Questions: 1. Discuss major categories that identify a surgical client as high risk. 2. List the two major classes/categories of anesthetics. 3. Describe the four stages of general anesthesia.

Sure, let's address each of the questions in turn.

1. Major categories that identify a surgical client as high risk:

   • Age: Very young and elderly patients are often considered high risk due to their physiological differences and potential for comorbidities.
   • Comorbidities: Patients with existing medical conditions such as cardiovascular disease, diabetes, respiratory issues, renal impairment, or obesity are at higher risk during surgery.
   • Previous Surgical History: Patients with a history of complications from previous surgeries or anesthesia may be at higher risk.
   • Type of Surgery: Certain surgeries, especially those that are lengthy or involve major organs, carry higher risks.
   • Nutritional Status: Malnourished or obese patients may face increased surgical risks.
   • Medications: Patients on certain medications, such as anticoagulants or immunosuppressants, may have increased surgical risks.
   • Lifestyle Factors: Smoking, alcohol use, and drug use can increase surgical risks.

2. Two major classes/categories of anesthetics:

   • General Anesthetics: These are drugs that induce a reversible loss of consciousness and sensation over the entire body. They are used for major surgeries and can be administered via inhalation (e.g., sevoflurane, isoflurane) or intravenous injection (e.g., propofol, ketamine).
   • Local Anesthetics: These drugs cause a reversible loss of sensation in a specific area of the body without affecting consciousness. They are used for minor surgical procedures and can be administered via injection or topical application (e.g., lidocaine, bupivacaine).

3. Four stages of general anesthesia:

   • Stage 1: Induction (Analgesia Stage): This is the initial stage where the patient progresses from being awake to losing consciousness. The patient may experience analgesia (loss of pain sensation) but remains conscious.
   • Stage 2: Excitement (Delirium Stage): During this stage, the patient may experience involuntary movements, irregular breathing, and increased heart rate. This stage is typically brief and can be minimized with rapid induction techniques.
   • Stage 3: Surgical Anesthesia: This stage is characterized by the patient being fully unconscious with no pain sensation, and it is the desired stage for surgical procedures. It is further divided into four planes, ranging from light to deep surgical anesthesia, depending on the depth of anesthesia required.
   • Stage 4: Overdose (Medullary Depression): This stage occurs if too much anesthetic is administered, leading to severe depression of the central nervous system, including the medullary centers that control vital functions such as respiration and cardiovascular activity. This stage is dangerous and can be fatal if not promptly managed.

In summary, high-risk surgical clients can be identified based on factors such as age, comorbidities, previous surgical history, type of surgery, nutritional status, medications, and lifestyle factors. The two major classes of anesthetics are general and local anesthetics. The four stages of general anesthesia include induction, excitement, surgical anesthesia, and overdose.