ANESTHESIA EFFECTS ON CHILDREN

By: Hunter, Erin, Marc, Elise, and Alexis

INTRODUCTION

A nurse anesthetists responsibilities is to assess the patient before administering medication and producing a plan to recommend what medication should be given and the amount. Must give notes after the procedure to the post op team

The medications given have an effect on the child relating to their oxygenation throughout the procedure

Vital signs must be monitored throughout the procedure to ensure the patient is stable

PICO QUESTION

How does anesthesia effect a child in surgery?Population: Children Intervention: anesthesia medication Comparison: type of medication & amount given

Outcome: patient has successful outcome after surgery

NURSING RESEARCH: ARTICLE

“Effects of Anesthetic Agents on Blood Brain Oxygenation Level Revealed with Ultra-high Field MRI”Done because of conflicting results with KetamineWhy use an MRI?Done on rats isoflurane, ketamine-xylazine, and medetomidine How is this related to a nurse anesthetist’s job?

PSYCHOLOGY RESEARCH: PROPOFOL

Background

First used in 1977

Approved by FDA in 2008

Brand name is Diprivan

PSYCHOLOGY RESEARCH: PROPOFOLUSES AND SIDE EFFECTS

Side effects

- Pain at injection site- Seizure - Weak and shallow

breathing

Uses

- Surgery- Medical exams- Patients on ventilators- Sedation during MRI’s

PSYCHOLOGY RESEARCH: HALF LIFE OF PROPOFOL

PSYCHOLOGY RESEARCH: ANESTHESIA USE IN THE PEDIATRIC ICU

Objective: Evaluate Propofol anesthesia delivered to pediatrics in a PICU who undergo oncology procedures

Testing: They studied fifty procedures on 28 pediatric patients ranging from 3 to 12 years old. The study recorded the time the patient entered the PICU, the time anesthesia administration, procedure start and end time, recovery time and discharge time.

PSYCHOLOGY RESEARCH: RESULTS

Time in MinutesPhase (Mean [+ or -] SD) Admit to PICU to the start of 24.6 [+ or -] 9.9 Anesthesia Start of anesthesia till 1.5 [+ or -] .7 anesthetized (Induction Time) Anesthetized to the start of 5.9 [+ or -] 2.6 Procedure Start of procedure to the end of 14.3 [+ or -] 11.3 procedure (procedure time) Anesthesia end time till awake 23.4 [+ or -] 11.5 (recovery time) Awake till discharge from PICU 23.5 [+ or -] 17.5 Length of stay 88.8 [+ or -] 27.7

 

 

PSYCHOLOGY RESEARCH: VERSED

Also known as Midazolam

Falls in the category of benzodiazepines

Often combined with Fentanyl

VERSED USES AND SIDE EFFECTS

USES

Procedures that do not require general anesthesia

“Twilight sleep”

In ICU to induce a “coma”

SIDE EFFECTS

• Respiratory depression

• Tachycardia or bradycardia

• Swelling

• Nausea

MIDAZOLAM VS. PROPOFOL

NURSING THEORY

Sr. Callista Roy

COGNITIVE THEORY : JEAN PIAGET

Ranges from infancy to adolescent

- Stages:Sensorimotor (birth- two years)Preoperational (2-7 years)Concrete operational (7-11 years) Formal Operational (11- older)

MAJOR RESEARCH FINDINGS

Medications can affect people in several different ways and it is really important to know what medication is right for your patient.

Propofol is a commonly used anesthetic due to its relatively low risk factor and short half life which allows the patient to be awake with little or no side effects in little as 20 minutes from the end of administration.

Versed, or Midazolam has a slower onset than other drugs, but when it is carefully combined with other anesthetics it can be highly effective in providing ideal comfort for a patient.

There are many ways to use Sr Callista Roy's Adaptation Model. It can be applied to the disease process, new diagnoses and day to day nursing care.

Every person might react differently to drugs no matter what age but younger people are more likely to have a reaction due to the brain not fully developed

CONCEPT MAP

Anesthesia Effects

Health Promotion-Educating the patient on the possible side effects before surgery-Educate the patient on how to have a safe recovery

Ethics - Do not give

patient medication faster than recommended time

- - Always check drug compatibility

Diversity-medication effects everyone differently

Lifespan consideration-different dosages based on weight and age- Monitor infants and elderly more frequently

Resources- Consult another nurse

about drug- Consult with

anesthesiologist - Research

Leadership- Main caregiver

during surgery- Researching the

best drug and does

Information Systems- Access to

latest drug studies

- Document all findings

- Review patient history

CLINICAL IMPLICATION

Asses the patient before administering

medication

Brain damage could be caused

Patient comfort during surgery

Make sure the patient receives the correct dosage

CONCLUSION

REFERENCES

Taylor, C. (2011). Theory, Research, and Evidence-based practice. Fundamentals of nursing: the art and science of nursing care(7th ed., ). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Roy's Adaptation Model. (2013, September 9).Roy's Adaptation Model. Retrieved April 20, 2014, from http://currentnursing.com/nursing_theory/Roy_adaptation_model.html

Anderson, B. D., Dalton, H. J., Gootenberg, J. E., Hauser, G. J., Hertzog, J. H., & Shad, A. T. (2000, October). Prospective Evaluation of Propofol Anesthesia in the Pediatric Intensive Care Unit for Elective Oncology Procedures in Ambulatory and Hospitalized Children. Pediatrics, 106(4), 742. Retrieved from http://go.galegroup.com/ps/i.do?id=GALE%7CA66665100&v=2.1&u=lom_ferrissu&it=r&p=AONE&sw=w&asid=610dc4b08a1e1ed899bcd420eb 220e9a

Propofol Official FDA information, side effects and uses.. (March, 2003). Propofol Official FDA information, side effects and uses.. Retrieved April 24, 2014, from http://www.drugs.com/pro/propofol.html

Diprivan (Propofol) Patient Information: Side Effects and Drug Images at RxList. (n.d.). RxList. Retrieved April 24, 2014, from http://www.rxlist.com/diprivan-drug/patient-images-side-effects.htmCiobanu L, Reynaud O, Uhrig L, Jarraya B, Le Bihan D (2012) Effects of Anesthetic Agents on Brain Blood Oxygenation Level Revealed with Ultra-High Field MRI.

PLoS ONE 7(3): e32645. doi:10.1371/journal.pone.0032645

Lamdin, R., & Shaw, S. (2011, August). Nurses have an ethical imperative to minimize procedural pain. Kai Tiaki: Nursing New Zealand, 17(7), 12+. Retrieved from http://

go.galegroup.com/ps/i.do?id=GALE%7CA266344840&v=2.1&u=lom_ferrissu&it=r&p=AONE&sw=w&asid=2e190fb6b16b1538a38842d1d854e7c

Taylor, C., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing: The art and Science of nursing care (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.364.

The blood supply of the brain and spinal cord (2001). National Center for Biotechnology. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK11042/

MORE REFERENCES

(2013). Medazolam. Drugs.com. Retrieved from http://www.drugs.com/cdi/midazolam.html

Aoki, K., Gokan, D., Hirose, N., Iwasaki, K., Kato, J., Ogawa, S., Ogawa, Y. (2010). The Different Effects of Midazolam and Propofol Sedation on Dynamic Cerebral Autoregulation. Anesthesia & Analgesia, 111(5). Retrieved from http://journals.lww.com/anesthesia- analgesia/Fulltext/2010/11000/The_Different_Effects_of_Midazolam_and_Propofol.30.aspx

Heisler, J. (2014). Versed (Medazolam). About.com Surgery. Retrieved from http://surgery.about.com/od/beforesurgery/qt/VersedMidazolamVersed.htm

Roth, M. (2011). Parasympathetic Nervous System Dominance. Dr. Michael Roth’s Weblog. Retrieved from http://drmichaelroth.wordpress.com/2011/08/03/parasympathetic-nervous-system-dominance/

Roth, M. (2011). Sympathetic Nervous System Dominance. Dr. Michael Roth’s Weblog. Retrieved from http://drmichaelroth.wordpress.com/2011/07/05/sympathetic-nervous-system-dominance/