Anesthesia

Question 1

“Anesthesia” was coined by _________ when the effects of ether were discovered. In the 1840s, surgeons and dentists began using ether and nitrous oxide with success, and the practice of anesthesia was born

Answer 1

Oliver Wendell Holmes

Question 2

Anesthesia care may be provided by:

Answer 2

• anesthesiologists,
• certified registered nurse anesthetics (CRNAs),
• anesthesiologist’s assistants, and
• perioperative nurses.

Question 3

Recommendations about the choice of anesthesia are made after a thorough physical evaluation, during which the patient is assigned a __________ which helps to estimate their perioperative risk

Answer 3

physical status classification

Question 4

The factors to take into consideration before determining what anesthetic to use for a particular patient are:

Answer 4

• Patient/surgeon preference
• Surgical procedure
• Physiological status
• Age
• Postoperative recovery time
• Length of surgery
• Position of patient
• Patient’s previous experiences with anesthesia

Question 5

Types of Anesthesia include:

Answer 5

• General - a reversible state of unconsciousness, consisting of amnesia, analgesia, and muscle relaxation.
• Regional - a reversible loss of sensation, which is achieved by injecting a local anesthetic to block the nerve fibers from transmitting impulses.
• Local - functions like regional anesthesia but usually applies to a smaller area or a single body part such as a finger or a toe.
• Monitored anesthesia care (MAC) - consists of intravenous medications and concurrent local infiltration of tissue at the surgical site

Question 6

During monitored anesthesia care (MAC) it is the responsibility of the perioperative nurse during this intraoperative period to monitor the patient for the following risks:

Answer 6

• Extravasation of intravenous medication
• A reduction of arterial oxygen saturation
• Breathing difficulty

Question 7

The action of anesthesia is divided into FOUR STAGES.

Answer 7

• Stage I: Initial Administration – The first stage is the actual administering of the anesthetic drugs. There are only a few seconds in between the initial administering of the drug and unconsciousness.
• Stage II: Excitement – In Stage II the patient is now unconscious. Also known as “excitement”, is the time from loss of consciousness to the loss of eyelid reflex. Involuntary movements may occur at this time.
• Stage III: Intrasurgery – This is the time of surgical anesthesia. The patient has rapid eye movement and breathing may be labored until the muscles completely relax. It is time to start the surgery.
• Stage IV: Possibility of respiratory failure - During this last stage of anesthesia, the patient might need help. If too much anesthesia has been given, this stage is characterized by respiratory failure, leading to circulatory failure. Without breathing apparatus and heart support, the patient can die.

Question 8

More specifically, Anesthesia can also be divided into THREE PHASES:

Answer 8

• Induction - This phase begins with the administration of anesthesia and lasts until the surgical incision is made.
• Maintenance - This phase begins with the surgical incision and lasts until near completion of the procedure (Stage 3).
• Emergence - This phase starts as the patient begins to awaken and ends upon exiting the operating room

Question 9

Interoperative responsibilities of the perioperative nurse caring for a patient undergoing a procedure with general anesthesia may include:

Answer 9

• Starting IVs
• Setting up monitoring equipment such as arterial lines
• Double-checking blood
• Obtaining warming blankets and emergency equipment as necessary
• Applying cricoid pressure

Question 10

Intravenous regional anesthesia or a _____________ is used most often for upper extremity nerve blockade.

Answer 10

Beir Block

Question 11

Perioperative nurses must be alert to the potential for __________ after the spinal anesthesia is given.

Answer 11

hypotension (due to vasodilation)

Question 12

One of the most consistent physiological indications of malignant hyperthermia is an _____.

Answer 12

increase in the end-tidal CO2.

Question 13

Recognition of MH is crucial to its treatment. Once detected, surgery should be _______. If this is not possible, all triggering agents should be________. MH should then be treated according to written protocol.

Answer 13

immediately stopped

stopped and replaced with safe agents

Question 14

For regional anesthesia - continuous nerve stimulation helps ensure ________ during peripheral nerve blocks.

Answer 14

proper needle placement