1. Members of the Surgical Team Surgeon Surgical assistant Anesthesiologist Certified registered nurse anesthetist Holding area nurse Circulating nurse Scrub nurse Surgical technologist Operating room technician

2. Environment of the Operating Room Preparation of the surgical suite and team safety Layout Health and hygiene of the surgical team Surgical attire Surgical scrub

3. Anesthesia Induced state of partial or total loss of sensation, occurring with or without loss of consciousness Used to block nerve impulse transmission, suppress reflexes, promote muscle relaxation, and, in some instances, achieve a controlled level of unconsciousness

4. General Anesthesia Reversible loss of consciousness is induced by inhibiting neuronal impulses in several areas of the central nervous system. State can be achieved by a single agent or a combination of agents. Central nervous system is depressed, resulting in analgesia, amnesia, and unconsciousness, with loss of muscle tone and reflexes.

5. Stages of General Anesthesia Stage 1: analgesia Stage 2: excitement Stage 3: operative Stage 4: danger

6. Administration of General Anesthesia Inhalation: intake and excretion of anesthetic gas or vapor to the lungs through a mask Intravenous injection: barbiturates, ketamine, and propofol through the blood Adjuncts to general anesthetic agents: hypnotics, opioid analgesics, neuromuscular blocking agents

7. Balanced Anesthesia Combination of intravenous drugs and inhalation agents used to obtain specific effects Combination used to provide hypnosis, amnesia, analgesia, muscle relaxation, and reduced reflexes with minimal disturbance of physiologic function (Continued)

8. Balanced Anesthesia (Continued) Example: thiopental for induction, nitrous oxide for amnesia, morphine for analgesia, and pancuronium for muscle relaxation

9. Complications from General Anesthesia Malignant hyperthermia: possible treatment with dantrolene Overdose Unrecognized hypoventilation Complications of specific anesthetic agents Complications of intubation

10. Local or Regional Anesthesia Sensory nerve impulse transmission from a specific body area or region is briefly disrupted. Motor function may be affected. Client remains conscious and able to follow instructions. Gag and cough reflexes remain intact. Sedatives, opioid analgesics, or hypnotics are often used as supplements to reduce anxiety.

11. Local Anesthesia Topical anesthesia Local infiltration Regional anesthesia –Field block –Nerve block –Spinal anesthesia –Epidural anesthesia

12. Complications of Local or Regional Anesthesia Anaphylaxis Incorrect delivery technique Systemic absorption Overdosage (Continued)

13. Complications of Local or Regional Anesthesia (Continued) Assess for central nervous system stimulation, central nervous system and cardiac depression, restlessness, excitement, incoherent speech, headache, blurred vision, metallic taste, nausea and vomiting, tremors, seizures, increased pulse, respirations, and blood pressure.

14. Treatment of Complications Establish an open airway. Give oxygen. Notify the surgeon. Fast-acting barbiturate is usual treatment. If toxic reaction is untreated, unconsciousness, hypotension, apnea, cardiac arrest, and death may result.

15. Conscious Sedation IV delivery of sedative, hypnotic, and opioid drugs reduces the level of consciousness but allows the client to maintain a patent airway and to respond to verbal commands. Diazepam, midazolam, meperidine, fentanyl, alfentanil, and morphine sulphate are the most commonly used drugs. (Continued)

16. Conscious Sedation (Continued) Nursing assessment of airway, level of consciousness, oxygen saturation, electrocardiographic status, and vital signs are monitored every 15 to 30 minutes.

17. Collaborative Management Assessment Medical record review Allergies and previous reactions to anesthesia or transfusions Autologous blood transfusion Laboratory and diagnostic test results Medical history and physical examination findings

18. Risk for Perioperative Positioning Injury Interventions include: Proper body position Risk for pressure ulcer formation Prevention of obstruction of circulation, respiration, and nerve conduction

19. Impaired Skin Integrity and Impaired Tissue Integrity Interventions include: Plastic adhesive drape Skin closures, sutures and staples, nonabsorbable sutures Insertion of drains Application of dressing Transfer of client from the operating room table to a stretcher

20. Potential for Hypoventilation Continuous monitoring of: –Breathing –Circulation –Cardiac rhythms –Blood pressure and heart rate Continuous presence of an anesthesia provider