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Reference — Perioperative Nursing

Anesthesia Types

Anesthesia selection depends on the surgical site, duration, patient comorbidities, and patient preference. Each type has distinct advantages, risks, and nursing implications for preoperative preparation, intraoperative monitoring, and postoperative recovery.

Educational use only. Anesthesia administration, drug selection, and dosing are the responsibility of the anesthesiologist or CRNA. Nursing responsibilities focus on assessment, monitoring, patient education, and complication recognition. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.

General Anesthesia

Complete unconsciousness

Mechanism

IV induction agents (propofol, ketamine, etomidate) + inhaled agents (sevoflurane, desflurane) + neuromuscular blocking agents. Airway managed with ET tube or LMA.

Advantages

  • +Complete patient unconsciousness and immobility
  • +Suitable for any surgical site
  • +Airway fully controlled by anesthesia team
  • +Patient has no recall of procedure

Risks

  • −Airway-related complications (laryngospasm, bronchospasm, aspiration)
  • −Hemodynamic changes (hypotension on induction)
  • −Malignant hyperthermia (rare but life-threatening)
  • −Post-anesthesia nausea/vomiting (PONV)
  • −Emergence agitation, delayed emergence
  • −Residual neuromuscular blockade

Nursing Implications

  • ✦NPO compliance most critical — aspiration risk during induction/emergence
  • ✦Post-op: AIRWAY is priority #1 — lateral positioning until reflexes return
  • ✦Monitor for respiratory depression and oxygen desaturation
  • ✦Warm blankets for post-anesthesia shivering
  • ✦Malignant hyperthermia emergency: dantrolen STAT, stop triggering agents
  • ✦Aldrete score ≥9 required before PACU discharge

Spinal Anesthesia

Fully awake (sedation may be added)

Mechanism

Local anesthetic injected into the subarachnoid space (intrathecal space), mixing with cerebrospinal fluid. Produces dense sensory and motor block below the injection level. Single-shot technique — effect is time-limited.

Advantages

  • +Complete anesthesia for lower abdominal, pelvic, and lower extremity procedures
  • +Patient remains conscious and can breathe spontaneously
  • +Avoids airway manipulation
  • +Reduced blood loss compared to general anesthesia
  • +Lower incidence of PONV

Risks

  • −Spinal headache (post-dural puncture headache — PDPH): severe positional headache
  • −Hypotension: vasodilation from sympathetic blockade (most common complication)
  • −High spinal: block ascends too high — respiratory compromise, hypotension, loss of consciousness
  • −Urinary retention
  • −Transient neurologic symptoms

Nursing Implications

  • ✦Assess dermatomal level of block — cannot move affected extremities (normal, not paralysis)
  • ✦Monitor BP closely — hypotension is most common complication; IV fluids and vasopressors (ephedrine, phenylephrine) per order
  • ✦Patient flat for specified time after procedure if PDPH concern
  • ✦PDPH: severe headache when upright, relieved when supine; notify provider — blood patch may be needed
  • ✦Assess return of motor and sensory function before ambulating
  • ✦Bladder scan — urinary retention common; may require catheterization

Epidural Anesthesia

Fully awake (sedation may be added)

Mechanism

Local anesthetic (and/or opioid) injected into the epidural space — outside the dura. Catheter left in place allows continuous infusion or repeat dosing. Slower onset and less dense block than spinal.

Advantages

  • +Catheter allows prolonged analgesia (labor, major abdominal, thoracic surgery)
  • +Titration possible — can increase or decrease block level
  • +Excellent postoperative pain management
  • +Reduces systemic opioid requirements
  • +Can be combined with general anesthesia for major procedures

Risks

  • −Hypotension (same mechanism as spinal)
  • −Accidental dural puncture → PDPH (or high block)
  • −Intravascular injection of local anesthetic → systemic toxicity (LAST): cardiac arrest, seizures
  • −Epidural hematoma or abscess (rare but serious)
  • −Inadequate or patchy block
  • −Urinary retention

Nursing Implications

  • ✦Assess dermatomal sensory level hourly — unexpected ascending level = call anesthesia STAT
  • ✦Monitor BP frequently — sympathetic blockade causes vasodilation and hypotension
  • ✦Assess motor function in lower extremities — motor block is expected but worsening strength after expected regression = call provider
  • ✦Local anesthetic systemic toxicity (LAST): perioral numbness, metallic taste, tinnitus, seizures — EMERGENCY: stop infusion, call code
  • ✦Assess epidural catheter site for infection, hematoma, or leakage
  • ✦Urinary catheter usually in place while epidural running

Regional Nerve Block

Fully awake (sedation may be added)

Mechanism

Local anesthetic injected near specific nerve(s) or plexus, blocking sensation and motor function in the distribution of those nerves. Performed with ultrasound or nerve stimulator guidance. Examples: brachial plexus block, femoral nerve block, popliteal sciatic block, interscalene block.

Advantages

  • +Site-specific anesthesia/analgesia without systemic effects
  • +Excellent postoperative pain control in the blocked region
  • +Reduces systemic opioid requirements
  • +Can be performed as single-shot or continuous catheter
  • +Patient awake and cooperative

Risks

  • −Intravascular injection → local anesthetic systemic toxicity (LAST)
  • −Nerve injury (rare with ultrasound guidance)
  • −Pneumothorax (interscalene/supraclavicular blocks near apex of lung)
  • −Phrenic nerve palsy with interscalene block (temporary hemidiaphragm paralysis)
  • −Falls from blocked extremity — patient may not feel or control limb

Nursing Implications

  • ✦Clearly label blocked extremity: post-op patients may not feel or know they cannot control the limb
  • ✦Immobilize blocked extremity to prevent injury (sling for arm block)
  • ✦Fall precautions: patient cannot bear weight on blocked leg until motor function returns
  • ✦Monitor for LAST: perioral numbness, dizziness, tinnitus, cardiac arrhythmia — STOP infusion, call provider
  • ✦Interscalene block: monitor respiratory rate and SpO2 — phrenic nerve palsy reduces respiratory reserve
  • ✦Document return of motor and sensory function

Local Anesthesia

Fully awake

Mechanism

Local anesthetic agent (lidocaine, bupivacaine, ropivacaine) injected directly into the tissue at the operative site by the provider. Blocks sodium channels in the nerve membrane, preventing depolarization and sensory transmission.

Advantages

  • +Minimal systemic effects when used appropriately
  • +No NPO requirement for minor procedures
  • +No PACU recovery required
  • +Patient able to report symptoms during procedure

Risks

  • −Systemic toxicity if large dose or inadvertent intravascular injection (LAST)
  • −Allergic reaction (rare — more common with ester-type agents like procaine)
  • −Epinephrine in local anesthetic: tachycardia, anxiety, hypertension; CONTRAINDICATED in ring-block of fingers, toes, nose, ears, penis (end-arterial circulation)

Nursing Implications

  • ✦Calculate maximum dose before administration — weight-based dose limits exist
  • ✦Epinephrine-containing solutions: NEVER use for ring blocks of digits, nose, ears, penis
  • ✦Monitor for LAST: metallic taste, perioral tingling, tinnitus, arrhythmia, seizures
  • ✦Allergy history: ester vs. amide class distinction if allergy reported
  • ✦Duration of action: lidocaine ~1–2 hrs (plain), ~2–4 hrs (with epi); bupivacaine ~4–8 hrs

Monitored Anesthesia Care (MAC) / Conscious Sedation

Sedated but rousable (responds to voice/touch)

Mechanism

IV sedation (midazolam, propofol, fentanyl, dexmedetomidine) titrated to achieve a relaxed, cooperative state. Patient maintains airway reflexes and can respond to commands. Local anesthetic may supplement at operative site.

Advantages

  • +Less physiologic impact than general anesthesia
  • +Faster recovery — no need for airway management
  • +Suitable for short, minimally invasive procedures
  • +Patient maintains protective airway reflexes
  • +Lower risk of PONV

Risks

  • −Airway obstruction from over-sedation (most significant risk)
  • −Respiratory depression — opioid + benzodiazepine combination especially risky
  • −Conversion to general anesthesia if patient becomes uncooperative or needs deeper sedation
  • −Paradoxical excitement (especially with benzodiazepines in elderly)

Nursing Implications

  • ✦Continuous monitoring required: ECG, SpO2, BP, EtCO2 (capnography preferred)
  • ✦Reversal agents at bedside: flumazenil (benzodiazepine reversal) and naloxone (opioid reversal)
  • ✦Assess level of sedation (Ramsay or MOAA/S scale) — target: patient sedated but rousable
  • ✦Airway management ready: bag-valve mask, oral airway, suction available
  • ✦Post-procedure: patient must have responsible adult driver — cannot drive after MAC
  • ✦NPO requirements same as general anesthesia (airway reflexes can be overcome by over-sedation)

Local Anesthetic Systemic Toxicity (LAST) — Know This

LAST can occur with any anesthesia type involving local anesthetic agents. Symptoms progress from CNS to cardiovascular:

Early CNS signs:

  • •Perioral/tongue numbness
  • •Metallic taste
  • •Tinnitus (ringing ears)
  • •Dizziness, visual disturbances
  • •Agitation, confusion

Severe (late) signs:

  • !Seizures
  • !Loss of consciousness
  • !Cardiac arrhythmias
  • !Wide QRS / VT / VF
  • !Cardiac arrest

Emergency treatment: Stop local anesthetic infusion. Lipid emulsion (Intralipid 20%) IV. Call code/anesthesia STAT. Supportive care.

NCLEX Pearls — Anesthesia Types

✦General anesthesia priority #1 post-op: AIRWAY — lateral positioning until protective reflexes return
✦Spinal anesthesia most common complication: HYPOTENSION — sympathetic blockade causes vasodilation
✦Spinal headache (PDPH): severe positional headache (worse upright, relieved supine) — blood patch is definitive treatment
✦Epidural vs. spinal: epidural catheter = continuous dosing possible; spinal = single dose, denser block
✦LAST (local anesthetic systemic toxicity): perioral numbness → metallic taste → tinnitus → seizures → cardiac arrest
✦Epinephrine in local anesthetic: NEVER use for ring block of digits, nose, ears, penis (end-artery occlusion → necrosis)
✦MAC/conscious sedation: patient sedated but ROUSABLE — maintains airway reflexes; reversal agents at bedside
✦Regional nerve block: label the blocked limb — patient has no sensation or motor control, high fall risk
✦Malignant hyperthermia: triggered by succinylcholine + volatile inhaled agents; treatment = dantrolene + cooling
✦Phrenic nerve palsy: complication of interscalene/supraclavicular blocks — monitor RR and SpO2

Related Resources

Anesthesia Comparison ChartSide-by-side comparison of all anesthesia types
Open →
Postoperative Nursing Care GuidePACU management after each anesthesia type
Open →
Preoperative Nursing Care GuideNPO guidelines and pre-anesthesia assessment
Open →
Postoperative Assessment ReferenceSystematic assessment including anesthesia-type considerations
Open →

Standards & sources

Fact-checked Jun 21, 2026

This page is written to align with AORN Guidelines for Perioperative Practice · American Society of Anesthesiologists (ASA). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →