A. General Anesthesia - is the loss of all sensation and consciousness.

Protective
reflexes such as cough and gag reflexes are lost. A general anesthetic acts by blocking
awareness centers in the brain so that amnesia (loss of memory), analgesia (insensibility
to pain), hypnosis (artificial sleep), and relaxation (rendering a part of the body less
tense) occur. General anesthetics are usually administered by intravenous infusion or by
inhalation of gases through a mask or through an endotracheal tube inserted into the
trachea.

Advantages:

1. Because the client is unconscious rather then awake and anxious, respiration and
cardiac function are readily regulated.
2. The anesthesia can be adjusted to the length of the operation and the client’s age
and physical status.

Disadvantage:

1. It depresses the respiratory and circulatory systems.

2. Some clients become more anxious about a general anesthetic that about the
surgery itself. Often this is because they fear losing the capacity to control their
own bodies.

B. Regional Anesthesia - is the temporary interruption of the transmission of nerve

impulses to and from a specific area or region of the body. The client loss sensation in an
area of the body but remains conscious. Several techniques are used:

Topical (surface) Anesthesia Is applied directly to the skin and mucous

membranes, open skin surfaces, wounds, and burns.
The most common used topical agents are lidocaine
(Xylocaine) and benzocaine. Topical anesthetics are
readily absorbed and act rapidly.
Local Anesthesia (Infiltration)is injected into a specific area and is used
for minor surgical procedures such as suturing a small
wound or performng a biopsy. Lidocaine or tetracaine
0.1% may be used.
Nerve Block Is a technique in which the anesthetic agent is
injected into and around a nerve or small nerve group
that supplies sensation to a small area of the body.
Major blocks involve multiple nerves or a plexus (e.g.
the brachial plexus anesthetizes the arm); minor
blocks involve a single nerve (e.g. a facial nerve)
Intravenous block (Bier Is used most often for procedures involving the arm,
block) wrist and hand. An occlusion tourniquet is applied to
the extremity to prevent infiltration and absorption of
the injected intravenous agent beyond the involved
 extremity.
Spinal anesthesia It requires a lumbar puncture through one of the
(Subarachnoid block) interspaces between lumbar disc 2 (L2) and the
sacrum (S1). An anesthetic agent is injected into the
subarachnoid space surrounding the spinal cord.
Categorized into Low Spinals (saddle or caudal
blocks) are primarily used for surgeries involving the
perineal or rectal areas. Mild Spinals (below the level
of the umbilicus – T10) can be used for hernia repairs
or appendectomies. High Spinals (reaching the
nipple line – T4) can be used for surgeries such as
cesarean sections.
Epidural (peridural) Is an injection of an anesthetic agent into the epidural
anesthesia space, the area inside the spinal column but outside
the dura mater.

Conscious Sedation may be used alone or in conjuction with regional anesthesia for some
diagnostic tests and surgical procedures. Conscious sedation refers to minimal
depression of the level of consciousness in which the client retains the ability to maintain
a patent airway and respond appropriately to commands.

Intravenous narcotics such as morphine or fentanyl (Sublimaze) and antianxiety agents

such as diazepam (Valium) or midazolam (Versed) are commonly used to induce and
maintain conscious sedation. Conscious sedation increases the client’s pain threshold and
induces a degree of amnesia but allows for prompt reversal of its effects and a rapid
return to normal activities of daily living. Procedures such as endoscopies, incision and
drainage of abcesses and even balloon angioplasty may be performed under conscious
sedation.

http://nursingcrib.com/nursing-notes-reviewer/medical-surgical-nursing/types-of-
anesthesia/
 Antibiotics

Antibiotics are a category of drugs used to combat bacteria that cause infection.
Antibiotics can be given orally, in pill form, or intravenously, or through an IV. While in
the hospital, antibiotics are most commonly given through an IV, but the vast majority of
home antibiotics are prescribed as pills. The selection of the antibiotic depends on the
type of surgery and the risk of infection by certain types of bacteria. Examples include:

• Amoxicillin
• Ampicillin
• Ancef (Cefazolin)
• Keflex (Cephalexin)
• Levaquin (Levofloxacin)
• Linezolid
• Maxipime (Cefepime)
• Piperacillin
• Rifampin
• Rocephin (Ceftriaxone)
• Vancomycin

Analgesics-Pain Relievers

Analgesics, or pain medications, are used to control pain before and after surgery. They
are available in a wide variety of forms, and can be given as an IV, in pill form, as a
lozenge, a suppository, as a liquid taken by mouth and even as an ointment where the
medication is absorbed through the skin.

The strength of individual pain medications varies widely, just as the dosage prescribed
by a physician can be different from one patient to another. For this reason, the
medication prescribed will depend greatly on the condition for which it is prescribed.
Most post-operative analgesics contain opioids, either purely or in combination with
acetaminophen or NSAIDs.

The following are examples of commonly prescribed choices:

• Codeine
• Darvocet
• Demerol(Meperidine)
• Dilaudid (Hydromorphone)
• Fentanyl
 • Lortab (Hydrocodone)
• Morphine
• Percocet (Oxycodone)
• Ultram (Tramadol)
• Vicodin (Hydrocodone)

IV Fluids

Intravenous fluids, or IV fluids, are given to patients for two primary reasons, to replace
fluids they have lost through illness or injury, or to provide fluids when they are unable to
drink as they normally would. The solution that is used is selected based on the patient’s
needs and can change periodically during a hospital stay.

• Half-Normal Saline (.45 NaCL)

• Normal Saline (.9 NaCl)
• Lactated Ringer’s
• 5% Dextrose (D5)

Electrolytes

Electrolytes are compounds in the blood that can conduct an electrical charge and help
the body complete essential functions, including helping the heart beat. Too many
electrolytes, or too few electrolytes, can cause disruptions in the heart’s function or other
serious problems.

To prevent complications from electrolyte imbalances, supplements can be given, orally

or through an IV.

• Calcium Chloride
• Magnesium Chloride
• Potassium Chloride
• Phosphorous (Potassium Phosphate)

Anticoagulants

Anticoagulants are a category of medications that slow the clotting of the blood. This is
important after surgery as one of the risks of surgery is blood clots, especially deep vein
thrombosis, which often occur in the legs.

To prevent blood clots from forming and causing complications such as a stroke or
pulmonary embolus, anticoagulants are given through an IV, an injection, or in a pill
form.

• Argatroban
• Coumadin (Warfarin)
• Heparin
 • Lovenox (Enoxaparin)

Diuretics

Diuretics are medications that increase the rate of urination. They can be used to
stimulate kidney function and are also used to help control high blood pressure.

• Lasix (Furosemide)
• Hydrochlorothiazide (HCTZ)

Anesthesia Drugs/Paralytics

There are several types of medication that are used to provide anesthesia for patients
having surgery. To keep patients calm immediately before the procedure, a barbiturate
may be used. During surgery, a combination of paralytics-drugs that paralyze the muscles
of the body, and drugs that cause unconsciousness are used together.

• Isoflurane Nitrous Oxide pancuronium

• Propofol
• Succinylcholine
• Vecuronium

Barbiturates/Benzodiazepines

Barbiturates and benzodiazepines, commonly known as “downers” or sedatives, are two

related classes of prescription medications that are used to depress the central nervous
system. They are sometimes used with anesthesia to calm a patient prior to surgery.

Because of side effects, barbiturates have basically been replaced by benzos to treat
anxiety and can be used to relieve symptoms of insomnia and prevent seizure activity.

• Ativan (Lorazepam)
• Librium (Chlordiazepoxide)
• Pentobarbital
• Valium (Diazepam)
• Versed (Midazolam)
• Phenobarbital
• Seconal (Secobarbital)

Antacids

Antacids are common part of recovery from surgery. Even if you aren’t feeling well
enough to eat or drink, your stomach continues to produce stomach acids. To prevent
nausea, vomiting, or other complications from acid being produced but not used, antacids
are given.
 • Pepcid (Famotidine)
• Tagamet (Cimetidine): Used as both a mouth swish and to treat ulcers

Mouth Care

Mouth care is very important after surgery, especially for patients who are on a ventilator.
Studies have shown that good mouth care, including rinsing the mouth with a solution
that helps kill bacteria, can help prevent ventilator acquired pneumonia, which is when
pneumonia develops in a patient who has been intubated and placed on a ventilator.

Mouth care is also important after dental surgeries, helping prevent infection in the gums
and the areas where surgery was performed.

• Chlorhexidine
• Lidocaine HCl (oral solution)
Contralateral ureteroscopy performed at percutaneous
nephrolithotomy

Tuesday, 23 November 2010- Immediate stone-free rates of ureteroscopy are rarely

reported. To establish accurate stone-free rates after ureteroscopy, P. Wirtza and
colleagues assessed the safety and success of ureteroscopy for patients undergoing the
procedure at contralateral percutaneous nephrolithotomy. They published their findings in
an online edition of the Journal of Urology.

"From our prospectively collected, institutional review board approved, percutaneous

nephrolithotomy database we identified patients who underwent contralateral
ureteroscopy for urolithiasis at percutaneous nephrolithotomy from December 2001 to
December 2008. Stone-free status was assessed with noncontrast computerized
tomography on postoperative day 1," the investigators wrote.

The results showed a total of 65 patients underwent ureteroscopy for urolithiasis at

contralateral percutaneous nephrolithotomy. There were 63 patients available for review
who had noncontrast computerized tomography on postoperative day 1. Immediate stone-
free status was achieved after ureteroscopy in 37 of 63 patients (58.7%).

The remaining 26 patients (41.3%) demonstrated a residual stone burden. Of these

patients with residual stones after ureteroscopy 65.4% (17 of 26) had residual fragments
of 1 to 3 mm and 34.6% (9 of 26) had residual stones larger than 3 mm. Three patients
(4.8%) underwent repeat ureteroscopy at secondary percutaneous nephrolithotomy. There
was no association of stone composition, patient age, stone location, gender or surgical
complications with residual fragments (p >0.05).

"Based on noncontrast computerized tomography 58.7% of patients who underwent

ureteroscopy were rendered immediately stone-free. When residual passable stone
fragments less than 3 mm were included the success rate increased to 85.7%. We found
no association between characteristics of patients, stones or procedures and residual
fragments," the researchers concluded.

http://www.urosource.com/home/todays-key-article/key-
articles/view/article/contralateral-ureteroscopy-performed-at-percutaneous-
nephrolithotomy/?
tx_ttnews[backPid]=85&cHash=ac6ce8895e954812951b257b534a776a
REACTION:

Kidney stones may require surgical removal if they do not pass naturally.

according to the University of Maryland Medical Center. For relatively small stones in
the lower urinary tract, the surgeon may choose ureteroscopy, a minimally invasive
procedure also known as a basket extraction. Larger stones may require percutaneous
nephrolithotomy, a procedure performed through a small opening in the kidney, or open
surgery through an incision in the flank. The aftereffects depend on the type of procedure
performed.

Pain

Flank discomfort occurs after any type of kidney stone extraction. The least invasive
procedure, ureteroscopy, causes the least pain and patients experience relief from oral
painkillers. Open surgery, on the other hand, requires a large incision and manipulation of
nearby tissues, so patients typically need stronger pain medication by injection or
intravenously for a few days while they are in the hospital, according to Urology Health.

Infection

Infection may occur after any surgical procedure but rarely after ureteroscopy, the least
invasive of the kidney extraction surgeries, according to Urology Health. The more
invasive treatments, including percutaneous nephrolithotomy and open surgery, carry a
higher risk of infection. Surgeons routinely order antibiotics to help prevent infection.
Patients may have low-grade fevers for the first 48 hours after surgery but a higher fever
may indicate an active infection.

Organ or Tissue Damage

Surgical procedures may cause damage to nearby organs and tissues. Ureteroscopy may
cause a tear in the ureter, the tube that drains urine from the bladder to the outside of the
body. If so, the surgeon places a stent or narrow tube in the ureter to allow it to heal and
removes it two to three weeks later, according to Urology Health. Rarely, damage to the
lung, blood vessels or bowel may occur during a percutaneous nephrolithotomy

Varying Recovery Times

Recovery time varies according to the invasiveness of the procedure. Ureteroscopy

patients go home the same day and return to their normal activities within two or three
days, according to Urology Health. After percutaneous nephrolithotomy, patients stay in
the hospital for one night and may involve additional X-ray studies to ensure that no
stone fragments remain. Normal activity can be resumed after approximately one to two
weeks. After open surgery, the most invasive procedure, patients stay in the hospital for
five to seven days and may not return to their usual activities for six weeks.

Recurrence

Kidney stones can recur after extraction procedures. In fact, as many as 50 percent of
patients have a recurrence within five years of an extraction.