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Nurse anesthesia text - dr. masoud sirati nir

NURSE ANESTHESIA TEXT - DR. MASOUD SIRATI NIR October 2014
Nurse Anaesthesia

Outline
I. Introduction
II. General layout of the Anaesthetic Room
III. Types of Anaesthesia
IV. Preparation for Anaesthesia
V. Intravenous Anaesthesia
VI. Guedal Describes Four Stages of Anaesthesia
General Aims :
The unit is designed to help you learn The main types of Anaesthesia and
Preparation for Anaesthesia and Stages of Anaesthesia to increase your
reading comprehension and to prepare you for reading similar passages.
Behavioral Objectives :
After studing the following text, it is expected that students will be able
to:
Describe the General layout of the Anaesthetic Room Name the main types of Anaesthesia Describe how Preparation for Anaesthesia Describe the Intravenous Anaesthesia Describe Four Stages of Anaesthe NURSE ANESTHESIA TEXT - DR. MASOUD SIRATI NIR October 2014

Anaesthetic Nurse

I. Introduction
Anaesthesia is a complex highly developed science. The anaesthetic
nurse or the technician work with the anaesthetist and help him. So the
anaesthetic nurse, assistant or technician must familiarise themselves
with the basic principles of anaesthetic apparatus and the use of
anaesthetic drugs in the particular theatre in which they work.
II. General layout of the anaesthetic room
Anaesthetic room should be of the same hygienic construction as the
theatre and sterilising room. If there are more than one anaesthetic room
in a multiple theatre suite, equipment should not be interchanged between
rooms and to avoid this it is important to ensure that adequate
replacements are available.
All anaesthetic rooms should contain dust-proof cupboards, having an
adequate number of wide shelves with an impervious surface. Equipment
stored in these cupboards is laid neatly on the shelves, labelled and in
order. All items must be clearly visible and always kept in the same
place. Items such as laryngoscopes should be duplicated as they are
known to fail to crucial moments. It is better to have another place to
store for general replacements. Various sizes of endotracheal tubes, etc.
may be keep separate by storing them complete with their connectors, in
individual paper bags.
Separate locked cupboards should be reserved for scheduled "DDA"
(dangerous drugs administered) and the keys carried by the anaesthetic
nurse or theatre sister on duty. These cupboards may also contain the
register used for recording dangerous drugs administered to the patient in theatre. It is the legal obligation of the anaesthetist to enter all use made NURSE ANESTHESIA TEXT - DR. MASOUD SIRATI NIR October 2014

of dangerous drugs, the name of the patient and quantity used. Drugs for
immediate use may be stored in a locked drawer fitted to the anaesthetic
machine.
A small wash basin with elbow operated mixing taps and requisites for
scrubbing up should be provided in the anaesthetic room. This basin
should be positioned away from areas in which sterile trolleys are being
used.
An adequate suction machine or pipe line suction device must be
available, together with a suction tube and selection of suction nozzles
and catheters with connectors of proper size.
A dispenser should be provided containing a selection of disposable
sterile syringes in sizes ranging form 2 ml to 20 ml, hypodermic and
intravenous needles.
In addition to general diffused lighting, a small maneuverable spotlight,
wall or ceiling mounted is useful during intravenous procedures.
Two trolleys about 45.7 cm (18 inches) square are necessary for the
exclusive use of the anaesthetist for transfusions and local anaesthetic
techniques.
At least two transfusion stands should be available, a Martin transfusion
pump to enable rapid transfusion of blood should be fitted to one or
ideally to each of the stands, to supplement the pumping device of plastic
recipient sets.
Essential equipment always ready for use should include a
sphygmomanometer, stethoscopes, tracheotomy set, cardiac arrest set
and transfusion sets. Access to a defibrillator and monitoring apparatus
is essential. All movable equipment is positioned suitably for
anesthetist's convenience.
NURSE ANESTHESIA TEXT - DR. MASOUD SIRATI NIR October 2014

III. TYPES OF ANAESTHESIA
The main types of anaesthesia are:
1. General anaesthesia
2. Local or regional anaesthesia 3. spinal and epidural anaesthesia
 General Anaesthesia
It induced by inhalation of gases or the vapour of volatile liquids which
vaporize readily at normal room temperatures. These include:

 Nitrous Oxide
Stored in cylinders in a liquid form, under pressure, often referred to
simply as 'gas'. Nitrous oxide is a weak agent of which high
concentration (50-60%) are used in conjuction with other anaesthetics
and oxyen.
 Cyclopropane
Apotent gas stored in cylinders in a liquid form and used only in low
concentrations (15%). It is flammable and explosive and therefore must
not be used in the presence of cautery or diathermy.
 D. Ether
A volatile liquid which has a wide margin of safety in use although
prolonged inhalation can cause post-operative vomiting and depression,
has an unpleasant, irritant smell, is inflammable and explosive when
mixed with O2.
NURSE ANESTHESIA TEXT - DR. MASOUD SIRATI NIR October 2014

 E. Halothane (Fluothane)
A volatile liquid which is neither inflammable nor explosive. It's
characteristics include lack of irritation of the respiratory tract;
effectiveness in low concentration, rapid recovery after administration,
absence of side effects such as vomiting.
 F. Methoxyfluorane (Penthrane)
Similar to halothane but vaporises less readily; induction and recovery
are slower has analgesic properties in low concentration.
 G. Trichloroethylene (Trilene)
A blue colored liquid with a relatively slow rate of vaporisation. Trilene
has a predominantly analgesic effect and is used to supplement other
gaseous anaesthetics. Used alone as a 0.5 per cent mixture in air it can be
administered in small amounts in child to relieve pain without loss of
consciousness, cannot be used in a closed circuit in the presence of
sodalime, which is incompatible with Trilene.
 General Anaesthesia induced by the IV Administration of
Such as the short acting barbiturates. The most commonly used in this class are thiopentone sodium (pentothal), methohexitone sodium (Brietal) and nonbarbiturates such as propanidid (Epontol) a very short acting agent, ketamine hydrochloride (ketalar) and Althesin, a steroid anaesthetic agent. Epontol is very suitable for use in accident and dental departments. Other drugs, although they may not be anesthetics in themselves, are often used in combination with those listed above. NURSE ANESTHESIA TEXT - DR. MASOUD SIRATI NIR October 2014

 Local Anaesthesia
It induced by surface application, local infiltration regional nerve, block
and epidural or subdural spinal injection of drugs such as procaine
(Novocaine), lignocaine, (Xylocaine), amethocaine (decicaine),
prilocaine (citanest), bupivacaine (marcaine) and cinchocaine
(decicaine), prilocaine (citanest), bupivacaine (marcaine) and
cinchocaine (nupercaine). Cocaine is used for surface application only,
e.g. ophthalmic surgery.
 Induced Hypothermia
It is a state of lowered body temperature produced by physical cooling of
patients who are under the effect of a general anaesthetic, and the so-
called lytic cocktail of which the most important element is
chlorpromazine (Largactil, Megaphen).
 Neuroleptanalgesia
It is a state of indifference and insensitivity to pain induced by the
intravenous administration of a potent analgesic drug combined with a
transquilliser, e.g. phenoperidine (operidine) or fentanyl (sublimaze)
combined with a butyrophenone transquiliser such as droperiodol
(Droleptan) or haloperidol.
The patient is easily rousable with a normal blood pressure and when
awakened remains quite. He is in a state of apathy and mental
detachment in which he is mildly sedated and uncaring about his
surroundings.
 Prepration for anaesthesia
1. The gas cylinders and soda lime canister, a box or container for
carbondioxide absorbent etc on the anaesthetic machine are checked by NURSE ANESTHESIA TEXT - DR. MASOUD SIRATI NIR October 2014

an experienced anaesthetic nurse or technician and reserves of these,
together with bottles of halothane (Fluothane), trilene and ether are kept
nearby.
2. The anaesthetic nurse also sets out instruments and apparatus required
by the anaesthetist. She or he prepares trolleys and trays when necessary
for open ether, intravenous anaesthesia, endotracheal intubation, and
local regional or spinal analgesia.
 Intravenous anaesthesia
A selection of intravenous anaesthetic agents, relaxants stimulants, and
antidotes should be clearly labeled and available for the anaesthetist.
The intravenous barbiturates in common use are thiopentone sodium
(Pentothal) 2.5%, methohexitone sodium (Brietal) 1% and the hypnotic
propanidid (Epontol) 5% and ketamine hydrochloride. A 2.5% solution is
prepared by dissolving 0.5 gin 20 ml of sterile pyrogen-free distilled
water respectively. Phenoperidine, pethindine and pentazocine are used
extensively. Pethindine is often diluated to 1% solution containing 10
mg/ml.
Relaxants in common use include the "competitive blocker" muscle
relaxants such as curare (tubarline), gallamine triethiodide (Flaxedil),
pancuronium bromide (pavulon) and depolarising muscle relaxants such
as suxamethonium (scoline).
Stimulants in common use include nikethamide (coramine)
aminophylline, methedrine, methoxamine, methoxamine, metaraminol,
noradrenalin and adrenaline. Antidotes commonly needed include,
prostigmine, nalorphine, etc.
It is the anesthetist's responsibility to prepare these solutions, but if the
anaesthetic nurse is permitted to do so, she should check the preparation
with a second person and show the anaesthetist the ampoules from which the injection has been prepared. NURSE ANESTHESIA TEXT - DR. MASOUD SIRATI NIR October 2014

The sizes of needles used vary with individual choice. For continous or
intermittent intravenous injections, either the syringe and needle are left
in position so that small quantities may be injected as required; or a
special needle such as butterfly is left in the vein. Continuous intravenous
anaesthesia can be maintained by using a very weak intravenous solution,
which is administrated via a saline transfusion or small quantities of the
drug can be injected into the rubber transfusion, as required.
When preparing different solutions at once, it is necessary to label
syringes to aid identification.
 Guedal Describes Four Stages of Anaesthesia
The first stage is one analgesia when peripheral sensation is lost, but the
nervous system is under control. In the first stage of induction there are
frequently swallowing movements, followed by regular respiration and
analgesia.
The second stage is one of excitement, with movements of the limbs
followed by tonic spasms of the muscles, dilated pupils and moving
eyeballs. Quite often this stage is very short and almost absent, especially
when anaesthetising the deeply sedated patient.
The third stage is the stage of surgical anaesthesia which may range from
moderarte to deep according to the type of operation.
The fourth stage which is respiratory and cardiac arrest.
If the patient collapses on the operation table with acute
cardiocirculatory arrest his recovery may well depend upon prompt
action by all theatre staff. Without treatment, irreversible damage may
occur in 3 minutes and a lasting recovery of the brain and thus the
whole body is impossible after 8 minutes.

Source: http://www.theresearch.ir/Resources/Doc/Anaesthetic-Nurse.pdf