ADJUSTING IV

ANALGESIA/SEDATION
The Surgical Experience
During the surgical procedure, the patient will need
sedation, anesthesia, or some combination of these.
There are many low-risk anesthesia agents to choose
from.
GENERAL ANESTHESIA
Anesthesia is a state of narcosis (severe central nervous
system depression produced by pharmacologic agents),
analgesia, relaxation, and reflex loss. General anesthesia
consists of four stages, each associated with specific
clinical manifestations. The entire surgical team must be
aware of this phenomenon and help prevent or manage it.
These stages occur in reverse as the patient wakes up at the end of surgery,
so the nurse must be aware of the need for appropriate patient support:

 Stage1: Beginning anesthesia- Dizines and a feeling of detachment may be

experienced during induction.
 Stage2: Excitement- The excitement stage, characterized variously by
struggling, shouting, talking, singing, laughing or crying, is often avoided if
IV anesthetic agents are given smoothly and quickly.
 Stage3: Surgical anesthesia- is reached by administration of anesthetic vapor
or gas and supported by IV agents as necessary.
 Stage4: Medullary depression- this stage reached if too much anesthesia has
been given, respirations become shallow, the pulse is weak and thready, and
the pupils become widely dilated and no longer constrict when exposed to
light.
INHALATION

Inhaled anesthetic agents include volatile liquid agents and gases.

Volatile liquid anesthetics produce anesthesia when vapors are inhaled.
Gas anesthetics are administered by inhalation and are always
combined with oxygen.
Nitrous oxide is the most commonly used gas anesthetic agent.
LARYNGEAL MASK AIRWAY (LMA) – is a flexible tube with an
inflatable silicone ring and cuff that can be inserted into the larynx
INTRAVENOUS ADMINISTRATION

General anesthesia can also be produced by the

IV administration of various agents, such as
barbiturates, benzodiazepines, nonbarbiturate
hypnotics, dissociative agents, and opioid
agents.
REGIONAL ANESTHESIA

In regional anesthesia, an anesthetic agent is

injected around nerves so that region supplied by
these nerves is anesthetized. The effect depends on
the type of nerve involved. Motor fibers are the
largest fibers and have the thickest myelin sheath.
EPIDURAL ANESTHESIA

Is achieved by injecting a local anesthetic agent into

the epidural space that surrounds the dura mater of the
spinal cord. The given medication diffuses across the
layers of the spinal cord.
SPINAL ANESTHESIA
Is an extensive conduction nerve block that is produced when
a local anesthetic agent is introduced into the subarachnoid
space at the lumbar level, usually between L4 and L5. It
produces anesthesia of the lower extremities, perineum, and
lower abdomen.
LOCAL CONDUCTION BLOCKS

Examples of common local conduction blocks include:

Brachial plexus block, which produces anesthesia of the arm.

Paravertebral anesthesia, which produces anesthesia of the nerves
supplying the chest, abdominal wall and extremities.
Trans-sacral (caudal) block, which produces anesthesia of the
perineum and, occasionally, the lower abdomen.
MODERATE SEDATION

Previously referred to as conscious sedation, is a form

of anesthesia that involves the IV administration of
sedatives or analgesic medications to reduce patient
anxiety and control pain during or therapeutic
procedures.
MONITORED ANESTHESIA CARE
(MAC)

Also, referred to as monitored sedation

given by an anesthesiologist or CRNA
who must be prepared and qualified to
convert to general anesthesia if necessary.
LOCAL ANESTHESIA

Is the injection of a solution containing the

anesthetic agent into the tissues at the planned
incision site. Advantages of local anesthesia are as
follows:
It is simple, economical, and nonexplosive.
Equipment needed is minimal
Postoperative recovery is brief.
 Undesirable effects of general
anesthesia are avoided.
 It is ideal for short and minor surgical
procedures.
Local anesthesia is often given in
combination with epinephrine.