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Cardiovascular Effects Of Anesthesia And Operation

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Cardiovascular Effects Of Anesthesia And Operation

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Cardiovascular Effects Of Anesthesia And Operation

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Question:
Discuss about the case study Cardiovascular Effects of Anesthesia and Operation.
 
 
Answer:
Introduction:

Vermiform appendix is a portion of the digestive tract and is present in the abdomen more specifically in the right lower quadrant. Vermiform appendix has a structure similar to a worm and originates during the embryological life from the cecum’s posteromedial wall which is around 2 cm beneath the ileocecal valve (Ghorbani, Forouzesh, & Kazemifar, 2014). The function of the appendix is still confusing as a human can lead a normal life without an appendix. However, according to the hypothesis of Prof. Bill Parker, the appendix is considered as a “Nature reserve” for various beneficial bacteria present in our gut. In the case of a severe infection in the gut such as in cholera, there can be a depletion or loss of this bacterial flora and the appendix has the ability to restore these bacteria (Sarkar, 2015). Though the function of the appendix is not clear but it can create a severe problem in the humans by producing appendicitis.
Acute appendicitis is found to be amongst the most common emergencies associated with the abdomen worldwide.  The root cause behind the development of an acute appendicitis is unclear but is believably multifactorial with the causative factors like luminal obstruction, dietary factors, and familial factors. Abdominal pain is found to be a primary symptom and complaint of the individuals with acute appendicitis (Humes, 2006). The treatment of appendicitis was found to be non-operative till hundred years ago but turned to be totally surgical within less than 20 years. The mainstay treatment for the acute appendicitis is operative and till 1981, McBurney’s procedure was represented as the gold-standard procedure for acute appendicitis, but at present, there has been a progressive increase in the laparoscopic appendectomies as it has been observed as a safe procedure associated with excellent and effective cosmetic results. Moreover, there is shorter hospitalization and allows a less painful and quicker postoperative recovery.  Open appendectomy or laparoscopic appendectomy are the two surgical treatment options for acute appendicitis. However, due to the presence of more therapeutic benefits laparoscopic approach is more favorable and it is preferred in immunocompromised, elder, and obese patients (Ruffolo, 2013). The urgent appendectomy is followed in case of acute appendicitis, which is carried out after rapid intravenous hydration, as well as, administration of broad-spectrum antibiotics (Howie, 2006). In case, there is no ruptured appendix, postoperative antibiotics are not necessary (Lawrence, 2013).
Anesthesia is found to result in a respiratory impairment, no matter if the patient is ventilated mechanically or breathing spontaneously. This respiratory impairment obstructs the matching of perfusion and alveolar ventilation and hence, the arterial blood’s oxygenation. The triggering factor behind this is the deprivation of the muscle tone, which in turn results in the decrease in the lung’s resting volume and its functional residual capacity (Hedenstierna & Rothen, 2012). Opioids are the common choice for analgesia and are considered to be the mainstays of acute and severe pain treatment. However, opioids are known as the definitive respiratory depressants, which are capable of producing a dose-associated depression of the total ventilation via a decrease in tidal volume and respiratory frequency.  Hence, these agents can obstruct the physiological control of respiration after the completion of a weaning process. Hence, it is very important to reverse or dissipate the residual impacts of these anesthetic agents adequately after the completion of a surgery and its administration (Karcz & Papadakos, 2013). As the patient’s respiratory rate is 10, which is below than the normal respiratory rate 12-20 breaths per minute. The potential decrease in the respiratory rate is hence, caused due to the use of anesthesia during the surgery. It is quite evident from the research that anesthesia causes depression in the respiration and causes respiratory impairment thereby affecting the normal respiration rate in the patient.
Surgery and anesthesia have a broad range of effects on one’s cardiovascular system. It has been observed that even in the case of healthy patients undergoing minor operations or surgery, the anesthetic agents can result in the significant hemodynamic instability or cardiac depression. Nearly all the anesthetic agents possess intrinsic properties of causing myocardial depression, although in some cases in may be masked with the sympathetic stimulation. The vasodilatory impact of the volatile substances can cause serious hypotension in the case it is associated with the negative inotropy. The patients having pre-existing cardiac disorders have serious complications and effects from these anesthetic agents. Moreover, it has been studied that the surgery itself is responsible for providing various complications to the one’s cardiovascular system, and these complications can be additive in the case with the impact of anesthesia. The effects may consist of  loss of blood, some volume shifts, hypothermia, the release of several substances in the circulation, abrupt changes in the heart’s preload and afterload, or myocardial ischemia in some cases (Barker, Gamel, & Tremper, 1987). As in the patient, we can see that he is hypothermic with the temperature of 35 degrees and is hypotensive with a blood pressure of 90/50 mmHg, these are the potential effects of surgery in combination with the use of anesthetic agents on the circulatory system of the patient.
 
Anesthetics can produce several changes in the behavioral state of the patient by interacting with the activity of the brain through two mechanisms, which are the global dose-dependent and region-specific suppression of brain’s neuronal activity, as well as, by the interruption of the functional interactivity in the neuron’s distributed networks. Several recent studies have shown that the anesthetics can not affect the brain as a whole to the same extent, but that the brain’s specific regions and particularly the cognitive processes, which are regulated by these brain regions shows more sensitivity to the anesthesia, as well as, sedation in comparison to others. The inhibition of multimodal related cortices’ activity like prefrontal and parietal association cortices by the anesthetic’s sedative concentration results in attention deficits and amnesia, while activity in the thalamus and unimodal cortices remains generally unaffected at the low doses of anesthetics and tends to be suppressed only in case of anesthetic concentrations resulting in  the unconsciousness. The anesthetics can also impair the functional connections existing between the  neurons in thalamocortical networks and distributed cortical, which also leads to the anesthesia state (Heinke & Koelsch, 2005). Hence, due to various effects of surgery and anesthesia on the one’s body, it is very important to assess the vital signs before discharging the patient from postoperative recovery unit. Before discharging the patient from the postoperative recovery unit it should be assessed that if the patient is in full consciousness without any excessive stimulation, he is capable of maintaining a clear airway, as well as, shows protective airway reflexes. The respiration and oxygenation should be satisfactory. The patient’s cardiovascular system should be stable and there should be no unexplained persistent bleeding or cardiac irregularity. His vital signs including the specific values of blood pressure and pulse should be in close proximity to the normal pre-operative or acceptable. The pain should be under control and the body temperature of the patient should be within the normal limits. Moreover, in case the patient shows the presence of significant hypothermia, he should not be discharged from the postoperative recovery unit to the ward.
Sol 3: Appendicitis is found to be the most common cause of the abdominal pain but the mortality rate from this disorder is very rare. Appendectomy is the final treatment for appendicitis and there are certain postoperative complications linked to an appendectomy, the most common are wound infection, postoperative obstruction of bowel due to adhesions, and pelvic abscesses. Hence, the primary thing to be included in the discharge plan is the followup of the patient with the surgeon for evaluation of the incision sites, as well as, recovery status. The patient is strongly recommended to have an immediate follow up with the physician in case he develops abdominal pain, fever, vomiting, or infection around the incision site (Brunner, Suddarth, & Smeltzer, 2008). The patient is referred to a dietician for the provision of continued monitoring and nutrition assessment. As it has been observed that there are several cases in which the patient becomes malnutrition after the surgery due to insufficient or deficit intake of diet (Boyd & Murray, n.d.). Hence, the patient is referred to a dietician. Further, the patient’s family is not at home and he has no one to look after at home, the patient will be assisted by the home nurse care who can help in assisting the patient and in identifying his needs and providing care at home. Moreover, the home nurse care will look after the complications or wound infection (Brunner, Suddarth, & Smeltzer, 2008). The patient is prescribed tramadol, hence he is strictly instructed not to drive or do any hazardous work as tramadol causes drowsiness, sedation, and tiredness. The patient is strongly recommended to avoid alcohol consumption as it increases the potential effects of tramadol (BMA Concise Guide to Medicine & Drugs, 2015). The education about side effects associated with tramadol is given to the patient, which includes dizziness, drowsiness, headaches, constipation, nausea, and respiratory depression (Lilley, Savoca, & Lilley, 2011). A strong emphasis is given on avoiding alcohol consumption especially with tramadol and even on taking metronidazole, as consumption of alcohol with metronidazole can cause nausea, as well as, vertigo (The Lippincott manual of nursing practice, 2006). The patient is also recommended to see a psychologist for his personal problems and to attend few behavioral therapies for coping up with his current situation. As the patient states that he is alcohol dependent and uses the drug, he is strongly recommended to attend rehabilitation services. A referral for a psychologist is provided to him and is recommended to see after his recovery (Liddle & Rowe, 2006).
 
References
Barker, S., Gamel, D., & Tremper, K. (1987). Cardiovascular effects of anesthesia and operation. Crit Care Clin., 3(2), 251-68.
BMA Concise Guide to Medicine & Drugs. (2015) (5th ed.). London.
Boyd, C. & Murray, B. Study skills for nurses.
Brunner, L., Suddarth, D., & Smeltzer, S. (2008). Brunner & Suddarth’s textbook of medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins.
Ghorbani, A., Forouzesh, M., & Kazemifar, A. (2014). Variation in Anatomical Position of Vermiform Appendix among Iranian Population: An Old Issue Which Has Not Lost Its Importance. Anatomy Research International, 2014, 1-4.
Hedenstierna, G. & Rothen, H. (2012). Respiratory Function During Anesthesia: Effects on Gas Exchange. Comprehensive Physiology.
Heinke, W. & Koelsch, S. (2005). The effects of anesthetics on brain activity and cognitive function.Current Opinion In Anaesthesiology, 18(6), 625-631.
Howie, J. (2006). Acute appendicitis: Acute appendicitis or acute appendicectomy?. BMJ, 333(7569), 653-653.
Humes, D. (2006). Acute appendicitis. BMJ, 333(7567), 530-534.
Karcz, M. & Papadakos, P. (2013). Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms. Can J Respir Ther., 49(4), 21-29.
Lawrence, P. (2013). Essentials of general surgery. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Liddle, H. & Rowe, C. (2006). Adolescent substance abuse. Cambridge, UK: Cambridge University Press.
Lilley, L., Savoca, D., & Lilley, L. (2011). Pharmacology and the nursing process. Maryland Heights, MO: Mosby.
Ruffolo, C. (2013). Acute appendicitis: What is the gold standard of treatment?. World Journal Of Gastroenterology, 19(47), 8799.
Sarkar, A. (2015). A Glimpse Towards the Vestigiality and Fate of Human Vermiform Appendix-A Histomorphometric Study. JCDR.
The Lippincott manual of nursing practice. (2006). Philadelphia.

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