse rate &
volume are normal & the skin is pink or
slightly flushed.
• Medullary depression;
 this stage is reached by if too much
anaesthesia has been administered.
• Respiration become shallow, the
pulse is weak, & pupils become
widely dilated & no reaction to light.
• Cyanosis develop, and without
prompt interventions death rapidly
follow.
ANAESTHETIC AGENT USED IN G.A.

Inhalation Intravenous
Liquid Vapour Gaseous - Opioid
Anaesthetic -benzodiazepines
delivery - neuromuscular
methods blocking agent
- antiemetic
Laryngeal Intranasal Oral
mask airway intubation intubation
1. Inhalation
 Inhaled anesthetic include volatile oxide liquid
agent and gases.
 Administered by in combination with Oxygen and
usually nitrous oxide as well.
• liquid anesthetic agent :-
volatile liquid anesthetic agent produce
anesthesia when their vapors are inhaled.
E.g. Halothane [fluenothan], enflurane
[ethrane], isoflurane[forane],
sevoflurane[ultrane].
• Gas anesthetic agent :-
Administered by combined with oxygen ,
nitrogen[nitrous ] oxide is use.
When inhaled , its enter the blood through the
pulmonary capillaries and act on cerebral
centers to produce loss of consciousness and
sensation.
• Vapor anesthetic agent :- It can be
administered by various three methods
 Laryngeal mask airway :- It is also known as
supraglottic airway is a medical device that
keeps a patient’s airway open during anesthesia
or unconsciousness.
• Intranasal intubation :-
 Insertion o the respiratory tube or gastrointestinal
tract through the nose and it may be performed in
patients undergoing maxillofacial surgery or dental
procedures .
• Oral intubation :-
 The endotracheal tube may be inserted through
mouth. It is the plastic tube into the trachea to
maintain an open airway to conduit through which to
administer drugs. And give after administration of
general anesthesia.
• Intravenous administered :-
 Iv , anesthetic and analgesics agents , including iv
medication used as muscle relaxants in the
intraoperative period .
 Its advantage is that the onset of anesthesia , there
and is none of buzzing , roaring or dizziness known
to follow administration of an inhalation anesthetic
agent.
Opiod :- Are used preoperatively for sedation
and analgesics , intraoperatively for induction and
maintenance for pain management.
All opiods produce dose- related respiratory
depression.
Benzodiazepines :- sedative –hepnotic
benzodiazepines are widely used premedication
before surgery for their amnesic effect as agents for
the induction and maintenance of anesthesia , for
conscious sedation as supplemental Iv sedation.
Neuromuscular blocking agents :-
 These muscle relaxant are used as adjucts to G.A. to
facilitate endotracheal intubation and to optimize
surgical working conditions by providing relaxation
of skeletal muscle.
 Agents intrupt the transmission of nerve impulses at
neuromuscular junction.
e.g. neustigmine , endrophronium etc.
• Antiemetics :-
 Antiemetic are used preoperatively ,
intraoperatively , and postoperatively to
prevent and treat nausea and vomiting
associated with the administration of
anesthesia.
Medications of G.A.
s.no DRUG category dose
1 ATRACURIUM B ADULT:-0.4-0.5 mg
CHILD:-0.3-0.4 mg

2 ENFLURANE B ADULT:- 0.4%

3 HALOTHANE C ADULT:- 2-4%

4 ISOFLURANE c

5 HYOSCYAMINE C ADULT:-0.125-
0.25mg
CHILD:-0.062-
0.12mg
NURSES ROLE IN G.A.
• Completion of preoperative
assessment.
• Check & confirm operative permits.
• Completion the “time out” for patient
identification and confirmation of
correct procedure and sight.
• Administration of aspiration
prophylaxis.
• Assist with airway management.
• Monitor patient safety.
• Prepare the patient for movement to
PACU.
REGIONAL ANAESTHESIA
• In R.A., an anaesthetic agent is injected
around nerves so that the region
supplied by these nerves in
anaesthetised.
• Epidural anaesthesia;
It is achieved by injecting a local
anaesthetic agent into the epidural
space that surrounds the dura matter
of the spinal cord.
The administered medication diffuses
across the layers of the spinal cord to
provide anaesthesia and pain relief.
Treatment of the complication
includes airway support, I.V. fluids and
the use of vasopressor.
• Spinal anaesthesia;
It is an extensive conduction nerve
block that is produced when a local
anaesthetic agent is introduced into the
subarachnoid space at the lumbar
level, usually between L4 & L5.
Nausea, vomiting and pain may occur
during surgery when spinal anaesthesia
is used. Headache may be an after effect
of spinal anaesthesia.
• Local conduction blocks;
Brachial plexus block, which produces
anaesthesia of the arm.
Paravertebral anaesthesia, which
produces anaesthesia of the nerves
supplying the chest, abdominal wall
and extremities.
 transsacral block, which produces
anaesthesia of the perenium and
occationally, the lower abdomen.
MEDICATIONS OF THE R.A.
S.NO. DRUG CATEGORY DOSE

11-2 MORPHINE C ADULT:-10-30mg


CHILD:-based on
age, size and
need .
2 MEPERIDINE C ADULT:-15-35mg
CHILD:-1-2mg

3 C ADULT:-1-2mg
HYDROMORPONE

4 SUCCINYLCHOLINE C ADULT:-5-10mg
CHILD:-2-4mg
LOCAL ANAESTHESIA
• It is the injection of a solution
containing the anaesthetic agent into
the tissues at the planned incision site.
Often it is combined with a local
regional block by injecting around the
nerve immediately supplying the area.
ADVANTAGES OF L.A.
• It is a simple, economical and non
explosive.
• Equipment is minimal.
• Post operative recovery is brief.
• Undesirable effect of G.A. are avoided.
• It is deal for short and minor surgical
procedures.
MEDICATION OF L.A.
S.NO. DRUG CATEGORY DOSE

1 BENZOCAINE C ADULT;-10mg
CHILD:-not
recommended.
2 BUPIVAIN A ADULT:-175-
225mg
CHILD:- 9mg
3 LIDOCAINE A,B ADULT:-1-1.5 mg
CHILD:- 1mg

4 MEPIVACAINE C ADULT:-400mg
CHILD:-5-6mg

5 OXETAZAINE B ADULT:-10mg
CHILD:-not
NURSES ROLE IN L.A.
• Pt. education is important for patients
with nerve blocks.
• Continuous assesssment of motor and
sensory functions and vital.
• Obtain enough assistance with transfer
of pt. 1st time out of bed post
operatively.
• Continuous femoral nerve block affects
the quadriceps muscle.
• Pt. can ambulate continuous infusion
using the bag aparatus on the
shoulder.
• The concentration and amount of the
anaesthetic delivered is determined
by the pt’s. response.
• Dose of the medication can be
adjusted accordingly.
• pt. can admnister a bolus dose.
METHODS OF ADMINISTRATION
• Topical application is of the agent
directly to the skin, mucous membrane
or open surface.
• Regional nerve block- it is achieved by
the injection of the local anaesthetic into
or around a specific nerve and group of
nerve.
• Spinal anaesthesia involves the
injection of a local anaesthesia into
the cerebro – spinal fluid found in
the subarachnoid space usually
below the level of L2.
• Epidural block involves the injection
of local anaesthetic local space via
either a thoracic or a lumbar
approach.
RISK OF ANAESTHESIA
• Respiratory depression & coma
• Cardiac arrest
• Physical injuries
• Sore throat
• Nerve injury
• Blindness
• Death
ANAESTHETIC CONSIDERATION
• Controlled hypotension
• Hypothermia
• Cryoanaesthesia
• Acupuncture