NRSG258 - part 3 Flashcards
Types of anaesthetics
- General
- Central Nerve blocks - Spinal / Epidural
- Regional anaesthesia
- Local infiltration
- Sedation/analgesia
General anaesthesia
Reversable , unconscious state characterise by amnesia, analgesia and suppression of reflexes.
Physiological effect on CNS
* Sensory pathways
Depress
- Conscious thought
- Motor control
- Perceptions
- Memory
- Sensations
- Cardiovascular
- Respiratory
Stages of anaesthesia
Stage I - analgesia
Stage II - delirium stage
Stage III - surgical anaesthesia
Stage IV - medullary depression
Pharmacological agents used in anaesthesia
IV Induction agents
Inhalation agents
Adjuncts
- Opioids
- Benzodiazepines
- Neuromuscular blocking agents (muscle relaxants)
- Antiemetics
Oxygen
Nitrous oxide
Neuromuscular agents
Endotracheal intubation
Skeletal muscle relaxation
Non depolarising
* Suxamethonium
Depolarising
- Atracurium
- Vecuronium
- Pancuronium
- Rocuronium
Reversable by anticholinesterase agents
* Neostigmine
Opioids - examples
Fentanyl Morphine Pethidine Alfentanil Remifentanil
Opioids
Induce and maintain anaesthesia
Reduce stimuli
Analgesia
- During surgery
- Anaesthetic recovery
opiods - adverse effects
- Respiratory depression
- Vomiting
- Bradycardia
- Peripheral vasodilation when combined with anaesthesia
- Pruritis
Antiemetics
Prevention of vomiting with aspiration
Counteract emetic effects
- Inhalation agents
- Opioids
Antiemetics - adverse effects
Headache Dizziness Sedation Malaise Acute dystonic reactions
Anaesthetic emergencies
Anaphylaxis Laryngospasm Bronchospasm Aspiration Malignant hyperthermia
Anaphylaxis - Treatment
- Remove the causative agent
- Administer O2 at 100%
- Fluid replacement
- Adrenaline
Laryngospasm - Treatment
- Deepen anaesthesia
* Suction to remove stimulus
Bronchospasm - Treatment
- Bronchodilators
* Increase inhalation agent
Aspiration - Treatment
Ventilatory support in ICU
Malignant hyperthermia - Treatment
Sodium dantrolene
pain is….
an unpleasant sensory and emotional experience associated with actual or potential tissue damage
what ever the person says it is existing where ever they say it is
Protective mechanism - Warns of potential injury from within the body or outside envoronment
Pain - types
Physical
Emotional
Physical
Spiritual
Pain threshold
Level at which pain is felt
Pain tolerance
- Level of pain becomes unbearable
* Individual
Pain assessment
- Empower your patient - patient controlled analgesia (PCA) is a good option
- Accept patient’s assessment of their pain.
- Pain is subjective.
- Pain is what the patient says it
- Knowledge – you must understand the drugs you are administering.
- Consult pain management teams/anaesthetists
- For patients who are non-verbal - consider which pain assessment tool is appropriate
Pain
Acute
Chronic
Acute pain
Sudden onset
Related to an injury
Chronic pain
- Persistent or recurring
- Continues more than 3 months
- Continues after healing
- Difficult to relieve
- Goal of treatment – minimise pain related disabilities
