Chapter 20 The objectives of this chapter are the following: 1 Describe the types of anesthesia and the perioperative physiological effects of anesthesia on the body 2 List the potential complications that can occur with anesthesia by body system 3 Provide an introduction to the basic operative body positions and discuss the potential for complications related to OR positioning 4 Discuss the physical therapy considerations related to postoperative effects of anesthesia on the patient The acute care setting is multifactorial in nature and applies to many body systems. For this reason, specific practice patterns are not delineated in this chapter. Please refer to Appendix A for a complete list of the preferred practice patterns in order to best delineate the most applicable practice pattern for a given diagnosis. Surgery may be classified by urgency (elective, required, urgent, or emergent) and by purpose (diagnostic, explorative, reconstructive, transplant, curative, or palliative). The surgical classification determines the preoperative preparations, operative setting, and type of anesthesia.1 There are two types of anesthesia: general and regional. General anesthesia is a reversible state of unconsciousness consisting of four components (amnesia, analgesia, inhibition of noxious reflexes, and skeletal muscle relaxation) and is achieved by the use of intravenous and inhalation anesthetics, analgesics, and muscle relaxants.2 Regional anesthesia is used for site-specific surgical procedures of the upper or lower extremity or lower abdomen and is achieved by spinal (subarachnoid), epidural (thoracic or lumbar), or peripheral nerve blocks.2 Local anesthesia is considered a subset of regional anesthesia and involves the topical or direct application of an anesthetic to the skin or mucosa and the injection of a local anesthetic to a superficial site.1 The administration of anesthesia to a patient for a brief diagnostic or surgical procedure has transitioned from the operating room (OR) to other inpatient and outpatient settings.3 Procedural sedation (formerly conscious sedation) is characterized by the patient’s ability to maintain a patent airway without intervention, spontaneously ventilate, maintain cardiovascular function, and respond purposely to verbal or tactile stimulation.2 The major intraoperative effects of general anesthesia include the following4: A Neurological effects. Decreased cortical and autonomic function. B Metabolic effects. Hypothermia or malignant hyperthermia (in patients with a genetic predisposition). C Cardiovascular effects. The potential for arrhythmia, hypotension, hypertension, decreased myocardial contractility, and decreased peripheral vascular resistance.5 1. Anesthesia has multiple effects on the lung, including decreased or altered: 2. The shape and motion of the chest are altered because of decreased muscle tone, which causes the following: 3. Other factors that affect respiratory function and increase the risk of postoperative pulmonary complications (e.g., atelectasis, pneumonia, lung collapse) include the following7: a. Underlying pulmonary disease such as chronic obstructive pulmonary disease (COPD) b. Incisional pain, especially if there is a thoracic or upper abdominal incision g. The need for large intravenous fluid administration intraoperatively h. Prolonged operative time (more than 180 minutes)
Anesthesia
Perioperative Considerations for the Physical Therapist
Preferred Practice Patterns
Types of Anesthesia
Intraoperative Effects of Anesthesia
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Anesthesia: Perioperative Considerations for the Physical Therapist
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