Question 1: What are the different types of anaesthesia?

There are different types of anaesthesia:

  • Local – involves the administration of local anaesthetic to a small area being operated on. Via injection, topical or spray.
  • Regional – provides analgesia over a specific body area, like the legs or an arm. This includes epidural, spinal or nerve infiltrations.
  • General – produces unconsciousness, body relaxation and loss of sensation. Medication is administered via inhalation or IV. Airway and breathing need to be supported.

Question 2: What’s the difference between sedation and anaesthesia?

Sedation is a continuum than ranges from a state of minimal sedation to deeper state. As the continuum progresses, patient responsiveness, airway, ventilation and cardiovascular function become more and more compromised. At the end of this continuum, it’s general anaesthesia where the patient has lost consciousness, doesn’t respond to painful stimulation, airway and breathing have to be supported and cardiovascular function may be impaired.

Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Therefore, practitioners intending to produce a given level of sedation, should be able to rescue patients whose level of sedation becomes deeper than initially intended.

Question 3: What medication is used in sedation practice?

Different medications are used in sedation practice. Benzodiazepines, like midazolam are used for its anxiolytic effect, allowing patients to be relaxed and comfortable during procedures. 

Opioids, like fentanyl are used to manage interventional pain, making sure the patient is pain free throughout the procedure.

When administering opioids and benzodiazepines, we need to account for synergistic effects and be mindful that a reduced dose of each medication will be necessary to reach the desired sedation level. For this reason, we always administer opioids first and always titrate drugs to effect.

During sedation, the patient will be able to respond purposefully and will be aware but may not recall periods of the intervention due to the effects of medication.

Question 4: What complications can occur in sedation and anaesthesia? 

Airway obstruction and inadequate ventilation are two common complications that may occur as a result of the sedative drugs. It’s important to keep monitoring the patient’s clinical status, make sure the airway is patent, that ventilation depth and frequency are adequate, and intervene as soon as possible when required.

Over sedation can happen, even if professionals are careful with administration and titrate-to-effect. This is because there is always a certain degree of patient variability in sedation. When the patient becomes over-sedated, the airway and breathing may be compromised.

Paradoxical agitation can also occur, particularly with the administration of midazolam. The patient will become very agitated, try to climb off the table, but will not be aware. It’s important to stop the procedure, reassure and calm the patient.

Regurgitation and aspiration are also possible but rare risks which can occur.

Patients need to be pre-assessed so we can identify possible risks and minimize these complications.

Question 5: How do you make sure the patient is safe during sedation?

Practicing sedation is an advanced role. Keeping the patient safe starts way before the patient is on the operating table.

  1. Nurses need to have specific training to make sure we have the right knowledge and skills. 
  2. Patients need to be pre-assessed so we identify possible risks.
  3. The environment needs to be prepared, including staff, equipment and medication.
  4. Administering medication carefully, using titration to effect and noticing how the patient responds to the medication.
  5. Using adequate equipment to monitor the clinical status. Capnography is a very important tool which gives us insight into the patients breathing. It’s the quickest equipment to inform us of respiratory compromise. We also use pulse oximetry, ECG and blood pressure monitoring. We interpret the information provided by the equipment, observe the patient and make clinical decisions.

About the author

My name is Andreia Trigo RN BSc MSc, I am a nurse consultant with over a decade of experience in anaesthesia, sedation and pain management.

This involves patient care, as well as lecturing at post grad level on these topics, presenting at conferences and co-developing a very successful sedation course at SedateUK. My passion for creating safer environments for patients and professionals led me to collaborate with Medtronic and share my knowledge and expertise with our professional community.

 

The content of this article is written by a blogger with whom Medtronic has a relationship. However, the contents represent the personal objective views, comments and techniques of the blogger and are not statements from Medtronic. To the extent this material might contain images of patients or any material where a copyright is held by a third party, all necessary written permissions from the patient or copyright holder, as applicable, with respect to use, distribution or copying of such images or copyrighted materials has been obtained by the blogger.

  • 1. Anaesthesia Explained by RCOA at https://www.rcoa.ac.uk/document-store/anaesthesia-explained

  • 2. Types of Anaesthesia by ASA at https://asa.org.au/patient-information/types-of-anaesthesia/

  • 3. Types of Anesthesia by American Society of Anesthesiologists at https://www.asahq.org/whensecondscount/anesthesia-101/types-of-anesthesia/

  • 4. Anaesthesia by NHS https://www.nhs.uk/conditions/anaesthesia/

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