Continuous Spinal Anesthesia And Continuous Epidural Anesthesia

Anesthesiologists give patients anesthetics in a variety of ways, such as “orally, intravenously, by gas or direct injection to render patients insensible to pain Anesthesiologists typically maintain the same daily schedule a surgeon follows, participating in both scheduled and unscheduled operations. Anesthesiologists are responsible for determining the proper anesthetic and dosage level for each patient. They monitor the patients progress prior to, during, and after surgery.”(“Anesthesiologist” 31)

In the summer of 1969 Dr. Moore, a board-certified obstetrics and gynecology doctor, administered a spinal anesthetic to a patient (Showalter, 2017). However, Dr. Moore did not follow the typical

This Anaesthetic case study would describes and discussed the scenario of a patient through the anaesthetic role of their surgical procedure. It will include and discuss the anaesthetic safety procedures equipment and drug interventions used to ensure this particular patients maximum safety and comfort before and during the procedure. The case study will include pre and peri-operative assessment in order to describe the involvement contribution of various specialties in the holistic care of the critical care patient. This assignment will focus only on the anaesthetics side of the procedure but will also highlight the importance of the triad of anaesthesia and discuss the administration, maintenance and reversal of

(History of Nurse Anesthesia Practice. 2010, May), (Koch, E., Downey, P., Kelly, J. W., & Wilson, W. 2001).

The practice of patient-controlled analgesia (PCA) has been around for approximately four decades now. During this time there have been improvements to the technology and the understanding of how to use this form of patient pain control; however, there continues to be concern related to the safety and efficacy of PCA. As this analysis proceeds it will briefly explain what PCA is and how it is used, then delve into the benefits and the safety issues surrounding PCA use as it pertains to the patient and the nurse. Some of the benefits of PCA include improved pain management, improved use of nursing resources, increased patient satisfaction, and reduced pulmonary issues (Hicks, Sikirica, Nelson, Schein & Cousins, 2008). Some of the safety

Could you imagine going through a surgery without anesthetics? You know, an anesthesiologist isn't the only one who gives anesthesia—it's a team effort. Nurse anesthetists have been the primary administers of anesthesia since World War II. Many health care facilities do not have anesthesiologists on staff, but they have a CRNA, or a Certified Registered Nursing Anesthetist. They are the nurses that put IVs (intravenous sedatives) into patients before surgery, as well as a combination of other medicines to relax the patient ("Nurse Anesthetist" Career Articles). The anesthesia promotes a controlled state of unconsciousness, muscular relaxation, and insensitivity to pain. So when you go to the operating room, you will most likely have a nurse

Anesthesia was developed in order to block or prevent pain during medical procedures. Anesthesia has been the backbone of the medical world for around 100 years now. Early anesthetics were primitive and many patients simply did not trust anesthetics. Anesthesia is still a risky process even in todays advanced medical world. Anesthesia is not used to treat or diagnose any specific disease; the sole purpose is to aid both the patient and surgeon through procedures. However, anesthesia is used in different ways based on the magnitude of the procedure. There are three levels of anesthesia which include; local, regional, and general anesthesia. An anesthesiologist determines which type of anesthesia will be needed.

It seems essential that pain management as well as treatment of nausea be improved.” (Rullander, 2013, p. 58) It is well stated that pain control and nausea/vomiting needs to be controlled. There was also reference to whether PCEA which gives the patient the feeling of control. It is also shown “that the most effective analgesic method is a double epidural catheter with continuous infusion of ropivacaine.” (Rullander, 2013, p. 51). It is also mentioned that we need to take a holistic approach to treating these patients.

• You will talk with an anesthesiologist. This is the person who will be in charge of the anesthesia during the procedure. Spinal fusion usually requires that you are asleep during the procedure (general anesthesia).

Just as any medical procedure, epidural anesthesia comes with risks. It can decrease your blood pressure and increase your oral and vaginal temperature (which can lead to treatment for a non-existent infection for you and your baby). You may also experience post-partum backache due to bruising from the injection. There is even a possibility of experiencing spinal block, which requires a blood patch and bed rest. Other moms also have to use a catheter because their urine retention is affected.

The management of postoperative pain has received much interest nowadays. The intensity of postoperative pain depends on many factors such as type and duration of the surgery, type of anesthesia and analgesia used, and the patient’s mental and emotional status (11).

Learning about the potential complications of epidural reinforced my knowledge in being able to choose the right anaesthetic monitoring equipment. Knowing that Spinal and epidural anaesthesia can cause unpredictable and profound arterial hypotension necessitate the use of adequate monitoring like the; Pulse oximetry, ECG and Blood pressure cuff. This knowledge will help me to be able to select appropriate monitoring devices during epidural catheter insertion. Also it goes without saying that an epidural must be performed in a work area that is equipped for airway management and resuscitation.

With an incidence once as high as 40%, spinal cord paralysis in thoracoabominal procedures has declined, however, still remains a devastating threat post-surgery (Roman, Grewal, Taylor, & Grigore, 2014). Modern techniques for repair of thoracic aneurysms and dissections include an open incision with extracorporeal bypass and aortic clamping. This surgical procedure puts patients at great risk for spinal cord paralysis. Open procedures required meticulous reimplantation of intercostal blood vessels, deep hypothermic cardiac arrest, epidural cooling, and various pharmacologic interventions. As surgical technique has advanced to percutaneous endograft repair, most of these techniques are no longer needed. However, the incidence of paralysis is still prevalent in patients having a TEVAR procedure. Naloxone, an opioid antagonist, has been studied as an additional pharmacologic adjunct in the prevention of spinal cord paralysis (Roman, Grewal, Taylor, & Grigore, 2014). Spinal cord injury can be multifactorial and a review of the literature indicates for patients undergoing endovascular repair of thoracic aneurysms, the use of multiple spinal cord protection strategies collectively reduce spinal cord injury compared to the use of naloxone as a primary measure.

There is general, regional and local anesthesia. In general anesthesia, one is unconscious and has no awareness or other feelings. There are a number of general anesthetic drugs such as gases or vapors inhaled through a breathing mask or tube and medications introduced through an IV. In regional anesthesia, the anesthesiologist makes and injection near a cluster of nerves to numb the area of the body that requires surgery. The patient may stay awake, or may be given a sedative, either way they do not see or feel the actual surgery taking place. There are several kinds of regional anesthetics. The two most common are spinal anesthesia and epidural anesthesia. In local anesthesia, the anesthetic drug is usually injected into the tissue to numb just the specific location of the body requiring minor surgery. No matter what anesthetic is received the patient will not have feeling during the surgery.

According to Vickery (2001) however, the spinal board is considered to be the gold standard for spinal immobilisation during the pre-hospital phase of trauma management. For some patients, effective spinal immobilisation is beneficial and can also be vital in preventing the devastating effects of cord damage however it has been suggested that for many the excessive use of this preventative measure may not be prudent or necessary. It has been estimated that over 50% of trauma patients with no complaint of neck or back pain were transported with full spinal immobilisation (McHugh & Taylor 1998). Inappropriate spinal immobilisation may lead to patients experiencing unnecessary pain, skin ulceration, aspiration and respiratory compromise, which in turn may lead to further unnecessary procedures, a longer hospital stay which then incurs increasing costs to the National Health Service (Kwan, Bunn & Roberts, 2001). Shooman & Rushambuza (2009) report that immobilisation is a crucial part of the management of a trauma patient. They believe that if the mechanism of injury is uncertain, the patient should remain immobilised until further imaging even if there are no symptoms of spinal instability after log rolling. However, in a recent study by Pandie, Shepherd & Lamont (2010) they concluded that on its own, standard