in the surgical experience sedation and anesthesia play an important role

1. The Surgical Experience SEDATION AND ANESTHESIA Presented by: Mr. K.F.Monteiro Dual role nurse practitioner

13. Anesthesia

21. METHODS OF ANESTHESIA ADMINISTRATION

26. Requirement with respect to physiology: peripheral blood flow Diminished high reduce the amount of anesthetic required. greater quantities of anesthetic are required vasoconstriction or shock in the muscularly active or the apprehensive patient

30. The endotracheal technique

35. Muscle relaxant Purified curare was the first widely used muscle relaxant

36. The ideal muscle relaxant has the following characteristics:

39. The patient receiving spinal or local anesthesia is awake and aware of his or her surroundings unless medications are given to produce mild sedation or to relieve anxiety. #The nurse must avoid careless conversation, unnecessary noise, and unpleasant odors; these may be noticed by the patient in the OR and may contribute to a negative view of the surgical experience. # A quiet environment is therapeutic. #The diagnosis must not be stated aloud if the patient is not to know it at this time.

40. Conduction Blocks and Spinal Anesthesia

41. Types of conduction block *Epidural anesthesia *Brachial plexus block * Paravertebral anesthesia * Transsacral (caudal) block

44. Spinal anesthesia Spinal anesthesia is a type of extensive conduction nerve block that is produced when a local anesthetic 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.

45. For the lumbar puncture procedure, the patient usually lies on the side in a knee–chest position . Sterile technique is used as a spinal puncture is made and the medication is injected through the needle. As soon as the injection has been made, the patient is positioned on his or her back . If a relatively high level of block is sought, the head and shoulders are lowered .

47. Nausea, vomiting, and pain may occur during surgery when spinal anesthesia is used. As a rule, these reactions result from manipulation of various structures , particularly those within the abdominal cavity. The simultaneous intravenous administration of a weak solution of thiopental and inhalation of nitrous oxide may prevent such reactions.

48. Headache may be an after-effect of spinal anesthesia .

49. Factors are involved in the incidence of headache: 1.The size of the spinal needle used 2. The leakage of fluid from the subarachnoid space through the puncture site 3.The patient’s hydration status.

51. Local Infiltration Anesthesia Infiltration anesthesia is the injection of a solution containing the local anesthetic into the tissues at the planned incision site.

53. Local anesthesia is often administered in combination with epinephrine . Epinephrine constricts blood vessels, which prevents rapid absorption of the anesthetic agent and thus prolongs its local action. Rapid absorption of the anesthetic agent into the bloodstream, which could cause seizures , is also prevented. The skin is prepared as for any surgical procedure, and a small gauge needle is used to inject a modest amount of the anesthetic into the skin layers. This produces blanching or a wheal . Additional anesthetic is then injected in the skin until an area the length of the proposed incision is anesthetized. A larger, longer needle then is used to infiltrate deeper tissues with the anesthetic.

54. The action of the agent is almost immediate, so surgery may begin as soon as the injection is complete. Anesthesia lasts 45 minutes to 3 hours , depending on the anesthetic and the use of epinephrine.

55. Thank you