anesthesia and true and false labor sept.29

8/8/2019 Anesthesia and True and False Labor Sept.29

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AnesthesiaAnesthesia


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What is Anesthesia?What is Anesthesia?

y Anesthesia involves the use of medicines to block painsensations (analgesia) during surgery and other medicalprocedures.

y Anesthesia is administered by an anesthesiologist, a doctor

who undergoes several years of specialized training afterthe completion of medical school.

y Anesthesia is sometimes administered by a certifiedregistered nurse anesthetist (CRNA). A CRNA is a

registered nurse who has undergone advanced training inanesthesia. Certified registered nurse anesthetists are able toadminister anesthesia during a surgical procedure, butusually work under the supervision of an anesthesiologist.


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Types of AnesthesiaTypes of Anesthesia

y Local Anesthesia

y Regional Anesthesia

y

General Anesthesia


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A. Local AnesthesiaA. Local Anesthesia

y Local anesthesia blocksthe nerves in a small,specific area of the body.

y

For example, if a surgicalprocedure is performedon the right hand, a localanesthetic is used tonumb that hand without

affecting any other partof the body.


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Local AnesthesiaLocal Anesthesiay Cocaine

Cocaine which was isolated fromcoca leaves by Albert Niemann in Germany in the 1860s.

Also in 1884, Dr. William Stewart Halsted was the first to describe the injection ofcocaine into a sensorynerve trunk tocreate surgical anesthesia. Halsted was an eminent surgeon who had been trained in Britain.

By the turn of the twentieth century, the addictive properties ofcocaine had become clear.

December of 1914, the Harrison Narcotics Tax Act outlawed the sale and distribution ofcocaine in theUnited States.

y Procaine - Procaine is a local anesthetic drug of the amino ester group. It is used primarily to reduce the pain ofintramuscular injection of penicillin, and it was also used in dentistry.

y Lidocaine - is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching,

burning and pain from

skin infl

amm

atio

ns, injec

ted as a dental

anesthetic

o

r as aloc

al

anesthetic

fo

rm

ino

rsurgery.

y Mepivicaine - less vasodilative qualities and hence can be used without the epinephrine vasoconstrictor. Theadvantage to this is that these anesthetics can be used more safely in patients who are taking medications whichmay interact negatively with the vasoconstrictor.


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B. Regional AnesthesiaB. Regional Anesthesia

y Regional Anesthesia is a method of painprevention for surgeries and procedures.Instead of making the patient sleep

through surgery, the area of the body thatwould feel pain is numbed, allowing thepatient to have the procedure whileawake.

y One benefit of a regional anesthetic is thepatient can be sedated or be fullyconscious.


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Types of Regional AnesthesiaTypes of Regional Anesthesia

y Spinal Anesthesia

y Epidural Anesthesia

yNerve Block Anesthesia

y

SaddleB

lock (CaudalB

lock)

y Intravenous Block Anesthesia


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Regional (Spinal)Regional (Spinal)

y Spinal anesthesia is injected into the spinal fluid with a specialneedle that penetrates the spinal column through the back.

y You are numb from about the nipple line to the waist and down.How high the numbness goes depends on where your surgery will

be.

y This type of anesthesia is commonly used for genitourinaryprocedures and procedures of the lower extremities.

y You are not able to move your legs when the medicine starts to

work.You can move your legs in 1 to 4 hours when the medicinewears off. Spinal anesthesia is best for surgeries below the waist.


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Regional (Epidural)Regional (Epidural)

y is medicine used to numb you from about the nipple line to the waist and down.While lying on your side or sitting up, a catheter (tiny tube) is put into your backthrough a needle.

y The needle is then taken out but the catheter is left in place to give you more

medicine if needed.Y

ou are awake during surgery but may be given medicine inyour IV so that you are sleepy.

y Your lower body is numb and you may be able to move your legs but should notfeel pain. Feeling returns to your legs when caregivers stop putting medicine in thecatheter and when the medicine wears off. Epidural anesthesia is good forprocedures below the waist.

y This type of anesthesia is commonly used in labor and delivery and for proceduresof the lower extremities.

y Epidural anesthesia can give longer lasting pain relief than spinal anesthesia.


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Regional (Saddle Block / Caudal)Regional (Saddle Block / Caudal)

y This is medicine used to numb you below the waist. You may lie onyour abdomen (belly) while your caregiver puts a shot of medicinein the lowest part of your spine.

y is an injection of anesthetic agent directly into the spinal canalbelow the spinal column to cause loss of sensation below theinjection site.

y You may lie on your back with your legs up in leg holders (stirrups).

y You are awake during the surgery but may be given medicine in

your IV so that your are sleepy.

y Saddle block or caudal anesthesia is used for procedures orsurgeries of the rear end or legs.


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Regional ( IV block)Regional ( IV block)y This is medicine put into an IV in the injured arm or leg.

y A pressure cuff is put on your upper arm or leg. The pressure cuff istightened after caregivers tightly wrap your arm or leg with a stretchybandage.

This cuff keeps the medicine in the arm or leg so you do not have pain.

y You are awake (but may be sleepy) during surgery. You may also be givenmedicine in your IV so that you are sleepy.

y This type of anesthesia may be called a Bier block if done on your arm. IVregional anesthesia can be used for many kinds of surgeries or procedures

on your arm or leg.

Ex. hand or forearm for carpal tunnel surgery


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Regional (Nerve Block)Regional (Nerve Block)

y This is a type of regional anesthesia

which involves the administration of the

anesthetic agents in the area of a single

group of nerves to numb the extremitiesour other parts of the body.


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C. GeneralAnesthesiaC. GeneralAnesthesia

y is given into a vein (intravenously) or is inhaled. It affects thebrain as well as the entire body.

y This medicine is used to keep you completely asleep duringsurgery.

y General anesthesia can be used for most procedures orsurgeries.

y The medicine may be given as a liquid in your IV.

y It may also be given as a gas through a face mask,endotracheal tube, or a laryngeal mask airway.


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y An endotracheal tube or "ET"tube is put into your mouth ornose and down your throat intoyour lungs. The ET tube helps

protect your windpipe duringsurgery.

y The laryngeal mask airway isalso known as LMA. This is a

tube with a small mask on theend that fits into the back of yourthroat instead of down yourwindpipe. The small mask isfilled with air.

y The ET tube and the LMA allowyou to breathe in oxygen oranesthesia gas during surgery.


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ComplicationsComplications


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y Complications are rare, but no procedure iscompletely free of risk. If you are planning to haveanesthesia, your doctor will review a list of possiblecomplications, which may include:

y Pain and tenderness around the injection site

y Bruising, infection, or bleeding of the injection site

y Headache

y Decrease in blood pressure

y Nerve damage

y Medicine mistakenly injected into a vein or arteryy Damage toorgans


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y The most common complication is nausea and vomiting. This occurs more frequently in children,those susceptible to motion sickness and those who have had such previous experiences withanesthesia.

y Inhaling stomach contents into the lungs is a more serious complication. It is important not to eat ordrink anything prior to your surgery.You may be given a preoperative medication to reduce theamount of your stomachs contents.

y Other complications include, but are not limited to, low blood pressure, high blood pressure,irregular heartbeats, heart attack, allergic reactions, cardiac arrest, airway blockage, lack of oxygen,

physical injury (such as chipped teeth, loss of teeth), muscle cramps, and death. When a pressure

tourniquet is used on an operated limb, skin nerve and muscle (that are all necessarily compressed)are all potential sites of injury.

y Minor complications such as sore throat, headache, hoarseness, drowsiness, muscle aches, andfatigue are common during the first several days following surgery.

y Regional anesthesia, involving the use of local anesthetics that produce a loss of sensation in alimited area, can produce systemic reactions that can cause dizziness, ringing in the ears, a funnyfeeling, loss of consciousness, seizures, and cardiac arrest.


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Nursing ManagementNursing Management

y Inform Consent for Surgery and Anesthesia

y Instruction for NPO for patient undergoinggeneral surgery.

y Monitoring of vital signs esp. BP and RR

y

Physical Examination

y Instruction about physical limits and diets.


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True LaborTrue Labor vsvs False LaborFalse Labor


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False Labor True Labor

Contractions don't get closer together. Contractions do get closer together.

Contractions don't get stronger. Contractions do get stronger.

Contractions tend to be felt only in the

front.(abdomen)

Contractions tend to be felt allover.

Contractions don't last longer. Contractions dolast longer.

Walking has no effect on the contractions. Walking makes the contractions stronger.

Cervix doesn't change with contractions. Cervix opens and thins with contractions.


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BraxtonBraxton--Hicks ContractionsHicks Contractions --

False LaborFalse Labory Braxton-Hicks contractions are your body's way of preparing for labor and

delivery.

y Most women experience Braxton-Hicks as menstrual like cramping or brieftightening in the lower abdomen.

y This feeling tends to be sporadic, meaning it comes and goes at varioustimes.

y Braxton-Hicks while common sometimes do result in discomfort or pain.This is part of the reason so many women have a difficult timedistinguishing between false and true labor

y False labor contractions may occur regularly at 5 minute intervals, butgenerally only last about 30 seconds or so. It isn't uncommon for womenwho have had children before to misinterpret Braxton-Hicks as the realthing and show up at the hospital, only to be sent home a short while later


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True LaborTrue Labory True labor is characterized by contractions that come regularly, gradually

strengthen over time and do not go away if you change position.

y Your water may also break during true labor. If in doubt, it never hurts tocall your physician.

y Most doctors will recommend that if contractions occur regularly and lastmore than thirty seconds, you should try first drinking lots of fluids andlying down. If this doesn't stop the contractions you may be in labor.

y You might avoid timing your contractions until they feel quite strong andare regular. Early labor, particularly for first time mothers, can last hoursand hours, and you may find it tedious to time early contractions duringlabor.

y Vaginal pressure or back pain accompanies contractions.

y Contractions are accompanied by a bloody show or the mucous plug.

anesthesia and true and false labor sept.29

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