[¹an- + esthesi- + -ia]
1. Complete or partial loss of sensation, with or without loss of consciousness, as a result of disease, injury, or administration of an anesthetic agent, usually by injection or inhalation.
Preoperative: Before induction of anesthesia, contact lenses, hearing aids, dentures (partial plates as well as full sets), wristwatches, and jewelry are removed. The anesthesiologist or nurse-anesthetist interviews and examines the patient briefly, assessing general respiratory and cardiovascular health. The patient is questioned regarding compliance with prescribed preoperative fasting. The American Society of Anesthesiologists Guidelines recommend minimum fasting as follows: 2 hours for clear liquids, 4 hours for breast milk, 6 hours for formula, nonhuman milk, or a light meal (tea and toast), and 8 hours for a regular meal (easily remembered as “2-4-6-8”). These guidelines may be modified by individual surgeons for particular patients and their conditions. Baseline vital signs are assessed and recorded. An electrocardiogram, complete blood count, serum chemistries, and urinalysis are ordered for many general surgeries unless results of recent tests are available. Allergies, previous surgeries, and any untoward responses to anesthetic agents are reviewed, along with any special patient restrictions. If a menstruating female is using a tampon, it is removed and replaced with a perineal pad. Depending on the patient’s health status and the planned procedure, nasal oxygen, monitoring electrodes, and graduated compression stockings are applied. An intravenous route is established, and, after determining that the proper informed consent form has been signed, induction relaxation medication is administered.
Postoperative: During emergence from general anesthesia, the patient's airway is protected and vital signs monitored. Level of consciousness, status of protective reflexes, motor activity, and emotional state are evaluated. The patient is reoriented to person, place, and time; this information is repeated as often as necessary. For patients who have received ketamine, a quiet area with minimal stimulation is provided. Children may be disoriented, hallucinatory, or physically agitated as they emerge from general anesthesia. A security toy and the presence of parents may help them maintain orientation and composure. The temperatures of older patients should be monitored, heat loss prevented, and, as necessary, active rewarming provided. The mental status and level of consciousness of each patient should be carefully observed for changes. Patients' eyeglasses and hearing aids are returned to them as soon as possible. Before nerve block anesthesia, an intravenous infusion is established to ensure hydration. The patient is protected with side rails and other safety measures, and the anesthetized body part is protected from prolonged pressure. For regional anesthesia, sympathetic blockade is assessed by monitoring sensory levels along with vital signs (the block will wear off from head to toe, except for the sacrum and perineum, which wear off last). In obstetrics, maternal hypotension results in diminished placental perfusion and potential fetal compromise; therefore, hydration and vital signs must be closely monitored. Outcomes indicating returned sympathetic innervation include stable vital signs and temperature, ability to vasoconstrict, perianal pinprick sensations (“anal wink”), plantar flexion of the foot against resistance, and ability to sense whether the great toe is flexed or extended. The patient must tolerate oral fluids (unless restricted) and urinate before discharge. If the patient is at risk for postanesthesia headache, oral or intravenous hydration is administered, and the patient is encouraged to remain flat in bed. Prescribed analgesics are administered, and comfort measures, breathing exercises, abdominal support, and position changes are provided.
2. The science and practice of anesthesiology.
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