Anaesthesia and the Respiratory System

Question: Discuss about the Anaesthesia and the Respiratory System. Answer: Vermiform appendix, which is a part of the digestive system is a blind-ended tube and is connected to the cecum from which it originates embryologically. The appendix is present near the junction of the large intestine and small intestine, the right side of abdomen mostly the lower quadrant (Cohen, Wood, Memmler, 2000). It resembles a roundworm, hence having the name vermiform. Vermiform appendix is about 9 cm in length and few millimeters wide (Singh, 2005). Conventionally, the vermiform appendix has been considered as redundant, potentially troublesome organ without any useful aspects. However, at present few scientists believe that the vermiform appendix offers a place to good bacteria and localize them as a reserve in case there occurs a sudden disease caused by some malevolent bacteria. But this function of the vermiform appendix is still a topic of debate, because of the fact that individuals who have their appendix removed lead their lives without any problems or complication s (More Vita-More, 2013). The appendixs function is still a topic of debate, but it can be troublesome as it leads to the appendicitis. Acute appendicitis is found to be the most popular surgical abdominal emergency. The incidence of complications is increased in case there is a delay in the treatment of the appendicitis, and if left untreated, it may result in several complications like the formation of an inflammatory mass, rupture, appendix abscess, or generalized peritonitis. Acute appendicitiss diagnosis is chiefly clinical, and presentation of this disease can be atypical or typical. The typical presentation initiates with vague periumbilical pain for past few hours, which then spreads to the right iliac fossa, with nausea, lack of appetite, or vomiting. The atypical presentation usually lacks this typical progression and can include the right lower quadrant pain as a starting symptom (Nshuti, Kruger, Luvhengo, 2014). Appendectomy has been regarded as a gold standard in treating acute appendicitis for several years. Open appendectomy was first described by McBurney in 1891 and is considered as a well-establish ed treatment procedure with having safety and efficacy. However, since the introduction of laparoscopic appendectomy in 1980, it has more acceptance because of the several advantages related to this approach, mainly, less pain after surgery, faster recovery to the normal activity, and less infection rate of the surgical wound. But there are few concerns also related to the laparoscopic approach, which includes longer operative duration, increased costs, and increased formation of the intra-abdominal abscess. Despite of few concerns, the laparoscopic approach is the favorable approach in treating acute appendicitis due to the associated advantages (Resende, Almeida, Costa Maia, Bessa Melo, 2016). Sol 2: General anesthesia is found to cause disturbance of pulmonary gas exchange with impairment of both oxygenation, as well as, elimination of carbon dioxide. However, the initial effect of general anesthesia appears to be on the chest walls shape and motion. This, in turn, may cause an alteration in the mechanical properties of the lung, as well as, the chest wall. Alteration in the intrapulmonary gas distribution appears to be secondary (Rehder, 1979). Venous admixture, as well as, physiological dead space are also found to be increased during anesthesia. The main reason behind these changes is increased inequality of the ventilation to perfusion, which is an effect primarily attributable to the intrapulmonary distributions alteration of the ventilation. Hence, with this variation in the pulmonary gas exchange, anesthesia is found to cause the alteration in the mechanism of the respiratory system, more particularly to decrease the functional residual capacity (FRC) in the recumb ent subjects. Hence, the alterations induced in the chest wall behavior by the anesthesia are responsible for related variation in the lung function, as well as, in consequent impairment of the exchange of pulmonary gasses (Gelb, Southorn, Rehder, 1981). As opioids are mostly used to treat acute pain, these cause respiratory depression and are results in the dose-related total ventilation depression by decreasing the respiratory frequency and tidal volume, thus blocking the physical control of respiratory mechanism after the weaning process (Karcz Papadakos, 2013). Hence, it is very clear that the use of anesthesia can result in the respiratory depression, as well as, respiratory impairment, which might be the possible reason behind the patients low respiratory rate of 10 in the postoperative respiratory unit in comparison to the normal respiratory rate of 12-20 breaths per minute. Anesthetics are found to have both direct and indirect impact on the ones cardiovascular system. In general, it is observed that the anesthetic agents are having a depressant effect on both contractility and vascular tone, thus, affecting the cardiac output. In addition to this, anesthetic agents are also found to have an indirect effect on the cardiovascular system by influencing the autonomic nervous system through suppressing or augmenting parasympathetic or sympathetic tone. Hence, the effect of anesthetics on the cardiovascular system seems to be synergistic (Levine, Govindaraj, DeMaria, 2013). General anesthesia generally results in the significant alterations in the hemodynamics, mainly at the time of inducing anesthesia. It is observed that both the intravenous and inhalational anesthetic agents can impact the performance of the cardiovascular system, including effects on the heart rate, cardiac output, systemic vascular resistance, myocardial contractility, cardiac conducti on system, blood pressure, or coronary blood flow. Hence, it is very important to maintain the stability of the cardiovascular system, which requires careful and effective titration of medications, diligent monitoring of patients vital signs, and knowledge of basic and clinic science in pharmacology and physiology ("Handbook of Cardiac Anatomy, Physiology, and Devices", 2005). The surgery itself can be responsible for causing several complications in the functioning of the cardiovascular system, which can be additive with the use of anesthesia. Loss or volume shift of blood, hypothermia, preload and afterload changes in the heart, or myocardial ischemia are few of the effects that can be produced in some cases(Barker, Gamel, Tremper, 1987). Hence, the hypothermic condition of the patient with the body temperature of 35 degrees can be attributed to the effect of the surgery and anesthetic agents. Moreover, the patient was having a low blood pressure of 90/50 mmHg in the postoperativ e recovery unit, which may be the potential effects of the use of anesthesia as anesthesia are found to impact the normal functioning of the cardiovascular system. Anesthetics are found to result in various alterations in the individuals behavioral state through interaction with the brains activity via two mechanisms. The first mechanism is the suppression of the neuronal activity of ones brain in the global dose-dependent, as well as, region-specific manner. While the second mechanism occurs either by suppressing the neuronal activity of the brain and by interrupting the function of the distributed networks of the brains neuron (Heinke Koelsch, 2005). Though anesthesia is capable of inducing amnesia and unresponsiveness, the extent of producing unconsciousness is difficult to establish. For example, certain anesthetics are found to abolish the behavioral responsiveness by acting on the cortex areas of the brain present close the midline but does not necessarily produce consciousness. Unconsciousness occurs when there is an inactivation of the brain parts in the posterior parietal area. Hence, anesthetics tend to produce unconsciousness when t hese agents block the ability of the brain to integrate information (Alkire, Hudetz, Tononi, 2008). For better management of the effects produced by the body on surgery and use of anesthetics, it is very important to assess all these vital signs before discharging the patient from the postoperative recovery unit. The stability of the patients cardiovascular system, respiration and oxygenation condition, body temperature, and other vital signs should be assessed thoroughly. If there is a presence of the variation in the vital signs from the normal range in blood pressure, respiratory rate, temperature, or pulse rate, the patient should not be discharged to the general ward. Sol 3: The discharge plan for the patient will include special instructions related to the medications he has been prescribed. As the patient is prescribed tramadol and metronidazole, the patient is strongly recommended to avoid alcohol consumption with these medications. The consumption of alcohol can increase the side-effects of tramadol and can cause vertigo and nausea with metronidazole (Woodfield et al., 2016). The patient is instructed to avoid driving or doing any kind of hazardous work after taking tramadol because tramadol results in sedation, drowsiness, and tiredness (BMA Concise Guide to Medicine Drugs, 2015). As postoperative diet of the patient is always in demand after an appendectomy, the patient is referred to a dietician for maintaining a proper log of his dietary intake, which is best suitable to his health (Talamini, 2006). The home nurse care will assist the patient at home for providing health care and will look after his needs as his family is overseas and he is alone at home. The patient is educated about the possible complications that may arise in the wound area like redness, tenderness, or infection around the incision site. The home nurse care will also keep an eye on the healing status of the wound and related infection if present (Brunner, Suddarth, Smeltzer, 2008). The patient is instructed to keep an eye and immediately inform the office in case of fever, diaphoresis, chills, abdominal pain and tenderness, vomiting, or nausea. The patient is also instructed to avoid lifting heavy objects and strenuous activity for at least one month following the surgery. The patient is encouraged to keep scheduled followup appointments for monitoring his healing and recovery status, as well as, to monitor the presence of any kind of complications. The patient is alcohol dependent and drug abuse after having breakup with his girlfriend, so there is a high need for him to overcome his dependency. Hence, the patient is recommended to seek a psych ologist once he gets fully recovered for management of his personal problems. A referral to the psychologist is provided to the patient in case he wants to see the psychologist in a near future. Moreover, the patient is advised to join some rehabilitation services for the management of his alcohol dependency and drug use (Monti, Colby, O'Leary, 2001). References Alkire, M., Hudetz, A., Tononi, G. (2008).Consciousness and anesthesia.Science,322(5903), 876-880. 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. Brunner, L., Suddarth, D., Smeltzer, S. (2008).Brunner Suddarth's textbook of medical-surgical nursing. Philadelphia: Lippincott Williams Wilkins. Cohen, B., Wood, D., Memmler, R. (2000).Memmler's the structure function of the human body. Philadelphia: Lippincott Williams Wilkins. Gelb, A., Southorn, P., Rehder, K. (1981). Effect of general anaesthesia on respiratory function.Lung,159(1), 187-198. 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