02.02 General Anesthesia

Hey guys today I'm going to talk to you a little bit about general anesthesia as it pertains to the surgical patient.

So what is general anesthesia? Basically, it's a combination of medications that are given to the surgical patient so that they can tolerate a procedure.  These medications together produce an unconscious state in the patient, also amnesia not being able to remember, no pain or analgesia, and muscle relaxation if they use a muscle relaxant, and respiratory depression.  So obviously with respiratory depression the patient will need to be intubated and connected to a ventilator. Guys check out our lesson specifically on intubation in the OR.

With general anesthesia we have three different phases, induction when the medications are given so the patient “goes off to sleep.”  With maintenance, medications are continued to be given to keep them “asleep.” And finally emergence is going to be when the patient is given medications to reverse the anesthesia or the anesthesia medications wears off and the patient “wakes up.”

So what are some common medications that are used with general anesthesia? Propofol is one that I think everybody is pretty familiar with its a non barbiturate intravenous anesthetic that looks milky. Sometimes inhalation agents are used, sometimes not, but if they are sevoflurane is one of them.  The facility where I work we use all intravenous medications and no gas, it enables patients to wake up faster and not have excess side effects that sometimes can be created from inhalation agents. Opioids are often used for the pain component of surgery things like morphine and fentanyl. And if a muscle relaxant is used succinylcholine is a common one.

So during anesthesia the patient is going to be monitored continuously by the anesthesia team, things like vital signs, oxygen saturation, EKG, capnography which is measuring the CO2 levels of the patient will all be monitored.

So I just think it's important to mention that one of the tools used by anesthesia is the ASA Physical Status Classification system. This was developed by the American Society of Anesthesiologists and it grades the patient's overall health or their risk before anesthesia and surgery.

So here is a little chart that will show you the different classes in the ASA Physical Status Classification system. The levels are 1 through 6. ASA I is going to be a normal healthy patient all the way to ASA VI where the patient is considered brain dead and their organs are being harvested for donation.

So besides general anesthesia there are other anesthesia options for a surgical patient.  Considerations to the anesthesia type can be based on the patient’s comorbidities and mental status.  A patient’s postoperative recovery concerns for instance if they are expecting to drive themselves home is something to consider.  Driving immediately after general anesthesia is not allowed or safe so the patient might opt for local anesthesia instead. Make sure you check out the additional lessons we have on local anesthesia and moderate sedation for more information.

Ok guys it’s important to review some of the side effects that we see with general anesthesia.  Each patient reacts differently some have no side effects at all and some with have nausea and/or vomiting, shivering, and sleepiness.  Sore throat and hoarseness typically have to do with the endotracheal tube needed during general anesthesia.

Ok lets review some of the nursing considerations with general anesthesia.  It’s important to recognize that the elderly and patients with chronic conditions are going to be at a greater risks of complications associated with anesthesia including pneumonia, confusion, stroke, and cardiac issues.

Additionally, pre-existing conditions like a seizure disorder, smoking, obstructive sleep apnea, and alcohol and drug abuse can also increase the risk of complications. Also patients that have chronic renal, hepatic, cardiac and respiratory conditions are at an increased risk of issues postoperatively. A super important consideration is a history of anesthesia issues that the patient or the patient’s family might have like malignant hyperthermia.  Guys malignant hyperthermia is an extremely serious potentially life-threatening condition that is associated with general anesthesia. Make sure you check out the lesson all about malignant hyperthermia!

The patient should also have a complete overall health status assessment, pre-procedure vital signs, and planning of the patient’s needs before, during, and after anesthesia.  Go check out the specific lessons we have on the preoperative nursing priorities and preoperative nursing assessment.

So what happens after anesthesia?  So typically the surgical patient who has received general anesthesia will “wake up” or be recovered in the post anesthesia care unit or PACU.  Sometimes the patient will be recovered in the Intensive Care Unit or ICU. In order for the patient to be discharged they must meet certain criteria.  Make sure to check out the lesson on post-anesthesia recovery!

Ok so what should we teach the patient?  It’s important to teach the patient what they can expect before, during, and after anesthesia.  In my experiences as a perioperative nurse patient’s are the most concerned that they won’t “wake up” so talking to them about the process helps to ease their anxiety.  Also it’s important that patients know how critical it is to follow instructions like being NPO before anesthesia and not driving after anesthesia. And as always they should be encouraged to ask questions!

So when we think of the nursing concepts related to general anesthesia, comfort and patient-centered care come to mind as anesthesia enables a patient to undergo surgery in an unconscious state, lets be honest who wants to be aware of someone physically removing their gallbladder….not me!  Of course patient safety is paramount and the reason we assess our surgical patients who will receive general anesthesia preoperatively.

Ok some key points to take with you!  General anesthesia includes giving a combination of medications to the surgical patient that produces an unconscious state without memory and pain, relaxation of muscles, and respiratory depression.  Common medications include propofol, morphine, and succinylcholine. Side effects can include dry mouth, nausea/vomiting, shivering, and sleepiness. As perioperative nurses we will assess the patient’s overall health, vital signs, conditions that increase their risk of complications, and their needs after anesthesia.  Finally we will teach our patients what to expect with general anesthesia, the importance of following instructions, and encourage asking questions!

Okay guys I hope you enjoyed this lesson on general anesthesia!  Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course. Now, go out and be your best self today. And, as always, happy nursing!