Date post: | 10-Jul-2015 |
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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
http://www.fotosearch.com/bthumb/BLD/BLD018/er813.jpg
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
http://latinainstitute.files.wordpress.com/2008/11/hospital-bed1.jpg
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.