Anesthesia: Delivery Systems and Client Care

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By Jessica Whittemore

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Assessment of RiskAmerican Society of Anesthesiologists Classification System

http://www.asahq.org/clinical/physicalstatus.htm

General Anesthesia

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Goals:

-Analgesia

-Anesthesia

-Amnesia

-Areflexia

-Anxiolysis

-Antiemesis

-Muscle relaxation

-Physiologic Stability

Phases:

Induction

-Narcotics

-Sedative/Hypnotics

- Muscle Relaxants

-depolarizing

- nondepolarizing

Maintenance

-Intraoperative period

-Inhaled/IV

-Muscle Relaxants/Narcotics

Emergence

-Anticholinesterases

-AnticholinergicsCole, K. (2006).

Measurement of Outcomes

dsf.chesco.org/.../health/dental/thermomet

er.jpg

“Apgar”

Gawande, A.A. (02/2007). An Apgar Score for Surgery. Journal of the American College of Surgeons, 204, Retrieved 03/04/09

< 5556-6566-7576-85>85Lowest

Heart

Rate

(bpm)

-----> 7055-6940-54< 40Lowest

Mean

Arterial

Pressure

(mmHG)

------< 100101-600601-1,000> 1,000Estimated Blood

Loss

(mL)

43210

• Mailignant Hyperthermia -Rapid rise in temp (40° C and above) -Dark Brown Urine ► Repeated or untreated → Renal

failure-Tx -Cooling Blanket -Dantrolene - IV fluids- Respiratory- Airway obstruction/Respiratory Depression- Resultant Hypoxemia- Sore throat

Neurologic - Muscle weakness - Pain -Over-Sedation

Complications

Cardiovascular

-HTN

-Hypotension

- Hypothermia

-DysrhythmiasGI

- Naus/Vom

Cole, K (2004). (2008). Malignant Hyperthermia. Retrieved March 09, 2009, from Medline Plus Medical Encyclopedia Web site:

http://www.nlm.nih.gov/medlineplus/ency/article/001315.htm

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Malignant hyperthermia sequence of eventsTrigger

-All potent inhalational agents Increased Cytoplasmic Free calcium -Rigidity - may or may not be present Hypermetabolism

-Increased oxygen consumption -Increased carbon dioxide production -Increased heat production

Cell damage -Leakage of cell contents

Compensatory mechanisms -Heat loss Increased circulating catecholamines Increased cardiac output - may not keep up with O2 demand

Temperature rise -Severity of stimulus -Environmental temperature -Starting temperature -Amount of vasoconstriction vs vasodilatation

Secondary systemic manifestations -Cardiac arrhythmias -Disseminated intravascular coagulation -Hemorrhage -Cerebral edema -Renal failure http://www.anes.ucla.edu/dept/mh.html#Malignant%20Hyperthermia%20The%20sequence%20of%20events

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Epidural animation

Epidural and Spinal Anesthesia

Spinal

“Neural Blockade”

Pros

Smaller needle

Cons

Limited duration

Uses

Lower extremity/abdominal issues

Epidural

“Segmental Neural Blockade”

Pros

Catheter allows for continuous or intermittent administration

Can be combined with other methods

Cons

-Large volume of medication

-Technically more difficult

Uses

Longer cases

Post-op Pain Management

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Post Anesthesia Client Care

Immediately

-Connection

-Oxygenation/Ventilation

-Institution

-iNitiation

Assessment

-Know your ABC’s

-Make sure they’re “PARS” for the course

-And of course… everything else

Interventions

-“Phase I”

-Stir it up and watch

-“Phase II”

-Keep watching

- You gotta maintain

- Analgesia

- “Care”

-”Play it safe”

CVPH. (2001). Immedeate Post-Procedure Patient, the Nursing Management of (Phase I & Phase II) [Brochure]. Plattsburgh, NY: Lisa Rabideau, RN.

CVPH. (2001). Immedeate Post-Procedure Patient, the Nursing Management of (Phase I & Phase II) [Brochure]. Plattsburgh, NY: Lisa Rabideau, RN.

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Hypnosis surgery

Just for Funzies

So, Let’s Review…..

Anesthesia is….

-Inhaled

-IV

-Intrathecal

-Regional

-Topical

Client Care

-ABC it’s easy as 123!

-Requires careful assessment

Any Questions????

Activity Time!

References1. Cole, K. (2008). Malignant Hyperthermia. Retrieved March 09,

2009, from Medline Plus Medical Encyclopedia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001315.htm

2. CVPH. (2001). Immedeate Post-Procedure Patient, the Nursing Management of (Phase I & Phase II) [Brochure]. Plattsburgh, NY: Lisa Rabideau, RN.

3. Awande, A.A., Kwaan, M.R., Regenbogen, S.E., Lipsitz, S.A., & Zinner, M.J. (2007). An Apgar Score for Surgery. American College of Surgeons, 204, Retrieved 03/09/09,from http://www.ncbi.nlm.nih.gov/pubmed/17254923.

4. Badrinath, S, Amarov, M.N., Shadrick, M., Witt, T.R., & Ivankovitch, A.D. (2000). The Use of a Ketamine-Propofol Combination During Monitored Anesthesia Care. Ambulatory Anesthesia. 90, 858-862.

5. CVPH. (2001). Immedeate Post-Procedure Patient, the Nursing Management of (Phase I & Phase II) [Brochure]. Plattsburgh, NY: Lisa Rabideau, RN.