General Anesthesia

 General anaesthesia 

Fantasy, at its best, is balm for the soul. But it is faulty logic to assume that balm is necessarily mind-numbing anesthesia.

              -Vera Nazarian

Introduction:

  One name stands out amongst all others when the founder of modern anesthesia is discussed, William T.G. Morton (1819-1868). A young Boston Dentist, Dr. Morton had been in the search for a better agent than what had been used by many dentists: nitrous oxide.

In 1846, Morton participated in the first public demonstration to use ether as a general anaesthetic in surgery at Massachusetts General Hospital. The operation was judged a success and surgeons across Europe and America were quick to see the potential benefits of a general anaesthesia.

 This is the induction of a state of unconsciousness with the absence of pain sensation over the entire body, through the administration of anesthetic drugs. The medication is either inhaled through a breathing mask or tube or administered through an intravenous line. An endotracheal tube may be inserted into the trachea to maintain proper breathing during surgery. Once the surgery is complete the anesthetist ceases the anesthetic medication and the patient recovers in the recovery room.

General anesthetic medicines:

1.Inhaled anesthetic agents

• Halothane 
• Enflurane
• Isoflurane
• Nitrous Oxide

2.Intravenous anesthetic agents

• Thiopental
• Propofol
• Ketamine

Contraindications for General anesthesia:

• People with heart, lung or kidney problems
• People with allergies or a family history of being allergic to medicines
• People who abuse alcohol or medications
• Smokers
• Diseases of the endocrine system, such as diabetes or thyroid problems 

Side effects of general anesthesia :

1. Headache
2. Blurred vision or double vision
3. Drowsiness
4. Shivering or trembling
5. Light headedness
6. Muscle pain
7. Nausea and vomiting
8. Night Mares
9. Sore throat 

Most of the side effects usually disappear as the the anesthetic wears off .

Physiologic monitoring during the procedure:

• Continuous Electrocardiography (ECG)
• Continuous pulse oximetry
• Blood pressure monitoring (BP)
• Agent concentration measurement
• Low oxygen alarm
• Circuit disconnect alarm indicates failure of circuit to achieve a given pressure during mechanical ventilation
• Temperature measurement
• EEG or other system to verify depth of anesthesia may also be used

Nurse's interventions:

Preoperative cate for a patient requiring general anaesthesia

1. Establish a rapport with the patient to decrease anxiety.
2. Explain the preoperative and postoperative nursing care to decrease fear of the unknown. While explaining include family and significant others.
3. Promote an atmosphere where, they are free to ask questions.
4. Avoid additional anxiety and not to give too much information. Sometimes avoidance is the best defense mechanism.
5. Get informed consent of  the patient and the relatives.
6. Monitor vital signs Preoperatively
7. Assess any allergies to medications, foods or any other substances.
8. Assess the nutritional status of the patient and give required vitamins as prescribed.
9. Routine preoperative blood work up and results should be monitored.
10. Obtain the drug history and discuss with the physician regarding withholding of any medications preoperatively.
11. Inform the patient regarding the surgery and general anaesthesia.
12. Giving information is more important because it decreases anxiety, influences recovery and promotes patient satisfaction.
13. Inform the family regarding the time of procedure, how long it will take approximately and then inform that progression and recovery until out of anesthetic agent will be communicated by the physician.
14. See that the preoperative check list id completed.

• NPO 6 hrs for adults
• Signed consent
• Completion of physical preparation
• Recording of preoperative medications
• ID band in proper order
• Jewelry should be removed.

Postoperative care:

• The patient is transferred to a recovery room after the surgery , and removal of endotracheal tube.
• Provide oxygen inhalation as prescribed.
• Postoperative -vitals are monitored.
• Administer medications and iv fluids as prescribed.
• Monitor for complications such as airway obstructions, respiratory insufficiency or bleeding (internal haemorrhage).
• The patient is ready to be shifted from recovery room once.

1. Stable vital signs
2. Patent airway with sufficient ventilation
3. Improving consciousness
4. Responding to questions 
5. Normal movements