Chapter 13 (Anaesthesia, Physiological Monitoring, and Postanaesthetic Recovery)

Introduction to Surgical Technology

• Health Tech Academy's guide focuses on preparing for a certification as a Surgical Technologist.

Chapter 13: Key Concepts of Anesthesia

Objectives

• Understand key anesthesia concepts and personnel roles.

• Learn about patient preparation, monitoring, equipment, airway management, and anesthesia types.

• Explore the layout and functions of the Post-Anesthesia Care Unit (PACU).

Overview of Anesthesia

• Anesthesia: Achieves "without sensation" to enable surgery while maintaining homeostasis.

• The anesthesia team manages patients before, during, and after surgery in collaboration with surgical staff.

• Ongoing physiological monitoring is critical to detect any abnormalities during anesthesia.

Types and Concepts of Anesthesia

Definitions of Key Terms

• Consciousness: Awareness continuum to unresponsiveness.

• Sensation: Awareness of stimuli (pain, temperature, etc.).

• Analgesia: Loss of pain sensation through drug administration.

• Sedation: Decreased consciousness and responsiveness.

• CNS Depression: Reduced physical and sensory function.

• Amnesia: Drug-induced memory loss related to anesthesia.

Anesthesia Personnel

• Anesthesia Provider (AP): Ensures patient safety during surgery, manages vital functions, and communicates with surgical teams.

• Roles of APs include administering anesthesia, continuous monitoring, and addressing emergencies. Types include:

  • Anaesthesiologist (MDA): Medical doctor specializing in anesthesia.

  • Certified Registered Nurse Anaesthetist (CRNA): Licensed nurse with advanced training in anesthesia administration.

Preoperative Patient Assessment

• Performed by a surgeon or AP; includes medical history, allergy checks, and medication reviews.

• Utilizes the ASA Classification System for anesthesia risk assessment:

  1. ASA 1: Healthy patient.

  2. ASA 2: Mild systemic disease.

  3. ASA 3: Severe disease limiting activities.

  4. ASA 4: Serious systemic disease threatens life.

  5. ASA 5: Moribund state.

  6. ASA E: Emergency status indication.

Airway Management

• Airway evaluations performed to identify potential obstructions or difficulties during anesthesia.

  • Mallampati Assessment: Categorizes airway difficulty risk based on anatomical features.

Patient Preparation for Anesthesia

Day-Before Instructions

• Consult with AP and surgical teams at least one week prior.

• Discuss medication alterations; hygiene practices before surgery are crucial.

• Fasting Guidelines: Prevent aspiration risk; guidelines vary based on patient condition.

• Verify patient identity and surgery details for accuracy.

Moving to Surgery

• Remove prosthetics and jewelry; prepare for surgery under strict hygiene protocols.

Types of Anesthesia Techniques

• General Anesthesia: Induces unconsciousness with multiple phases (induction, maintenance, emergence).

• Regional Anesthesia: Targets sensation loss in specific areas (e.g., nerve blocks).

• Local Infiltration: Injection into surface tissues to cause localized anesthesia.

Monitoring During Anesthesia

Physiological Monitoring

• Essential for tracking vital signs, consciousness level, and physiological stability throughout the surgical procedure.

• Monitoring Techniques: Includes capnography, ABG analysis, pulse oximetry to assess patient status.

• Temperature regulation is vital to prevent hypothermia using devices like warming blankets.

Neuromuscular Response

• Monitored to ensure adequate muscle relaxation during general anesthesia.

Postanesthesia Care Unit (PACU)

PACU Functionality

• Designed for postoperative recovery monitoring, staffed by specialized nurses.

• Critical care devices and emergency supplies maintained for immediate access.

• Layout facilitates swift care and monitoring of patients post-surgery.

PACU Procedures

• Patients are only admitted after confirmation of stability from the anesthesia care provider.

• Handover Protocols: Clear communication and documentation of patient history, surgical details, and medication administered are essential.

Postoperative Assessments and Complications

Assessment Areas in PACU

• Continuous monitoring of respiratory, circulatory, and neurological functions.

• Recognition of potential complications: pain, nausea, respiratory issues, bleeding, or adverse reactions to anesthesia.

• Glasgow Coma Scale (GCS) utilized to assess consciousness level and recovery.

Elements of Discharge Planning

• Ensures patient readiness for release by meeting specified medical criteria. Includes:

  1. Transport planning.

  2. Home care arrangements.

  3. Patient education and follow-up instructions.

Unanticipated Outcomes

• Strategies in place for emergencies, including resuscitations, unfavorable patient responses, or unexpected discharges against medical advice.

Review Questions

1. When is regional anesthesia appropriate?

2. What comprises the ASA risk assessment?

3. Why is preoperative patient assessment critical?

4. Discuss common methods of regional anesthesia.

5. What is the role of the surgical technologist in anesthesia procedures and emergencies?

Terminology

• Key anesthesia terms include:

  • Airway: Passageway for breathing.

  • Analgesia: Absence of pain.

  • Amnesia: Loss of memory.

  • General Anesthesia: Unconsciousness induced for surgery.

  • PACU: Area for patient recovery post-anesthesia.