Surgical Anesthesia Procedures

Dressing and Emotional Support

• Change into a hospital gown and remove personal items to prevent loss during surgery.
• Provide reassurance to the patient, highlight the supportive staff, and encourage any last-minute questions.

Intraoperative Types of Anesthesia

• General Anesthesia: Induces unconsciousness using intravenous and inhalational agents.

  • Stages:
    • Induction: Transition from awake to unconscious using IV drugs like propofol or inhalation agents.
    • Excitement: Involuntary movements and heightened reflexes; a brief phase.
    • Surgical Anesthesia: Safe for surgery; patient is fully unconscious.
    • Danger: Final stage; risk of respiratory and cardiovascular collapse if not monitored.
  • Objectives:
    • Oxygenation, unconsciousness, analgesia, muscle relaxation, control of autonomic reflexes.

• Regional Anesthesia: Blocks sensation in a specific body area.

  • Common techniques include nerve blocks, spinal, and epidural anesthesia.
  • Nerve Block: Anesthetic near a nerve for local sensation loss.
  • Spinal Anesthesia: Injected into cerebrospinal fluid for lower abdominal and pelvic surgeries.

Surgical Incisions

• Midline Incision: Vertical abdominal incision for wide access.
• Pfannenstiel Incision: Transverse incision above the pubic symphysis, typically used in gynecological surgeries and cesarean sections.

Positioning the Client for Surgery

• Supine Position:

  • Patient lies flat on the back; common for various surgeries.
  • Ensure padding to prevent pressure ulcers and monitor for complications.

• Lithotomy Position:

  • Patient lies on the back with legs elevated; commonly used for gynecological and urological surgeries.
  • Careful leg handling is necessary to avoid strain.

• Trendelenburg Position:

  • Head lowered, legs elevated; used during shock or certain abdominal surgeries.
  • Monitor for intracranial pressure and secure positioning.

• Reverse Trendelenburg Position:

  • Head elevated, feet lower; facilitates respiratory function.
  • Monitor for hypotension and ensure securing.

• Modified Fowler's/Sitting Position:

  • Patient seated at a 45-60 degree angle; used for head, neck, and upper respiratory surgeries.
  • Ensure back support and monitor respiratory function.

Postoperative Complications

• Deep Vein Thrombosis (DVT): Caused by vein damage or immobility.

  • Monitor for calf pain or tenderness; manage with hydration, ambulation, and anticoagulants.

• Pulmonary Complications: Includes atelectasis and bronchitis.

  • Management involves deep breathing exercises, incentive spirometry, and early ambulation.

• Urinary Difficulties: Commonly retention and incontinence post-surgery.

  • Caused by bladder spasms; induce voiding with environmental measures.

• Intestinal Obstruction: Caused by adhesive loops of intestines.

  • Symptoms include nausea and absence of bowel movements; management may include surgery.

• Wound Complications:

  • Infection: Monitor for fever, redness, or pus; maintain aseptic techniques and administer antibiotics.
  • Hematoma: Monitor bleeding; prepare for clot evacuation if necessary.
  • Wound Dehiscence: Disruption of the incision; Evisceration involves organ protrusion; inspect for bloody fluid.

Patient Inspection and Assessment

• Normal Findings:

  • Quiet respiration, pink nail beds, normal respiratory rate (12-20 breaths/min), symmetrical chest appearance.

• Abnormal Findings:

  • Barrel chest, funnel chest, pigeon chest, kyphoscoliosis indicate structural abnormalities.
  • Crepitation indicates subcutaneous air leakage; asymmetry in expansion may indicate pleural effusion.

• Palpation:

  • Assess tenderness, temperature, and vibrations in the chest wall.
  • Abnormal fremitus can indicate masses or pneumothorax.

• Percussion:

  • Normal resonance indicates healthy lung function; dull sounds may suggest fluid or solid masses.

• Auscultation:

  • Normal breath sounds include vesicular, bronchovesicular, and bronchial.
  • Abnormal sounds include crackles, rhonchi, pleural friction rubs, and wheezes, indicating various pulmonary conditions.

Upper Airway Infections

• Upper Airway Infections (URIs): Commonly caused by viruses, particularly rhinoviruses, leading to significant healthcare visits.
• Rhinitis: Characterized by nasal inflammation; types include acute, chronic, allergic, and non-allergic.
  • Symptoms include nasal congestion and sneezing; management focuses on symptomatic relief for viral causes.