ANESTHESIA

1. To identify the definition and types of anesthesia

2. To understand the risks and complications associated
with anesthesia
3. To determine the nursing considerations for patients
undergoing procedures requiring anesthesia
4. To discuss the definition, functions, safety features,
types, parts and components of an anesthesia machine
• DEFINITION
• TYPES
• RISKS AND COMPLICATIONS
• NURSING CONSIDERATIONS
• ANESTHESIA MACHINE
DEFINITION OF ANESTHESIA

-Comes from the Greek word

Anesthesis meaning “negative
sensation”

-produces muscle relaxation, block

transmission of pain, nerve impulses
and suppress reflexes

- Decreases temporarily the memory of

retrieval and recall
 TYPES OF ANESTHESIA
1. General Anesthesia
-places the entire body, including the brain, into a state of
unconsciousness (sleep) during which the patient has no
awareness and feels nothing, and will remember nothing of
the surgical experience
- this is commonly induced either via inhalation or
injection thru IV
- Inhalation type uses gas or vapor formulations and
it is delivered via face masks
- Intravenous type is either incorporated in the
intravenous solution or bolus (undiluted)
MAC (Monitored Anesthesia Care)
- is the intravenous administration of mild sedatives to
help a patient relax and relieve anxiety during minor
procedures that do not require general anesthesia
- Provide comfort & safety during diagnostic / therapeutic
procedures: biopsies, colonoscopies
2. Regional Anesthesia
- is the injection of a local anesthetic around major nerves or
the spinal cord to block pain from a large region of the body, such
as a limb

- provides muscle relaxation, postoperative pain relief since its

numbing effects can last 8 to 12 hours, depending upon the dose

-reduces the need for pain medicine after surgery, and other
side effects such as nausea

- If necessary, a mild sedative may be given to help patient

relax or sleep during surgery
Epidural & Spinal Anesthesia
-can be used for most surgeries below the belly button
-an IV must first be inserted since these procedures
require the patient to be properly hydrated
-Both epidural and spinal anesthesia use a local
anesthetic to numb the area where the needle is
inserted
-Depending on the type of surgery, patients may also
be placed under general anesthesia or a mild sedative
that allows them to relax and/or sleep.
Epidural Anesthesia

- administered in the lower back/lumbar region using a special needle that is

inserted between the vertebrae of the spinal column into the epidural
space around the spine.
- Once in place, a small catheter (tube) is placed into the epidural space via
the needle, and then the needle is removed, leaving the catheter in
place. Local anesthetics and narcotics are then given through the catheter.
- The procedure usually takes 10 to 25 minutes. Because an epidural uses a
catheter, pain medicine can continue to be administered to provide
post-operative pain relief if needed.
 Spinal Anesthesia

- administered in the lower back/lumbar region using a spinal needle that

is inserted between the vertebrae of the spinal column into the dural
membrane, which covers the spine and nerve roots
- Once in place, medicines including a local anesthetic and sometimes a
narcotic are given through the needle, and then the needle is removed
- entire process usually takes anywhere from 5 to 20 minutes
3. Local Anesthesia
- administered via injection of anesthetic agents to
tissues within and around the operative site
- indicated for minor surgeries:
- excisions, suturing of superficial lacerations,
and insertion of any material
Topical administration: involves the application of cream, lotion,
ointment, or drop of local anesthetic to traumatized skin to
relieve pain. It can also involve application of these forms to the
mucous membranes in the eyes, nose, throat, mouth, urethra,
anus, or rectum.
Infiltration:
-involves injecting the
anesthetic directly into the
tissues to be treated. It brings
the anesthetic into contact with
the nerve endings in the area
and prevents them from
transmitting nerve impulses to
the brain
Axillary Nerve Block –
Local anesthetic is
injected around the nerve
that passes through the
axilla (armpit) from the
shoulder to the arm to
numb the feeling in your
arm and hand. Typically
used for surgery of the
elbow, forearm, wrist, or
hand.
Interscalene Nerve
Block – Local
anesthetic is
injected around the
nerve block in the
neck used to numb the
shoulder and arm.
Typically used for
surgery of the
shoulder and upper
arm.
∙ Femoral Nerve
Block – Local
anesthetic is
injected around the
nerve block in the
upper thigh/groin area
to numb the leg from
the knee to the hip.
Typically used from
surgery of the anterior
thigh, hip or knee.
∙ Ankle Block – Local
anesthesia is injected
around the ankle to
block the five nerve
branches that supply
sensation to the foot
∙ -used for surgery of
the ankle, foot or
toes.
∙ Bier Block – Local
anesthetics are injected
intravenously to numb a
limb, typically the arm,
and then a tourniquet
is applied to prevent
the anesthetic from
leaving the area.
Typically used on
surgeries of hand or
arm that last less than
an hour.
RISK AND
COMPLICATIONS
Like other medications and
procedures, anesthesia use
doesn’t hold the record of not
having any unwanted effects.

-significant number of cases of

anesthesia-related problems
may be due to:
• patient-related factors
• anesthesia/procedure-relat
ed factors
• or both
1. Patient-related factors
-Nutritional status of the client;
-Respiratory, cardio, hepatic, and renal status of
the client;
-Extreme age (too young-under 8 years old and
too old-more than 65 years old);
-Circulatory status;
-Allergies;
-Chronic use of alcohol, cigarette, and other
substances;
-On medication maintenance
 Some of the most common
2. Procedure-related factors complications of anesthesia use are:
-Type of anesthesia to be used (general - Cardiac problems like myocardial
anesthesia have a higher risk than regional infarction (MI)
and local anesthesia); - Respiratory problems like
-Urgency of the procedure (an pneumonia, apnea (temporary loss of
immediate/emergency procedure have a respiration), and pulmonary embolism
higher risk than elective procedures); - Renal problems like renal
-Length of the procedure (the longer the insufficiency and failure
procedure, the more anesthesia is used, - Neurological problems like
the higher the risk); temporary-permanent cognitive
-Involvement of more body parts (the more dysfunction
tissues/organs involved, the higher the - Development of some allergies
risk). - Death
Nursing Considerations
- Establishment of rapport and good relationship
- Proper identification
- Establishment of pre-anesthetic vital signs
- Provision of learning needs of the client
- Provision of or ensure the presence of support
system
- Pre-operative or pre-anesthetic preparation of
the client: family history, allergies, history of
smoking/drug / alcohol use (may alter effects of
anesthesia medications) - Review of laboratory results,
- Health education on what is expected before, immunologic and hydration status, and the
during, and after the induction of anesthesia overall health status of the client
- Secure consent legally and ethically - Preparation of emergency materials like
- Ensure safety upon administration of resuscitation equipment and antidotes
pre-anesthetic agents - Ensure continuous communication among
- Continuous monitoring of vital signs, mobility, health care team members
response, and cognition of the client - Maintaining a safe environment for the
client (even when awake/conscious)
INSIDE THE OPERATING ROOM:
INSIDE THE OPERATING ROOM:
ANESTHESIA MACHINE

• Definition
• Functions
• Safety features
• System components
• Parts
• Types
ANESTHESIA MACHINE
-an apparatus used to deliver general anesthesia to patients as they
undergo a medical procedure
-a device which delivers a precisely-known but variable gas mixture,
including anesthetizing and life-sustaining gases

What it does:
1. receives medical gases from a gas supply
2. controls the flow and reduces the pressure of desired gases to a safe
level
3. vaporizes volatile anesthetics into the final gas mixture
4. delivers the gases to a breathing circuit that is connected to the patient’s
airway
ANESTHESIA MACHINE
Functions:
1. to deliver oxygen to a patient (Everything about an anesthesia
machine is built around the purpose of delivering oxygen to a
patient. All the fail-safe systems of a machine concern the
prevention of the delivery of a hypoxic mixture, not the delivery of
anesthetic agents)
2. to provide a means of positive-pressure ventilation (means of being
able to force oxygen into a patient because apnea is a major effect
of anesthetics)
3. to deliver inhalational anesthetic agents to a patient
ANESTHESIA MACHINE
Safety features:
• linkage of the nitrous oxide gas flow to the oxygen gas flow
helps ensure a minimum oxygen concentration of 25%
• All modern vaporizers are agent specific and temperature
corrected, capable of delivering a constant concentration of
agent regardless of temperature changes or flow through the
vaporizer
• Pressure relief valves
• Color coded cylinders
• Pressure regulator
 Required components of an anesthesia workstation
1. Battery backup for 30 minutes
2. Alarms
• Grouped into high, medium, and low priority
• High priority alarms may not be silenced for more than 2 minutes
• Certain alarms and monitors must be automatically enabled and functioning
prior to use, either through turning the machine on, or by following the
pre-use checklist: breathing circuit pressure, oxygen concentration, exhaled
volume or carbon dioxide (or both)
• A high-priority pressure alarm must sound if:
*user-adjustable limits are exceeded
*continuing high pressure is sensed
*negative pressure is sensed
Required components of an anesthesia workstation

3. Required monitors for:

• Exhaled volume
• Inspired oxygen: with a high priority alarm within 30 seconds of oxygen
falling below 18% (or a user-adjustable limit)
• Oxygen supply failure alarm
• A hypoxic guard system must protect against less than 21% inspired
oxygen if nitrous oxide is in use
• Anesthetic vapor concentration
• Pulse oximetry
• blood pressure monitoring
• EKG
 Required components of an anesthesia workstation
4. at least one oxygen cylinder attached
5. Hanger yoke:
• must be pin-indexed, have a clamping device that resists leaks, and contain a
filter
• must have a check valve to prevent transfilling, a cylinder pressure gauge and
cylinder pressure regulators
6. Flowmeters:
• Single control for each gas
• Each flow control next to a flow indicator
• Uniquely shaped oxygen flow control knob
• Valve stops (or some other mechanism) are required such that excessive rotation
will not damage the flowmeter.
• An auxiliary oxygen flowmeter is strongly recommended
 Required components of an anesthesia workstation
7. Vaporizers
• Concentration-calibrated
• An interlock must be present
• Liquid level indicated, designed to prevent overfilling
• No discharge of liquid anesthetic occurs from the vaporizer even at
maximum fresh gas flow
8. Only one common gas outlet at 22 mm outer diameter, 15 mm inner
diameter, which is designed to prevent accidental disconnection
9. Pipeline gas supply with Pipeline pressure gauge and inlets for at least
oxygen and nitrous oxide
10. Checklist must be provided (electronic or manual)
System Components

A. Electrical Components:
1. Master Switch: activates both pneumatic & electrical functions
System Components

A. Electrical Components:
2. Power Failure Indicator: audible & visible
3. Reserve Power: rechargeable and dual supply
4. Electrical Outlets: to power monitors, does not provide
electricity during power failure
5. Circuit Breakers: when activated, electrical load should be
reduced before resetting the circuit breaker
System Components

A. Electrical Components:
6. Data Communication Ports:
communication between the
machine, monitors and the data
management system
System Components

B. Pneumatic System:
1. High pressure circuit (gas cylinders on the back of the
machine)
2. Medium pressure circuit (receives gases at low, relatively
constant pressures: gases from the pipeline or wall source)
3. Low pressure circuit (flowmeters)
High pressure circuit
-Receives gases from cylinders at high, variable
pressures and reduces those pressures to lower,
more constant pressure suitable for use in the
machine
COMPONENTS:
• Hanger yoke assembly
• Cylinder pressure gauge
• Pressure reducing device
High pressure circuit: Hanger yoke
-orients and supports the
cylinder
-provides a tight seal and
ensures unidirectional gas
flow
-there must be one yoke each
for oxygen and nitrous oxide
High pressure circuit: Cylinder pressure gauge

displays the cylinder pressure for each gas supplied

by cylinders
High pressure circuit: Pressure reducing device
/Pressure regulators

-Reduces high and variable pressure of cylinder to a

lower, more constant pressure suitable for use in an
anesthesia machine
± O2 : 2200 psig to 45 psig
±N2O: 750 psig to 45 psig
PARTS:
• Oxygen source— air tanks or pressurized air lines
• Oxygen flowmeter—keeps the flow of oxygen at a set point. Consistency of
the air flow is important, so most machines have electronic proportional
control valves that keep everything consistent
• Vaporizer— takes the liquid form of the anesthetic and transforms it into a
vapor, so the patient can inhale it
• Patient breathing circuit—This is how the anesthetic is delivered to the
patient, usually a combination of a hose and face mask that fits over the
patient’s nose and mouth
• Scavenging system—This removes any excess gases from the machine and
prevents it from contaminating the immediate atmosphere. Gases escaping
into the room can have consequences on the other people in the room
SAMPLE PHOTOS:
 ventilator
Flow
meter

bellow
vaporizer

Corrugated APL valve

tube

Scavenging
system
Soda lime
Types of anesthesia machine:
• Intermittent
-gas flows only during
inspiration
-operate on demand
system
-used in: obstetric and
dental analgesia, OPD
diagnostic procedures
Ex. Entonox apparatus,
Mackenssons apparatus
Types of anesthesia machine:
• Continuous
-gas flows both
during
inspiration and
expiration
Ex. Boyle
machine,
Forregar,
Draeger
Post test: