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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.
MIS
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How does the surgeon decide btwn a MIS and an open surgery
- Risk vs. benefits
- pt wishes
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-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.
General anesthia
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What are the complications for general anesthesia
- overdose
- unrecognized hypoventilation
- intubation complications
- myocardial depression
- hepatotoxicity
- N/V
- confusion
- Malignant hyperthermia
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What patients are at a greater risk for general anesthetic overdose
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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
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What are the complications of intubation with general anesthesia
- Broken teeth
- sore throat
- damaged vocal cords
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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.
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What drugs is MH usually associated with
- volatile inhaled anesthetics (Fluranes)
- neuromuscular blocking drugs.
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What should an S&S of MH should a nurse watch for
- tachycardia and dysrythmias,
- muscle rigidity (esp. in the jaw)
- hypotension
- skin mottling
- cyanosis, tachypnea, and decreased O2 sats
- increased pCO2
- increased body temp(late sign)
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What pt are at a higher risk for MH from anesthesia
- Children,adolescents, and patients with musculoskeletal abnormalities (MD, pstosis, strabismus)
- Family history
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How is MH treated
Dantrolene Sodium (Dantrium)
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What anesthetic
-disrupts nerve impulses to specific body area,
-often given with sedatives, opioid analgesics, and hypnotics
-Allows th pt to remains conscious and follows instructions
-maintains airway
-may be parental (IV), topical, or intrathecal
Local/regional anesthesia
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When is local anesthesia used
- Contraindications for general anesthesia
- Pt request
- To manage post op pain
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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
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What are the complications of local anesthesia
- allergic reaction
- systemic absorption
- overdose
- systemic toxic reaction
- Spinal headache(if dura is punctured)
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What should an RN watch for a pt is receiving local anesthesia
- restlessness
- excitement
- incoherent speech
- HA
- blurred vision
- metallic taste
- N/V
- tremors, seizures,
- increased HR, resp., and BP.
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A spinal headache can occur __ days after a procedure
5
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What are some interventions for a spinal headache
- bed rest(self limiting)
- analgesics
- caffine
- blood patch
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What are the nursing interventions if someone is experiencing an adverse effect to anesthesia
- ABC;
- Apply O2
- Call Surgeon
- Surgeon may order barbiturates
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What anesthia:
-Prevents nerve transmission in skeletal and smooth muscle
-Create paralysis
-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!
NMBD
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What are the two types of NBBD
- depolorizing(mimic Ach, competitive agonist)
- nondepolorizing(competitive antagonist)
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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
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What is a common depolarizing NMBD
Succinylcholine
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What are the examples of nondepolarizing NMBD
Vecuronium and Pancuronium
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What are the rare adverse reactions of NMBD
- depolarizing: Muscle damage,Muscle pain,Hyperkalemia (due to muscle damage)
- Nondepolarizing:Hypotension,Tachycardia
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What causes NMBD toxicity
- prolonged use
- ie., management of a prolonged mechanical ventilator
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What drugs are used as an antidote for NMBD
Anticholinesterase drugs (Neostigmine, pyridostigmine, and endrophonium) – used to reverse muscle paralysis.
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What else is Neostigmine used for besides NMBD
myasthenia gravis
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