Recovering General and Local Anesthetic Patients Pam Bailey Orbis Staff Nurse 2011

Introduction To recover patients who have had anesthetic we need to: Understand the difference between General Anesthetic (GA) and Local Anesthetic (LA) Know why patients who have had a GA or LA have different care needs Identify these needs and develop appropriate care plans Provide basic principles for working in a recovery unit providing care for GA and LA patients 2

Objectives Describe difference between general and local anesthetic List the advantages and disadvantages of general and local anesthetic Provide guidelines on recovering patients who have had either a general or local anesthetic Provide knowledge of the different needs required by general and local patients

Outline Definition, advantages and disadvantages of GA Definition, advantages and disadvantages of LA Care needs of GA patients Care needs of LA patients Care plan for GA patients Care plan for LA patients Difference between the care needs of GA and LA patients

Definition of General Anesthesia (GA) General Anesthetic is Loss of the ability to perceive pain while in a state of unconsciousness.

Advantages of General Anesthetic Blocks memory of the procedure (amnesia) Pain relief during medical & surgical procedures Protection of airway by breathing tube Limits normal body reflexes = safe, easier surgery If Muscle Relaxant used, relaxation of muscles. Suitable for patients sensitive to local anesthesia Suitable for Non Compliant patients

Disadvantages of General Anesthetic Ketamine increases IOP Inability to communicate with patient Increase in procedure time Greater risk of complication Frequent post-operative nausea and vomiting Longer recovery period Sometimes long hang-over effect (drowsy, weak, tired) Prolonged wake-up time from anesthetic itself Cannot drive/perform activities that could endanger themselves or others for 24 hours or longer if necessary

Definition of Local Anesthetic (LA) Local Anesthetic is the loss of pain sensation only in the area of the body where an anesthetic drug is applied or injected without affecting consciousness

Advantages of Local Anesthetic Provides pain relief and reduced stress during medical and surgical procedures It is safer and cheaper Most patients can return home immediately after local anesthesia Cuts out risks of nausea and vomiting and patients can eat and drink immediately. Less risks and side effects Often suitable for patients who are not fit for general anesthesia Patient is responsive, cooperative Stress free

Disadvantages of Local Anesthetic Unsuitable for infants, young children and uncooperative patients Unsuitable for surgery where relaxation of the muscles is necessary Patients who have had their eyes numbed need to wear a patch after surgery or treatment until full feeling in the eye area has returned Is not always effective in the presence of pus

Care needs of General Anesthetic Patients A GA patient requires a fully equipped recovery room with suitably trained recovery personnel Oxygen supply with an assortment of oxygen masks Suction unit, suction tubing and suction tips Multi Parameter Cardiac Monitor to monitor heart, pulse, blood pressure and oxygen saturation Assortment of blood pressure cuffs and ECG electrodes

Care needs of General Anesthetic patients (continued) Assortment of oral airways Stethoscope Thermometer Glucometer (blood sugar monitor)

Care needs of General Anesthetic Patients (continued) Equipment (continued) Defibrillator and Accessories Emergency Drug Trolley and Contents Adjustable recovery bed Baer Hugger for warming patient if necessary Fan for cooling patient

Care Plan for General Anesthetic Patients Care plan should include Patient identification-arm band and hand over between Operating and Recovery room staff Airway management to prevent obstructed airway by positioning, oxygen and suction Record of vital signs-blood pressure, heart rate, oxygen saturation and temperature Bed with safety rails, straps and brakes

Care Plan for General Anesthetic Patients (continued) Management of pain and nausea according to anesthesiologist’s orders Privacy and cultural considerations of patient Recovery criteria according to anesthesiologist’s orders Discharge criteria according to anesthesiologist’s orders

Care Plan for General Anesthetic Patients (continued) IV therapy as per anesthesiologist’s orders Complication management- malignant hyperthermia, hemorrhage Post operative according to surgeon Wound management-to monitor bleeding Documentation of all of the above

Care needs of Local Anesthetic Patients LA patients do not require a fully equipped recovery room unless conscious sedation has been given in which case they should be monitored similar to GA patients until fully conscious and responsive and until discharge criteria has been met Patients who have not received sedation or who have received minimal sedation prior to entering the operating room, need only remain in the recovery room for a short time as stipulated on the local patient discharge criteria.

Care needs of Local Anesthetic patients Equipment necessary to check patient’s vital signs on return to the Recovery Room Portable Dinamap-Non Invasive Blood Pressure Monitor (NIBP) to monitor heart rate, blood pressure & oxygen saturation Glucometer and thermometer if necessary Close to emergency trolley, defibrillator for treating unexpected emergencies

Care plan for Local Anesthetic Patient Care plan should include Patient identification by arm band Hand over Operating to Recovery room staff Record of patient’s vital signs-blood pressure, heart rate, oxygen saturation and temperature Privacy and cultural considerations of patient Recovery criteria as per anesthesiologist

Care plan for Local Anesthetic Patient (continued) Discharge criteria as per anesthesiologist IV therapy as per anesthesiologist’s orders Post operative orders as per surgeon’s orders Wound management to check for bleeding Documentation of above

Difference between Care needs of GA and LA patients General Anesthetic Local Anesthetic Record Level of Consciousness Yes-Patient drowsy/unconscious No-Awake and responsive Airway Management Yes- till awake & responsive No-unless sedated Record of Vital Signs Frequently as per criteria Once/twice unless sedated Pain & Nausea Management Yes- if pain or nausea present Should have no pain or nausea

Difference between Care needs of GA and LA patients General Anesthetic Local Anesthetic Specialized nursing staff Anesthetic knowledge needed Registered nurse/ nursing tech Recovery Time More than an hour Less than 30 min unless sedated IV therapy in Recovery Room Yes- for fluids/IV Medication Discontinued unless sedated Oral fluids When fully alert, not nauseous Soon as desired

Difference between Care needs of GA and LA patients General Anesthetic Local Anesthetic Wound management Check for swelling and bleeding Complications May react to anesthetic Very rarely Ambulation After an hour Less than an hour Needs to be driven home Yes No

Conclusion regarding General Anesthetic Needs staff with anesthetic experience Needs careful monitoring to prevent airway obstruction as airway has been compromised Requires constant monitoring on a 1:1 basis until completely stable May require intervention for pain, nausea or anesthetic complications like sensitivity to opiates or adverse reactions to anesthetic drugs Need IV therapy for drug administration and IV fluids until able to take medication orally

Conclusion regarding General Anesthetic (continued) Requires longer recovery time Takes longer to ambulate (walk) Infants, children and uncooperative patients need to be accompanied by a parent or companion Are not allowed to drive for 24 hours or perform activities that could endanger themselves or others Should be carefully observed for duration of time spent in recovery room Requires more extensive documentation Requires more staff

Local Anesthetic Summary LA patients Usually arrive back in the recovery area, fully awake and responsive Can usually eat and drink immediately Should have little or no pain or nausea Can be ambulated in less than half and hour Allow for a quick turn over of patients in the recovery room Can be discharged within half an hour or according to the discharge criteria Require less documentation Require less staff

References Resources Books Dobson, Michael B. Anaesthesia at the District Hospital. 2nd ed. World Health Organization, 2000. Periodicals Adachi, Y.U., K. Watanabe, H. Higuchi, and T. Satoh. "The Determinants of Propofol Induction of Anesthesia Dose." Anesthesia and Analgesia 92 (2001): 656-661. Other Wenker, O. "Review of Currently Used Inhalation Anesthetics Part I." "The Internet Journal of Anesthesiology." 1999. http://www.ispub.com/journals/IJA/Vol3N2/inhal1.htm.http://www.answers .com/topic/local-anesthesia#ixzz1HWFEeZMm http://en.wikipedia.org/wiki/Anesthesia http://medical-dictionary.thefreedictionary.com/general+anesthesia