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-AKA endoscopic surgery
-used during abdominal surgery
-injection of gas (insufflation) is used to separate organs.
-DaVinci device is used in this area.
-Surgeon inserts necessary components then leaves the sterile field to complete the surgery at a computer console.
How does the surgeon decide btwn a MIS and an open surgery
- Risk vs. benefits
- pt wishes
-Causes a reversible loss of consciousness.
-Depresses the CNS to achieve analgesia, amnesia, and loss of muscle tone/reflexes.
-Can be inhaled or IV. May be used together.
What are the complications for general anesthesia
- unrecognized hypoventilation
- intubation complications
- myocardial depression
- Malignant hyperthermia
What patients are at a greater risk for general anesthetic overdose
When giving a pt general anesthesia what should be watched to prevent unrecognized hypoventilation
- Monitor CO2 status by end tidal CO2 monitor
- Have system in place to detect any break in ventilator equipment
What are the complications of intubation with general anesthesia
- Broken teeth
- sore throat
- damaged vocal cords
Describe the process of MH
Skeletal muscle reacts to anesthesia causing an increase in serum calcium and potassium levels which leades to acidosis, cardiac dysrythmias, and increased body temp.
What drugs is MH usually associated with
- volatile inhaled anesthetics (Fluranes)
- neuromuscular blocking drugs.
What should an S&S of MH should a nurse watch for
- tachycardia and dysrythmias,
- muscle rigidity (esp. in the jaw)
- skin mottling
- cyanosis, tachypnea, and decreased O2 sats
- increased pCO2
- increased body temp(late sign)
What pt are at a higher risk for MH from anesthesia
- Children,adolescents, and patients with musculoskeletal abnormalities (MD, pstosis, strabismus)
- Family history
How is MH treated
Dantrolene Sodium (Dantrium)
-disrupts nerve impulses to specific body area,
-often given with sedatives, opioid analgesics, and hypnotics
-Allows th pt to remains conscious and follows instructions
-may be parental (IV), topical, or intrathecal
When is local anesthesia used
- Contraindications for general anesthesia
- Pt request
- To manage post op pain
What are the different types of local anesthesia
- Field block – inject around the op. site
- Nerve block – into or around the nerves of the involved area
- Spinal– injected into the CSF
- Epidural– injected into the epidural space
- Topical– applied to skin
What are the complications of local anesthesia
- allergic reaction
- systemic absorption
- systemic toxic reaction
- Spinal headache(if dura is punctured)
What should an RN watch for a pt is receiving local anesthesia
- incoherent speech
- blurred vision
- metallic taste
- tremors, seizures,
- increased HR, resp., and BP.
A spinal headache can occur __ days after a procedure
What are some interventions for a spinal headache
- bed rest(self limiting)
- blood patch
What are the nursing interventions if someone is experiencing an adverse effect to anesthesia
- Apply O2
- Call Surgeon
- Surgeon may order barbiturates
-Prevents nerve transmission in skeletal and smooth muscle
-Requires mechanical ventilation
-EXTREMELY important to give sedation and/or analgesia with these medications. These people are wide awake with theses meds– just cannot move!
What are the two types of NBBD
- depolorizing(mimic Ach, competitive agonist)
- nondepolorizing(competitive antagonist)
Describe the two stages of paralysis
- 1-muscle facilitates(twitches)
- 2-as depolarization continues, muscles no longer respond to Ach released because NMBD has filled receptor sites. Muscles become paralyzed
What is a common depolarizing NMBD
What are the examples of nondepolarizing NMBD
Vecuronium and Pancuronium
What are the rare adverse reactions of NMBD
- depolarizing: Muscle damage,Muscle pain,Hyperkalemia (due to muscle damage)
What causes NMBD toxicity
- prolonged use
- ie., management of a prolonged mechanical ventilator
What drugs are used as an antidote for NMBD
Anticholinesterase drugs (Neostigmine, pyridostigmine, and endrophonium) – used to reverse muscle paralysis.
What else is Neostigmine used for besides NMBD