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Angeles University Foundation Angeles City College of Nursing

Anesthesia

Anesthesia
A written report about anesthesia its history, types, uses and possible complication. In partial fulfilment of the requirements in Related Learning Experience 102.

Submitted to: Anita Viray, RN, MN

Submitted by: Johnrey I. Magcaling Group 17; III-5
07-0132-335

Anesthesia, has traditionally meant the condition of having sensation (including the feeling of pain) blocked or temporarily taken away. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. The word was coined by Oliver Wendell Holmes, Sr. in 1846. Another definition is a "reversible lack of awareness," whether this is a total lack of awareness (e.g. a general anesthetic) or a lack of awareness of a part of the body such as a spinal anesthetic or another nerve block would cause. Anesthesia is a pharmacologically induced reversible state of amnesia, analgesia, loss of
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Anesthesia
consciousness, loss of skeletal muscle reflexes and decreased stress response. Surgical anesthesia is intended to render the patient insensitive to pain. In a typical clinical procedure, known as balanced anesthesia, the patient is premedicated with a sedative intended to relieve pre-operative anxiety and facilitate the induction of anesthesia itself (often this is a benzodiazepine such as diazepam or midazolam; otherwise, a barbiturate such as thiopental or nonbenzodiazepine such as propofol may perform this function). Sedation is followed by the induction of general anesthesia by intravenous injection of a sedative, narcotic (e.g., morphine, fentanyl, alfentanyl), or ketamine. In addition, a nondepolarizing curare-like derivative (e.g., vecuronium, d-turbocurarine) or a depolarizing drug (e.g., succinylcholine) is administered to induce muscle paralysis. After intubation and connection to a ventilator for artificial respiration, general anesthesia may be maintained by a mixture of oxygen and nitrous oxide, often in combination with a volatile agent (e.g., halothane, enflurane, or isoflurane) or intravenous drug. At the conclusion of the surgery, muscle relaxation is reversed (e.g., by neostigmine or other anticholinesterase), and normal (unassisted) breathing is restored. In addition, the patient may be given an analgesic agent (e.g., morphine) to manage any acute pain experienced postoperatively. Another method, commonly used in office procedures and outpatient surgery, is known as "conscious sedation". In this procedure, the patient is sedated by barbiturates (e.g., sodium pentothal) or benzodiazepines (e.g., Valium), and receives a local or regional anesthetic (e.g., Novocain). Because no general anesthetic is involved, the patient never loses consciousness. He or she remains awake and able to move during the procedure, and can interact with the medical team, but feels no pain. Because of the amnesic properties of most sedative drugs, the patient may have no memory of the procedure after it is over. Some surgical procedures are appropriately performed with only local or regional anesthesia. Examples include the use of Novocain for routine dental work, or epidural blocks in obstetrics. Without sedation or anesthesia, the patient remains fully aware during the procedure, and retains conscious memory for the events of surgery. In neurosurgery, for example, patients are not commonly anesthetized because the brain has no afferent neurons to conduct pain messages. HISTORY OF ANESTHESIA Anesthesia for surgery was introduced in America only in the 1840s. Before this time, surgical patients were simply expected to withstand the pain of the procedure. Alternatively, they were intoxicated with alcohol or opiates (e.g., laudanum). Humphry Davy (1778-829), a famous English chemist, discovered through self-experimentation that nitrous oxide relieved headache and dental pain, but his report went unnoticed in the medial community; it did, however, led to the use of "laughing gas".
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Anesthesia
The first demonstration of surgical anesthesia was by Horace Wells (1815-1848), an American dentist who had observed the effects of nitrous oxide at a traveling medicine show. Wells had some of his own teeth extracted painlessly under nitrous oxide, but during his first public demonstration, in Boston in 1845. Despite the fact that the patient reported no awareness or memory of pain, the demonstration was judged a failure, and Wells mocked, because the patient screamed and struggled throughout the procedure. However, Wells's failure was observed by another dentist, William Morton, who began experimenting with ether. In 1846, Morton demonstrated the surgical removal of a tumor in a patient who showed no signs or reports of pain. (Click on the picture above left to see an enlarged painting of this event.) By 1847, ether and chloroform were firmly established as general anesthetics on both sides of the Atlantic. Except for childbirth: physicians worried about the effects of chemical analgesics on the fetus, and also worried that the absence of pain would impair the bonds between mother and child. Later, it was discovered that morphine lessened the amount of chloroform needed to produce complete anesthesia. In the early 20th century ether and chloroform werereplaced by halogenated hydrocarbons such as halothane (sometimes, a mixture of nitrous oxide and oxygen, or intravenous narcotics such as fentanyl, are used instead of a volatile agent). In 1942, Griffith and Johnson administered curare to reduce reflexive responses to surgical incisions (and artificial respiration to maintain breathing). This yielded the "balanced anesthesia" procedure still in use today: a "cocktail" of drugs to induce loss of consciousness, eliminate pain, and calm the operative area. Originally, general anesthesia was considered to be a purely "empirical" treatment, whose effectiveness had been demonstrated but whose mechanism of action was unknown. For this reason, anesthesia was initially ignored by established medical practitioners, who for professional reasons did not want to employ any technique whose scientific basis was not understood. USES OF ANESTHESIA • • •
• •

Relaxant Block pain Make you sleepy or forgetful Make you unconscious for your surgery Other medicines also may be used to relax your muscles during surgery Anesthesiologists (medically-trained physicians) Nurse anesthetists/certified registered nurse anesthetists (CRNAs)
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ANESTHESIA PROVIDERS •


Anesthesia
• • •


Anesthesiologist assistants Anesthesia technicians Veterinary anesthetists/anesthesiologists Local anesthesia - numbs a small part of the body. You get a shot of local anesthetic directly into the surgical area to block pain. It is used only for minor procedures. You may stay awake during the procedure, or you may get medicine to help you relax or sleep. Regional anesthesia - blocks pain to a larger part of your body. Anesthetic is injected around major nerves or the spinal cord. You may get medicine to help you relax or sleep. Major types of regional anesthesia include:


TYPES OF ANESTHESIA



Peripheral nerve blocks. A nerve block is a shot of anesthetic near a specific nerve or group of nerves. It blocks pain in the part of the body supplied by the nerve. Nerve blocks are most often used for procedures on the hands, arms, feet, legs, or face. Epidural and spinal anesthesia. This is a shot of anesthetic near the spinal cord and the nerves that connect to it. It blocks pain from an entire region of the body, such as the belly, hips, or legs.





General anesthesia - affects the brain as well as the entire body. You may get it through a vein (intravenously), or you may breathe it in. With general anesthesia, you are completely unaware and do not feel pain during the surgery and lose consciousness. General anesthesia also often causes you to forget the surgery and the time right after it.

MEDICINES USED FOR/AS ANESTHESIA A wide variety of medicines are used to provide anesthesia. Their effects can be complex, and they can interact with other medicines to cause different effects than when they are used alone. Anyone receiving anesthesia —even procedural sedation—must be monitored continuously to protect and maintain vital body functions. The complex task of managing the delivery of anesthesia medicines as well as monitoring your vital functions is done by anesthesia specialists. Medicines used for anesthesia help you relax, help relieve pain, induce sleepiness or forgetfulness, or make you unconscious. Anesthesia medicines include:

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Anesthesia


Local anesthetics, such as lidocaine (Xylocaine) or bupivacaine (Marcaine), that are injected directly into the body area involved in the surgery. Intravenous (IV) anesthetics, such as sodium thiopental (Pentothal), midazolam (Versed), propofol (Diprivan), or fentanyl (Sublimaze), that are given through a vein. Inhalation anesthetics, such as isoflurane and nitrous oxide, that you breathe through a mask. Muscle relaxants, which block transmission of nerve impulses to the muscles. They are used during anesthesia to temporarily relax muscle tone as needed. Reversal agents, which are given to counteract or reverse the effects of other medicines such as muscle relaxants or sedatives given during anesthesia. Reversal agents may be used to reduce the time it takes to recover from anesthesia. Your past and current health. The doctor or nurse will consider other surgeries you have had and any health problems you have, such as heart disease, lung disease, or diabetes. You also will be asked whether you or any family members have had an allergic reaction to any anesthetics or medicines. The reason for your surgery and the type of surgery. The results of tests, such as blood tests or an electrocardiogram (EKG, ECG).





Other medicines that are often used during anesthesia include:




HOW TO DETERMINE THE TYPE OF ANETHESIA TO BE USE





POTENTIAL RISKS OF ANESTHESIA Major side effects and other problems of anesthesia are not common, especially in people who are in good health overall. But all anesthesia has some risk. Your specific risks depend on the type of anesthesia you get, your health, and how you respond to the medicines used. Some health problems increase your chances of problems from anesthesia. Your doctor or nurse will identify any health problems you have that could affect your care. Your doctor or nurse will closely watch your vital signs, such as your blood pressure and heart rate, during anesthesia and surgery, so most side effects and problems can be avoided. PREPARATION BEFORE THE ANESTHESIA & SURGERY Make sure you get a list of instructions to help you prepare for your surgery. Your surgeon will also let you know what will happen when you get to the clinic or hospital, during surgery, and afterward. Your doctor will tell you when to stop eating and drinking before your surgery. When you stop
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Anesthesia
depends on your health problem and the type of anesthesia that will be used. If you take any medicines regularly, ask your doctor or nurse if you should take your medicines on the day before or the day of your surgery. You have to give your consent to be given anesthesia. Your doctor or nurse will discuss the best type of anesthesia for you and review risks, benefits, and other choices. Many people are nervous before they have anesthesia and surgery. Mental relaxation methods as well as medicines can help you relax. RECOVERING FROM ANESTHESIA Recovery from anesthesia occurs as the effects of the anesthetic medicines wear off and your body functions begin to return. Immediately after surgery, you will be taken to a post-anesthesia care unit (PACU), often called the recovery room, where nurses will care for and observe you. A nurse will check your vital signs and bandages and ask about your pain level. How quickly you recover from anesthesia depends on the type of anesthesia you received, your response to the anesthesia, and whether you received other medicines that may prolong your recovery. As you begin to awaken from general anesthesia, you may experience some confusion, disorientation, or difficulty thinking clearly. This is normal. It may take some time before the effects of the anesthesia are completely gone. Your age and general health also may affect how quickly you recover. Younger people usually recover more quickly from the effects of anesthesia than older people. People with certain medical conditions may have difficulty clearing anesthetics from the body, which can delay recovery. Some of the effects of anesthesia may persist for many hours after the procedure. For example, you may have some numbness or reduced sensation in the part of your body that was anesthetized until the anesthetic wears off completely. Your muscle control and coordination may also be affected for many hours following your procedure. Other effects may include:


Pain. As the anesthesia wears off, you can expect to feel some pain and discomfort from your surgery. In some cases, additional doses of local or regional anesthesia are given to block pain during initial recovery. Pain following surgery can cause restlessness as well as increased heart rate and blood pressure. If you experience pain during your recovery, tell the nurse who is monitoring you so that your pain can be relieved. Nausea and vomiting. You may experience a dry mouth and/or nausea. Nausea and vomiting are common after any type of anesthesia. It is a common cause of an unplanned overnight hospital stay and delayed discharge. Vomiting may be a serious problem if it causes pain and stress or affects surgical incisions. Nausea and vomiting are more likely with general anesthesia and lengthy procedures, such as surgery on the abdomen, the middle ear, or the



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Anesthesia
eyes. In most cases, nausea after anesthesia does not last long and can be treated with medicines called antiemetics.


Low body temperature (hypothermia). You may feel cold and shiver when you are waking up. A mild drop in body temperature is common during general anesthesia because the anesthetic reduces your body's heat production and affects the way your body regulates its temperature. Special measures are often taken during surgery to keep a person’s body temperature from dropping too much (hypothermia).

ANESTHETIC EQUIPMENTS In modern anesthesia, a wide variety of medical equipment is desirable depending on the necessity for portable field use, surgical operations or intensive care support. Anesthesia practitioners must possess a comprehensive and intricate knowledge of the production and use of various medical gases, anesthetic agents and vapors, medical breathing circuits and the variety of anesthetic machines (including vaporizers, ventilators and pressure gauges) and their corresponding safety features, hazards and limitations of each piece of equipment, for the safe, clinical competence and practical application for day to day practice.

ANESTHETIC MONITORING Patients being treated under general anesthetics must be monitored continuously to ensure the patient's safety. For minor surgery, this generally includes monitoring of heart rate (via ECG or pulse oximetry), oxygen saturation (via pulse oximetry), non-invasive blood pressure, inspired and expired gases (for oxygen, carbon dioxide, nitrous oxide, and volatile agents). For moderate to major surgery, monitoring may also include temperature, urine output, invasive blood measurements (arterial blood pressure, central venous pressure), pulmonary artery pressure and pulmonary artery occlusion pressure, cerebral activity (via EEG analysis), neuromuscular function (via peripheral nerve stimulation monitoring), and cardiac output. In addition, the operating room's environment must be monitored for temperature and humidity and for buildup of exhaled inhalational anesthetics which might impair the health of operating room personnel. ANESTHESIA RECORD The anesthesia record is the medical and legal documentation of events during an anesthetic. It reflects a detailed and continuous account of drugs, fluids, and blood products administered and procedures undertaken, and also includes the observation of cardiovascular responses, estimated blood loss, urinary body fluids and data from physiologic monitors
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Anesthesia
(Anesthetic monitoring, see above) during the course of an anesthetic. The anesthesia record may be written manually on paper; however, the paper record is increasingly replaced by an electronic record as part of an Anesthesia Information Management System (AIMS). REFERENCES USED: •

http://health.yahoo.com/pain-overview/anesthesia/healthwise--tp17798.html • http://www.institute-shot.com/anesthesia_and_surgery.htm • http://en.wikipedia.org/wiki/Anesthesia#History • http://www.nlm.nih.gov/medlineplus/anesthesia.html

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