DEFINITION

Anesthesia is a state of narcosis ( severe central nervous system depression produced

by pharmacologic agents) analgesia, relaxation and reflex loss.

4 STAGES OF ANESTHESIA

Stage 1- Beginning Anesthesia

 As the patients breathes in anesthetic mixture, warmth, dizziness and a
feeling of detachment may be experienced.
 The pt may have a ringing, roaring, and buzzing in the ears and although still
conscious, may sense an inability to move the extremities easily
 During this stage, noises are exaggerated; even low voices or minor sounds
seem loud and unreal. Necessary noises and motions are avoided when
anesthesia begins

Stage II – Excitement
 Stage characterized variously by struggling, shouting, talking, singing,
laughing or crying which often avoided if the anesthetic is administered
smoothly and quickly.
 The pupils dilate but contract when exposed to light; the pulse rate is rapid
and respirations maybe irregular.
 Must prepared for any restraint of patient because of the possibility of
uncontrolled movements of the patient during this stage. The patient should
not be touched except for the purpose of restraint but restraint should not be
applied over the operative site

Stage III- Surgical Anesthesia

 This stage is reached by continued administration of the anesthetic vapor or
gas. The patient is unconscious and lies quietly on the table.
 The pupils are small but contract when exposed to light.
  Respirations are regular, the pulse rate and volume are normal and the skin is
pink or slightly flushed.
 With proper administration of the anesthetic, this stage maybe maintained for
hours in 1 of several planes, ranging from light (1) to deep (4) , depending on
the depth of anesthesia needed.

Stage IV- Medullary Depression

 This stage is reached when too much anesthesia has been administered.
Respirations become shallow, the pulse is weak and thready and the pupils
become widely dilated and no longer contract when exposed to light.
 Cyanosis develops and without prompt intervention, death rapidly follows.
 If this stage develops, the anesthetic is discontinued immediately and
respiratory and circulatory support is initiated to prevent death

TYPES OF ANESTHESIA

1. GENERAL ANESTHESIA

 They loss the ability to maintain ventilatory function and require assistance in
maintaining a patent airway. Cardiovascular function maybe impaired as well.
 Patients under general anesthesia are not arousable, not even to painful
stimuli.
 Anesthetic agents used in general anesthesia are inhaled or administered by
IV.
 Anesthetics produced anesthesia because they are delivered to the brain at a
high partial pressure that enables them to cross the blood brain barrier
 Any condition that diminishes the peripheral blood flow, such as
vasoconstriction or shock may reduce the amount of anesthetic required.
Conversely, when the peripheral blood flow is unusually high as in muscularly
active or apprehensive patient, induction is slower, and greater quantities of
 anesthetic are required because the brain receives a smaller quantity of
anesthetic.

a. Inhalation
- Inhaled anesthetic agents include:
1. Volatile liquid agents
- produce anesthesia when their vapors are inhaled.
- commonly used are Halothane, Enflurane, Isoflurane, Sevoflurane
2. Gas Anesthetics
- are administered by inhalation and are always combined with
oxygen.
- Nitrous Oxide is the most commonly used agent
- when inhaled produce loss of consciousness & sensation
- the vapor from inhalation anesthetics can be administered to the patient by
several methods:
1. Laryngeal Mask Airway (LMA)
– a flexible tube with an inflatable silicone ring and cuff that can be
inserted into the larynx
2. Endotracheal Tube technique
– consists of introducing a soft rubber or plastic endotracheal tube into the
trachea, usually by means of a laryngoscope
- may be inserted through either the nose (Intranasal Intubation ) or mouth
(Oral Intubation)

b. Intravenous Administration
- administered to induce or maintain anesthesia, although often used in
combination with inhalation anesthetics
Examples are:
b.1. Opiod Analgesics
 Morphine Sulfate
 Fentanyl
  Alfentanil
b. 2. Depolarizing Muscle Relaxants
 Succinylcholine ( Anectine)
b. 3. Non depolarizing Muscle Relaxants- Intermediate Onset and Duration
 Atracurium
 Cisatracurium
 Mivacron
b. 4. Non Depolarizing Muscle Relaxants- Longer Onset and Duration
 Pavulon
 Metubine
b. 5. Intravenous Anesthetics
 Diazepam (Valium )
 Midazolam ( Versed)
 Sodium Methohexital ( Brevital)
 Thiopental sodium (Pentothal)

- IV Neuromuscular blockers (muscle relaxants)

o blocks the transmission of nerve impulses at the neuro muscular junction
of skeletal muscles.
o Uses:
 Relax the muscles in abdominal and thoracic surgery,
 Relax muscle on certain types of eye surgery.
 Facilitate endotracheal intubation
 Treat laryngospasm
 Assist in mechanical ventilation

- Advantages (IV Administration):

1. Onset of anesthesia is pleasant, no buzzing, roaring or dizziness known to
follow administration of inhalation anesthetics
2. The duration of action is brief
3. The patient awakens with little nausea or vomiting
 4. The IV anesthetic agents are non explosive, require little equipment and easy
to administer.

- Disadvantages:
1. Use less often to longer procedures of abdominal surgery.
2. Its powerful respiratory depressant effect (mostly- thiopental)
3. Must be administered by a skilled anaesthesiologist or anesthetist and only
when some method of oxygen administrationis available in case of difficulty
4. Sneezing, coughing, and laryngospasm are sometimes noted with its use.

- Contraindication:
1. Children who have small veins
2. Those who require intubation because of their susceptibility to respiratory
obstruction.

3. REGIONAL ANESTHESIA
- form of local anesthesia in which an anesthetic agent is injected around nerves
so that the area supplied by these nerves is anesthetized.
- the effects depends on the type of nerve involved.
* Motor fibers are the largest fibers and have the thickest myelin sheath
* Sympathetic fibers are the smallest and have a minimal covering.
* Sensory fibers are intermediate.
- A local anesthetic blocks motor nerves least readily and sympathetic nerves
most readily
- Pt receiving regional anesthesia is awake and aware of his surroundings unless
medications are given to produce mild sedation or to relieve anxiety.
- Nurse must avoid careless conversation, unnecessary noise , and unpleasant
odors to prevent negative response from the patient. Quiet environment is
therapeutic.
 a. Epidural Anesthesia
o Commonly used conduction block
o Achieved by injecting a local anesthetic into the epidural space that
surrounds the duramater of the spinal cord
o Blocks sensory, motor and autonomic functions
o Epidural doses are much higher because the epidural anesthetic does not
make direct contact with the spinal cord or nerve roots
o Advantage:- Absence of headache
o Disadvantage: Greater technical challenge of introducing the anesthetic
into the epidural rather than subarachnoid space .
 If inadvertent puncture of the dura might occur, high spinal
anesthesia may develop which results to hypotension, respiratory
depression and arrest
 Tx of this complications includes:
 Airway support
 IV fluids
 Use of vasopressors
o .
* Epidural Anesthesia differs from spinal anesthesia by the site of the injection and the
amount of anesthetic agent used

B, Spinal Anesthesia
o Spinal Anesthesia- involves injection through the duramater into the
subarachnoid space surrounding the spinal cord
o Is an extensive conduction nerve block that is produced when a local
anesthetic is introduced into the subarachnoid space at the lumbatr level,
usually bet L4 & L5.
o It produces anesthesia of the lower extremities, perineum and lower
abdomen.
 o For the Lumbar puncture procedure, the pt 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
o “ The spread of the anesthetic agent and the level of anesthesia depend
on the following:
 Amt. of fluid injected
 The speed with which it is injected
 The positioning of the patient after the injection
 Specific Gravity of the agent
 If the specific gravity is > that of CSF, the agent moves to
the dependent pos’n of the subarachnoid space
 If the specific gravity is < that of CSF, the anesthesia moves
away from the dependent position
o Examples are:Lidocaine (Xylocaine), Procaine (Novocaine)

c. Local Conduction Blocks

* Examples:
- Brachial Plexus Block which produces anesthesia of the arm
- Paravertebral Anesthesia which produces anesthesia of the nerves
supplying the chest,abdominal wall and extremities.
- Transsacral (Caudal ) block which produces anesthesia of the perineum
and occasionally , the lower abdomen

4. MODERATE SEDATION/ ANALGESIA

- previously referred to as conscious sedation
- is a form of anesthesia that involves the IV Administration of sedatives and or
analgesic medications to reduce patient anxiety and control pain during
diagnostic or therapeutic procedures
 - done by an Anesthesiologist, anesthetist, or other specially trained and
credentialed physician or nurse
- Goal: depress the patients’ level of consciousness to a moderate level to enable
surgical, diagnostic or therapeutic procedures to be performed while
ensuring the patient’s comfort during and cooperation with the procedures.
- pt is never left alone and closely monitored by a physician and a nurse who is
knowledgeable and skilled in detecting dysrythmias, administering O2 and
performing resuscitation.
- Continuous monitoring of VS, LOC and cardiac and respiratory function is
essential
- Adv:
1. Able to maintain a patent airway
2. Retain protective airway reflexes
3. Respond to verbal and physical stimuli

5. MONITORED ANESTHESIA CARE(MAC)

-aka: Monitored Sedation
-administered by an anaesthesiologist or anesthetist, which should be prepared
and qualified to convert to general anesthesia if necessary
- used for healthy patients undergoing relatively minor surgical procedures and
for some critically ill patients who may be unable to tolerate anesthesia
without extensive invasive monitoring and pharmacologic support

6. LOCAL ANESTHESIA
- is the injection of a solution containing the local anesthetic into the tissues at
the planned incision site
- often is combined with a local regional block by injecting the nerves immediately
supplying the area
- Advantages:
1. Simple and economical and non-explosive
2. Equipment needed is minimal
3. Postoperative recovery is brief
4. Undesireable effects of general anesthesia are avoided
5. It is ideal for short and superficial surgical procedures.
- often administered in combination with epinephrine, which constricts vessels
thus preventing rapid absorption of the anesthetic agent which results to prolong
local action
- Examples are: Lidocaine (Xylocaine), and Procaine (Novocaine)