It is the responsibility of the anesthetist or anesthesiologist to determine which plane is optimal for the procedure. The determination is made according to specific tissue sensitivity of the individual and the surgical site. Each successive plane is achieved by increasing the concentration of the anesthetic agent in the tissue (fig. 5-3).

Stage 4 is called the toxic or danger stage. Obviously, this is never a desired stage of anesthesia. At this point, cardiopulmonary failure and death can occur. Once surgical anesthesia has been obtained, the health provider must exercise care to control the level of anesthesia. Plane 4 of stage 3 is demonstrated by cardiovascular impairment that results from diaphragmatic paralysis. If this plane is not corrected immediately, stage 4 quickly ensues (fig 5-3).

RECOVERY PHASE

For purposes of this discussion, the recovery phase consists of the period that begins at the completion of the operation and extends until the patient has recovered from anesthesia. The recovery phase generally takes place in a specialized area called the recovery room. This unit is usually located near the operating room and has access to the following:

Surgeons and anesthesiologists or anesthetists

Nurses and Hospital Corps personnel who are specially prepared to care for immediate postoperative patients

Special equipment, supplies, medication, and replacement fluids

From the time of admission to the point of discharge, routine care in the recovery room consists of the following:

Measuring temperature and vital signs

.Take immediately upon admission and as ordered by the physician thereafter.

Maintaining airway patency

.Patients having an artificial airway in place will automatically expel it as they regain consciousness.

.Have a mechanical suction apparatus available to remove excessive excretions from the patient’s airway.

Ensuring the integrity of dressings, tubes, catheters, and casts

.Locate the presence of any of the above.

.Make notations regarding all drainage including color, type, and amount.

.Immediately report the presence of copious amounts of drainage to the nurse or physician.

Monitoring intravenous therapy (including blood and blood components)

.Make notations including type of infusion, rate of flow, and condition of the infusion site.

.Observe patients receiving blood or blood components closely for untoward reactions.

Monitoring skin color changes

.Check dressings and casts frequently to ensure they are not interfering with normal blood circulation to the area.

.Notify the physician or nurse of general skin color changes that may indicate airway obstruction, hemorrhage, or shock.

Assessing level of responsiveness

.For general anesthetics, check for orientation to the environment each time vital signs are taken.

.For regional anesthetics, check for return of sensory perception and voluntary movement each time vital signs are taken.

.Observing for side effects of the anesthetic agent. Each agent has the potential for causing specific side effects. Some common major side effects that may occur following the administration of both spinal