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

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

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

13. 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

14. 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

15. 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

16. 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

17. 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.

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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):
Other
Wenker, O. "Review of Currently Used Inhalation Anesthetics Part I." "The Internet Journal of Anesthesiology." com/topic/local-anesthesia#ixzz1HWFEeZMm