Angeles University Foundation

Angeles City
College of Nursing
 Anesthesia

Anesthesia
A written report about anesthesia its history, types, uses and
possible complication. In partial fulfilment of the
requirements in Related Learning Experience 102.

Submitted to:

Anita Viray, RN, MN

Submitted by:

Johnrey I. Magcaling

Group 17; III-5

07-0132-335

Anesthesia, has traditionally meant the condition of having sensation

(including the feeling of pain) blocked or temporarily taken away. This allows
patients to undergo surgery and other procedures without the distress and
pain they would otherwise experience. The word was coined by Oliver
Wendell Holmes, Sr. in 1846. Another definition is a "reversible lack of
awareness," whether this is a total lack of awareness (e.g. a general
anesthetic) or a lack of awareness of a part of the body such as a spinal
anesthetic or another nerve block would cause. Anesthesia is a
pharmacologically induced reversible state of amnesia, analgesia, loss of

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 Anesthesia
consciousness, loss of skeletal muscle reflexes and decreased stress
response.
Surgical anesthesia is intended to render the patient insensitive to
pain. In a typical clinical procedure, known as balanced anesthesia, the
patient is premedicated with a sedative intended to relieve pre-operative
anxiety and facilitate the induction of anesthesia itself (often this is a
benzodiazepine such as diazepam or midazolam; otherwise, a barbiturate
such as thiopental or nonbenzodiazepine such as propofol may perform this
function). Sedation is followed by the induction of general anesthesia by
intravenous injection of a sedative, narcotic (e.g., morphine, fentanyl,
alfentanyl), or ketamine. In addition, a nondepolarizing curare-like derivative
(e.g., vecuronium, d-turbocurarine) or a depolarizing drug (e.g.,
succinylcholine) is administered to induce muscle paralysis. After intubation
and connection to a ventilator for artificial respiration, general anesthesia
may be maintained by a mixture of oxygen and nitrous oxide, often in
combination with a volatile agent (e.g., halothane, enflurane, or isoflurane)
or intravenous drug. At the conclusion of the surgery, muscle relaxation is
reversed (e.g., by neostigmine or other anticholinesterase), and normal
(unassisted) breathing is restored. In addition, the patient may be given an
analgesic agent (e.g., morphine) to manage any acute pain experienced
postoperatively.
Another method, commonly used in office procedures and outpatient
surgery, is known as "conscious sedation". In this procedure, the patient is
sedated by barbiturates (e.g., sodium pentothal) or benzodiazepines (e.g.,
Valium), and receives a local or regional anesthetic (e.g., Novocain). Because
no general anesthetic is involved, the patient never loses consciousness. He
or she remains awake and able to move during the procedure, and can
interact with the medical team, but feels no pain. Because of the amnesic
properties of most sedative drugs, the patient may have no memory of the
procedure after it is over. Some surgical procedures are appropriately
performed with only local or regional anesthesia. Examples include the use
of Novocain for routine dental work, or epidural blocks in obstetrics. Without
sedation or anesthesia, the patient remains fully aware during the
procedure, and retains conscious memory for the events of surgery. In
neurosurgery, for example, patients are not commonly anesthetized because
the brain has no afferent neurons to conduct pain messages.
HISTORY OF ANESTHESIA
Anesthesia for surgery was introduced in America only in the 1840s.
Before this time, surgical patients were simply expected to withstand the
pain of the procedure. Alternatively, they were intoxicated with alcohol or
opiates (e.g., laudanum). Humphry Davy (1778-829), a famous English
chemist, discovered through self-experimentation that nitrous oxide relieved
headache and dental pain, but his report went unnoticed in the medial
community; it did, however, led to the use of "laughing gas".

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The first demonstration of surgical anesthesia was by Horace Wells
(1815-1848), an American dentist who had observed the effects of nitrous
oxide at a traveling medicine show. Wells had some of his own teeth
extracted painlessly under nitrous oxide, but during his first public
demonstration, in Boston in 1845. Despite the fact that the patient reported
no awareness or memory of pain, the demonstration was judged a failure,
and Wells mocked, because the patient screamed and struggled throughout
the procedure. However, Wells's failure was observed by another dentist,
William Morton, who began experimenting with ether. In 1846, Morton
demonstrated the surgical removal of a tumor in a patient who showed no
signs or reports of pain. (Click on the picture above left to see an enlarged
painting of this event.) By 1847, ether and chloroform were firmly
established as general anesthetics on both sides of the Atlantic. Except for
childbirth: physicians worried about the effects of chemical analgesics on the
fetus, and also worried that the absence of pain would impair the bonds
between mother and child.
Later, it was discovered that morphine lessened the amount of
chloroform needed to produce complete anesthesia. In the early 20th
century ether and chloroform werereplaced by halogenated hydrocarbons
such as halothane (sometimes, a mixture of nitrous oxide and oxygen, or
intravenous narcotics such as fentanyl, are used instead of a volatile agent).
In 1942, Griffith and Johnson administered curare to reduce reflexive
responses to surgical incisions (and artificial respiration to maintain
breathing). This yielded the "balanced anesthesia" procedure still in use
today: a "cocktail" of drugs to induce loss of consciousness, eliminate pain,
and calm the operative area. Originally, general anesthesia was considered
to be a purely "empirical" treatment, whose effectiveness had been
demonstrated but whose mechanism of action was unknown. For this reason,
anesthesia was initially ignored by established medical practitioners, who for
professional reasons did not want to employ any technique whose scientific
basis was not understood.
USES OF ANESTHESIA
• Relaxant
• Block pain
• Make you sleepy or forgetful
• Make you unconscious for your surgery
• Other medicines also may be used to relax your muscles during
surgery
ANESTHESIA PROVIDERS
• Anesthesiologists (medically-trained physicians)
• Nurse anesthetists/certified registered nurse anesthetists (CRNAs)

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• Anesthesiologist assistants
• Anesthesia technicians
• Veterinary anesthetists/anesthesiologists
TYPES OF ANESTHESIA
• Local anesthesia - numbs a small part of the body. You get a shot of
local anesthetic directly into the surgical area to block pain. It is used
only for minor procedures. You may stay awake during the procedure,
or you may get medicine to help you relax or sleep.
• Regional anesthesia - blocks pain to a larger part of your body.
Anesthetic is injected around major nerves or the spinal cord. You may
get medicine to help you relax or sleep. Major types of regional
anesthesia include:
○ Peripheral nerve blocks. A nerve block is a shot of anesthetic
near a specific nerve or group of nerves. It blocks pain in the part
of the body supplied by the nerve. Nerve blocks are most often
used for procedures on the hands, arms, feet, legs, or face.
○ Epidural and spinal anesthesia. This is a shot of anesthetic
near the spinal cord and the nerves that connect to it. It blocks
pain from an entire region of the body, such as the belly, hips, or
legs.
• General anesthesia - affects the brain as well as the entire body. You
may get it through a vein (intravenously), or you may breathe it in.
With general anesthesia, you are completely unaware and do not feel
pain during the surgery and lose consciousness. General anesthesia
also often causes you to forget the surgery and the time right after it.

MEDICINES USED FOR/AS ANESTHESIA

A wide variety of medicines are used to provide anesthesia. Their
effects can be complex, and they can interact with other medicines to cause
different effects than when they are used alone. Anyone receiving anesthesia
—even procedural sedation—must be monitored continuously to protect and
maintain vital body functions. The complex task of managing the delivery of
anesthesia medicines as well as monitoring your vital functions is done by
anesthesia specialists.
Medicines used for anesthesia help you relax, help relieve pain, induce
sleepiness or forgetfulness, or make you unconscious. Anesthesia medicines
include:

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• Local anesthetics, such as lidocaine (Xylocaine) or bupivacaine
(Marcaine), that are injected directly into the body area involved in the
surgery.
• Intravenous (IV) anesthetics, such as sodium thiopental
(Pentothal), midazolam (Versed), propofol (Diprivan), or fentanyl
(Sublimaze), that are given through a vein.
• Inhalation anesthetics, such as isoflurane and nitrous oxide, that
you breathe through a mask.
Other medicines that are often used during anesthesia include:
• Muscle relaxants, which block transmission of nerve impulses to the
muscles. They are used during anesthesia to temporarily relax muscle
tone as needed.
• Reversal agents, which are given to counteract or reverse the effects
of other medicines such as muscle relaxants or sedatives given during
anesthesia. Reversal agents may be used to reduce the time it takes to
recover from anesthesia.
HOW TO DETERMINE THE TYPE OF ANETHESIA TO BE USE
• Your past and current health. The doctor or nurse will consider other
surgeries you have had and any health problems you have, such as
heart disease, lung disease, or diabetes. You also will be asked
whether you or any family members have had an allergic reaction to
any anesthetics or medicines.
• The reason for your surgery and the type of surgery.
• The results of tests, such as blood tests or an electrocardiogram (EKG,
ECG).
POTENTIAL RISKS OF ANESTHESIA
Major side effects and other problems of anesthesia are not common,
especially in people who are in good health overall. But all anesthesia has
some risk. Your specific risks depend on the type of anesthesia you get, your
health, and how you respond to the medicines used. Some health problems
increase your chances of problems from anesthesia. Your doctor or nurse will
identify any health problems you have that could affect your care. Your
doctor or nurse will closely watch your vital signs, such as your blood
pressure and heart rate, during anesthesia and surgery, so most side effects
and problems can be avoided.
PREPARATION BEFORE THE ANESTHESIA & SURGERY
Make sure you get a list of instructions to help you prepare for your
surgery. Your surgeon will also let you know what will happen when you get
to the clinic or hospital, during surgery, and afterward. Your doctor will tell
you when to stop eating and drinking before your surgery. When you stop

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depends on your health problem and the type of anesthesia that will be
used. If you take any medicines regularly, ask your doctor or nurse if you
should take your medicines on the day before or the day of your surgery. You
have to give your consent to be given anesthesia. Your doctor or nurse will
discuss the best type of anesthesia for you and review risks, benefits, and
other choices. Many people are nervous before they have anesthesia and
surgery. Mental relaxation methods as well as medicines can help you relax.
RECOVERING FROM ANESTHESIA
Recovery from anesthesia occurs as the effects of the anesthetic
medicines wear off and your body functions begin to return. Immediately
after surgery, you will be taken to a post-anesthesia care unit (PACU), often
called the recovery room, where nurses will care for and observe you. A
nurse will check your vital signs and bandages and ask about your pain level.
How quickly you recover from anesthesia depends on the type of
anesthesia you received, your response to the anesthesia, and whether you
received other medicines that may prolong your recovery. As you begin to
awaken from general anesthesia, you may experience some confusion,
disorientation, or difficulty thinking clearly. This is normal. It may take some
time before the effects of the anesthesia are completely gone. Your age and
general health also may affect how quickly you recover. Younger people
usually recover more quickly from the effects of anesthesia than older
people. People with certain medical conditions may have difficulty clearing
anesthetics from the body, which can delay recovery.
Some of the effects of anesthesia may persist for many hours after the
procedure. For example, you may have some numbness or reduced
sensation in the part of your body that was anesthetized until the anesthetic
wears off completely. Your muscle control and coordination may also be
affected for many hours following your procedure. Other effects may include:
• Pain. As the anesthesia wears off, you can expect to feel some pain
and discomfort from your surgery. In some cases, additional doses of
local or regional anesthesia are given to block pain during initial
recovery. Pain following surgery can cause restlessness as well as
increased heart rate and blood pressure. If you experience pain during
your recovery, tell the nurse who is monitoring you so that your pain
can be relieved.
• Nausea and vomiting. You may experience a dry mouth and/or
nausea. Nausea and vomiting are common after any type of
anesthesia. It is a common cause of an unplanned overnight hospital
stay and delayed discharge. Vomiting may be a serious problem if it
causes pain and stress or affects surgical incisions. Nausea and
vomiting are more likely with general anesthesia and lengthy
procedures, such as surgery on the abdomen, the middle ear, or the

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eyes. In most cases, nausea after anesthesia does not last long and
can be treated with medicines called antiemetics.
• Low body temperature (hypothermia). You may feel cold and
shiver when you are waking up. A mild drop in body temperature is
common during general anesthesia because the anesthetic reduces
your body's heat production and affects the way your body regulates
its temperature. Special measures are often taken during surgery to
keep a person’s body temperature from dropping too much
(hypothermia).
ANESTHETIC EQUIPMENTS
In modern anesthesia, a wide variety of medical equipment is desirable
depending on the necessity for portable field use, surgical operations or
intensive care support. Anesthesia practitioners must possess a
comprehensive and intricate knowledge of the production and use of various
medical gases, anesthetic agents and vapors, medical breathing
circuits and the variety of anesthetic machines (including vaporizers,
ventilators and pressure gauges) and their corresponding safety features,
hazards and limitations of each piece of equipment, for the safe, clinical
competence and practical application for day to day practice.

ANESTHETIC MONITORING
Patients being treated under general anesthetics must be monitored
continuously to ensure the patient's safety. For minor surgery, this
generally includes monitoring of heart rate (via ECG or pulse oximetry),
oxygen saturation (via pulse oximetry), non-invasive blood pressure, inspired
and expired gases (for oxygen, carbon dioxide, nitrous oxide, and volatile
agents). For moderate to major surgery, monitoring may also include
temperature, urine output, invasive blood measurements (arterial blood
pressure, central venous pressure), pulmonary artery pressure and
pulmonary artery occlusion pressure, cerebral activity (via EEG analysis),
neuromuscular function (via peripheral nerve stimulation monitoring), and
cardiac output. In addition, the operating room's environment must be
monitored for temperature and humidity and for buildup of exhaled
inhalational anesthetics which might impair the health of operating room
personnel.
ANESTHESIA RECORD
The anesthesia record is the medical and legal documentation of
events during an anesthetic. It reflects a detailed and continuous account of
drugs, fluids, and blood products administered and procedures undertaken,
and also includes the observation of cardiovascular responses, estimated
blood loss, urinary body fluids and data from physiologic monitors

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(Anesthetic monitoring, see above) during the course of an anesthetic. The
anesthesia record may be written manually on paper; however, the paper
record is increasingly replaced by an electronic record as part of an
Anesthesia Information Management System (AIMS).
REFERENCES USED:
• http://health.yahoo.com/pain-overview/anesthesia/healthwise--tp17798.html
• http://www.institute-shot.com/anesthesia_and_surgery.htm
• http://en.wikipedia.org/wiki/Anesthesia#History
• http://www.nlm.nih.gov/medlineplus/anesthesia.html

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