MindMap Gallery Complications in anesthetized patients
Nursing complications of anesthetized patients: nursing issues, nursing measures. Including local anesthesia, spinal anesthesia, and general anesthesia.
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Complications in anesthetized patients
Local anesthesia
1. Commonly used local anesthetics
Classification of local anesthetic drugs
Lipids
Procaine, tetracaine
Amides
lidocaine, bupivacaine
Physicochemical properties and anesthetic properties
dissociation constant
fat soluble
Plasma protein binding rate
2. Commonly used local anesthesia methods
topical anesthesia
Act on local mucosal surface
Commonly used drugs: 1% to 2% tetracaine or 2% to 4% lidocaine
local infiltration anesthesia
Commonly used drugs: 0.25% ~ 1% procaine or 0.25% ~ 0.5% lidocaine
area block
Local mass removal, such as benign breast tumor resection
Nerve and plexus blocks
brachial plexus block, cervical plexus block
3. Nursing measures
Nursing care for toxic reactions
reason
overdose
Medication accidentally enters blood vessels
If the injection site has a rich blood supply, or if the feet are numb, vasoconstrictor drugs should be added
The patient's general condition is poor and his tolerance to local anesthetics is reduced.
Performance
Manifestations of central toxicity include numbness of the tongue or lips, dizziness, headache, tinnitus, blurred speech, muscle twitching, confusion, firm coma, and even respiratory arrest.
Cardiovascular toxicity manifests as conduction block in vascular smooth muscle and myocardium, inhibition of arrhythmia, weakened myocardial contractility, reduced cardiac output, lowered blood pressure, and even cardiac arrest.
prevention
1. The dosage of medication at one time should not exceed the limit
2. Note that only those who have no blood return before the injection can be injected
3. The dosage may be reduced based on the patient's specific condition and the site of administration.
4. If there are no contraindications, add an appropriate amount of epinephrine to the local anesthetic
5. Administer barbiturates or aniline benzodiazepines before anesthesia to raise the toxicity threshold
deal with
Once this occurs, stop taking the drug immediately and give oxygen as soon as possible to strengthen ventilation.
Allergic Reaction Care
Performance
After using a small amount of local anesthetic, urticaria, laryngitis, edema, bronchospasm, hypotension and angioedema may be life-threatening in severe cases.
prevention
Amide local anesthetics
deal with
Once this occurs, stop the medication immediately, keep the respiratory tract open, and give oxygen
Inject epinephrine as directed by the doctor, and give glucocorticoids and antihistamines at the same time
Maintain stable circulation, replenish blood volume appropriately, and use vasopressors appropriately in emergencies
Post-anesthesia care
Local anesthesia surgery has little impact on the body, there are no abnormalities during the operation, and generally no special care is required.
For outpatient surgery, the patient should rest in the operating room and leave only if there are no abnormal reactions. The patient should be told to see a doctor at any time if he or she feels unwell.
neuraxial anesthesia
subarachnoid space anesthesia
(lumbar anesthesia)
Care for intraoperative complications
A drop in blood pressure or a slowdown in heart rate
For those whose blood pressure drops, quickly infuse 200 to 300 ml of fluid to expand blood volume.
If necessary, inject ephedrine intravenously to constrict blood vessels and maintain blood pressure.
Patients with slow heart rate can be given intravenous atropine
Respiratory depression
Oxygen, tracheal intubation, artificial respiration
feel sick and vomit
Preoperative atropine prophylaxis
Treat symptomatically, such as giving oxygen, raising blood pressure, and suspending surgical traction.
If necessary, use droperidol, ondansetron and other drugs for prevention and treatment
Postoperative Complication Care
Headache after spinal anesthesia
Usually occurs 2-7 days after surgery
reason
During lumbar puncture, the dura mater and arachnoid membrane are punctured, cerebrospinal fluid is lost, intracranial pressure decreases, and intracranial blood vessels are dilated and stimulated.
Performance
The pain is located at the top of the occipital region or the temporal region. The headache worsens when you raise your head or sit up, and decreases or disappears when you lie down.
prevention
Use fine puncture needles during anesthesia to improve puncture techniques, avoid repeated punctures, and reduce needle holes.
Ensure adequate fluid intake during the perioperative period to prevent dehydration
After surgery, it is routine to remove pillows and lie down for 6 to 8 hours.
deal with
Rest on your back and drink 2500 to 4000 ml of fluid or saline every day.
Labor pain or tranquillizing drugs
Tie the abdomen with a belt
In severe cases, inject 15 to 30 ml of normal saline or 5% glucose or dextran into the epidural space, and use epidural autologous blood filling therapy if necessary.
urinary retention
reason
Parasympathetic nerves that control the bladder are delayed in regaining consciousness, incision pain in the lower abdomen, anus, or perineum is caused by surgery, bladder irritation by surgery, and patients who are not used to urinating in bed.
Performance
The bladder is filled with urine and cannot be discharged or urination is not smooth. Frequent urination often leads to a feeling of incomplete urination, accompanied by pain in the lower abdomen.
prevention
Preoperative guidance explains the reasons for urinary retention once postoperatively and instructs patients to practice urinating in bed and urinate promptly once they feel the urge to urinate.
deal with
Promote urination: Acupuncture at acupuncture points such as Zusanli and Sanyinjiao, or hot compress, or massage of the lower abdomen and bladder area
Follow the doctor's advice and intramuscularly inject the parasympathetic stimulant carbachol
Indwelling urinary catheter if necessary
epidural space block
Care for intraoperative complications
Total spinal anesthesia (most dangerous)
reason
Inject all or part of the local anesthetic into the subarachnoid space
Performance
After the patient is injected with the drug, he quickly develops difficulty breathing, a drop in blood pressure, confusion or disappearance of consciousness, and even breathing and cardiac arrest.
prevention
Strictly abide by operating procedures
Aspirate the cerebrospinal fluid before injecting the medicine
When injecting, use the test dose to confirm that it has entered the subarachnoid space before continuing the administration.
deal with
Stop medication immediately
Positive pressure ventilation with a new mask, and endotracheal intubation to maintain breathing if necessary
Speed up the infusion rate and give vasopressors as directed by the doctor to maintain circulatory function.
local anesthetic toxic reactions
blood pressure drops
Speed up the infusion and, if necessary, inject ephedrine intravenously to increase blood pressure.
Respiratory depression
Small doses of low-concentration local anesthetics
During anesthesia, closely observe the patient's breathing, provide oxygen with a regular mask, and be prepared for respiratory first aid.
feel sick and vomit
Postoperative Complication Care
spinal nerve root injury
reason
The puncture needle may cause direct trauma or damage to the spinal nerve roots or spinal cord due to the hardness of the catheter.
Performance
The patient has an electric shock-like sensation or radiates to the limbs
The patient develops local sensory or/and motor disturbances
deal with
Stop the competition immediately and adjust the needle insertion direction to avoid aggravating the injury.
People with prolonged paresthesia may suffer serious injuries, so block anesthesia should be abandoned.
Patients with spinal nerve root injuries will receive symptomatic treatment and will heal spontaneously within a week or a few months of surgery.
epidural hematoma
reason
Damage to blood vessels during epidural puncture and catheterization
Performance
Severe back pain, progressive spinal cord compression symptoms, accompanied by muscle weakness, urinary retention sphincter dysfunction, hematoma compressing the spinal cord, and paraplegia may occur
deal with
This morning I will perform an extra-membranous puncture to draw out the blood, and if necessary, cut the lamina and remove the hematoma.
Difficulty removing the catheter or breaking it
reason
Ankylosis of the lamina ligaments and paravertebral muscles or improper catheter placement technique, poor catheter texture, and improper force on the catheter
Performance
The catheter is difficult to remove or breaks during removal
deal with
Subject: It is difficult to extubate the tube. Do not use violence. You can put the patient on the edge, apply heat in the puncture position or inject local anesthetic around the tube before pulling it out.
If the catheter is broken, patients without infection or nerve irritation symptoms do not need to take it out, but due to close observation
general anesthesia
Reflux and aspiration
Reduce gastric content retention and promote gastric emptying
airway obstruction
upper respiratory tract obstruction
Quickly lift the lower jaw, insert the oropharyngeal and nasopharyngeal air tubes, and remove throat secretions and foreign bodies.
For patients with laryngeal edema and severe glucocorticoids, tracheotomy is required
Those who use monkey sperm and eggs should remove the inducement. If pressurized oxygen is ineffective, please buy a gold mask with succinylcholine injection and apply it until itching. If necessary, tracheal intubation for ventilation.
lower respiratory tract obstruction
Once discovered, report to the doctor immediately and assist in handling
hypoventilation
Mechanical Ventilation
Administer antagonist drugs as directed by your doctor
hypoxemia
In fact, give oxygen and perform mechanical ventilation if necessary
hypotension
First, reduce anesthesia, replenish blood volume, and completely surgically stop bleeding.
If necessary, the surgical operation is suspended, and the depth of anesthesia is adjusted with vasoconstrictor tape. The operation can be continued after the blood pressure is stabilized.
hypertension
Intravenous fentanyl before induction of general anesthesia
During the operation, the depth of anesthesia is adjusted according to the degree of surgical stimulation, and controlled blood pressure reduction is performed if necessary.
Arrhythmia
Maintain the depth of anesthesia, maintain hemodynamic stability, maintain myocardial oxygen supply balance, and deal with related triggers
High fever, convulsions, and convulsions
physical cooling