Peri-op Flashcards
Stage 1 of anesthesia (analgesia and sedation)
This stage begins with induction and ends with loss of consciousness. The patient may feel drowsy and dizzy. Hearing is exaggerated.
Nursing interventions:
- close OR door, dim lights and control traffic in the OR room
- Position patient safely with safety belts
- Don’t talk about the patient, maintains patient dignity
Stage 2 of Anesthesia (excitement, delirium)
In this stage there is a loss of consciousnes, relaxation, regular or irregular breathing, and loss of eyelid reflex. Increases muscle tones and involuntary movement of extremities. Laryngospasm or vomiting may occur.
Nursing Interventions:
- Protect the extremities
- assit with suctioning
- Stay with the patient
Stage 3 of Anesthesia (operative, anesthesia)
This is the stage that operation can occur, sensation to pain is lost. The jaw is relaxed, breathing is quiet and regular. If this stage is able to progress to the end then vital organs may begin to shut down.
Nursing Interventions:
- Assist the anesthesiologist with intubation
- Place patient into operative position
- Prep the patients skin over the operative site
Stage 4 of Anesthesia (Danger)
This stage is very dangerous, vital organs are being suppressed. Cardiac and respiratory failure may occur. Respiratory muscles are paralyzed. Pupils are fixed and dilated.
Nursing Interventions:
- Prepare for and assist the patient in treatment of cardiac and pulmonary arrest.
- Document the occurrence in the patient’s chart
Desflurane (suprane)
Agent: Inhalation
Advantages: Rapid induction and recovery
Disadvantage: May increase HR, lower BP
May induce Malignant Hyperthermia*
Enflurane (Ethrane)
Agent: inhalation
Advantages: Rapid induction and recovery
Less likely to induce dysrhythmias
Disadvantages: Respiratory depression may occur
Hypotension may occur
Lowers seizure threshold
An induce malignant hyperthermia*
Halthane (Fluothane)
Agent: inhalation
Advantages: Rapid and smooth induction
less likely to create post-op nausea and vomiting
Less irritating to respiratory tract
Disadvantages: Shivering post-op Hypotension and bradicardia may occur Can cause dysrhythmias Can rarely cause liver damage Can induce malignant hyperthermia*
Isoflurane (forane)
Agent: inhalation
Advantage: Rapid induction and recovery
induces additional muscle relaxation
Disadvantage:Respiratory depression possible
irritating odor
Sevoflurane (Ultane)
Agent: Inhalation
Advantage: rapid induction and recovery
induces additional muscle relaxation
Disadvantage: Can rarely induce kidney impairment
N2O
Agent: inhalation
Advantage: rapid induction and recovery
Useful for short procedures
When used with other agents, reduces the required concentration of other agents
minimal cardiovascular and respiratory distress
Disadvantage: Weak anesthetic
May create hypoxia in high concentrations
Needs longer acting agents for longer procedures
Etomidate (amidate)
Agent: IV
Advantage: rapid induction and recovery
useful for short procedures
little “hang over” effect
Disadvantage: can cause pain at Iv site
Laryngospasms
Ketamine (keralar)
Agent: IV
Advantage: rapid indcution and recovery
Protective reflexes remain
Disadvantage: stimulates cardiovascular response
Dissociative emergence reactions
Can cause nausea and vomiting
Midazolam (versed)
Agent: IV
Advantage: Induces anmesia around the event
Disadvantage: slower induction than other agents
Propofol (Diprivan)
Agent: IV
Advantage: Rapid recovery and induction
Disadvantage: can cause pain at IV site
May cause Propofol infusion syndrome (PrIS): this is : severe metabolic acidosis, hyperkalemia, kidney injury, cardiovascular collapse and rhabdomyolysis
Methohexital Sodium (brevital)
Agent: IV
Advantage: Acts directly on the CNS
Disadvantage: Can induce bradycardia and hypotension
