1. General Anesthesia

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

17. PRE AND POST NURSING
MANAGEMENT

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.