Chart — Perioperative Nursing

Anesthesia Comparison

Side-by-side comparison of the six major anesthesia types: general, spinal, epidural, regional nerve block, local, and monitored anesthesia care (MAC). Each type differs in level of consciousness, mechanism, primary risks, and nursing priorities.

Educational use only. Anesthesia selection and administration are performed by anesthesiologists and CRNAs. Nursing responsibilities focus on preoperative preparation, monitoring, and postoperative 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.

Type	Consciousness	Mechanism	Advantages	Key Risks	Nursing Priorities
General	Unconscious	IV induction + inhaled agents + neuromuscular blockade. ET tube or LMA secures airway.	+Any surgical site +Complete immobility +Airway fully controlled	−Aspiration on induction/emergence −PONV −Malignant hyperthermia −Delayed emergence −Residual NMB blockade	✦Airway is #1 post-op priority ✦Lateral positioning until reflexes return ✦Monitor RR and sedation with opioids ✦Warm blankets for shivering ✦Aldrete ≥9 for PACU discharge
Spinal	Awake (sedation optional)	Local anesthetic injected into subarachnoid space (intrathecal). Single shot — limited duration. Dense sensory and motor block below injection level.	+Lower abdominal and pelvic surgery +No airway manipulation +Lower PONV risk +Excellent surgical anesthesia	−Hypotension (most common) −Post-dural puncture headache (PDPH) −High spinal block −Urinary retention −Transient neurologic symptoms	✦Monitor BP closely — treat hypotension with fluids/vasopressors ✦PDPH: severe postural headache — blood patch if persistent ✦Assess dermatomal level hourly ✦Bladder scan — urinary retention common ✦No ambulation until motor function returns
Epidural	Awake (sedation optional)	Catheter placed in epidural space — outside dura. Continuous or intermittent dosing possible. Slower onset and less dense block than spinal.	+Continuous analgesia via catheter +Labor analgesia +Major abdominal/thoracic postop pain control +Opioid-sparing	−Hypotension −Accidental dural puncture → PDPH −LAST (local anesthetic systemic toxicity) −Epidural hematoma/abscess (rare) −Urinary retention −Patchy block	✦Assess sensory level hourly ✦Ascending level = call anesthesia STAT ✦LAST: perioral numbness → metallic taste → seizures → STOP infusion + code ✦Urinary catheter usually in place ✦Monitor for epidural site hematoma or infection
Regional Nerve Block	Awake (sedation optional)	Local anesthetic injected near target nerve or plexus (ultrasound/nerve stimulator guided). Single shot or continuous catheter.	+Site-specific analgesia +Major opioid reduction +Excellent postop pain control +Awake cooperative patient	−LAST (intravascular injection) −Nerve injury (rare with ultrasound) −Falls from blocked extremity −Pneumothorax (interscalene) −Phrenic nerve palsy	✦Label blocked limb — patient cannot feel or control it ✦Immobilize arm block (sling); do not weight-bear on blocked leg ✦Fall precautions until motor returns ✦Monitor SpO2 for interscalene (phrenic palsy) ✦Document motor/sensory return
Local	Fully awake	Local anesthetic injected directly into tissue at operative site by provider. Sodium channel blockade prevents depolarization.	+Minimal systemic effect +No NPO requirement for minor procedures +No PACU monitoring needed +Fastest recovery	−LAST if overdose or IV injection −Allergic reaction (rare — mainly ester class) −Epinephrine: vasoconstriction — NEVER in digits/nose/ears/penis	✦Never use epi-containing local in ring blocks (end-artery occlusion) ✦Monitor for LAST after large doses ✦Duration: lidocaine ~1–2 hrs plain; bupivacaine ~4–8 hrs ✦Allergy distinction: ester vs. amide class
MAC / Conscious Sedation	Sedated but rousable	IV sedation titrated (propofol, midazolam, fentanyl, dexmedetomidine) to relaxed but responsive state. Airway reflexes preserved. Local supplement optional.	+Less physiologic impact than general +Faster recovery +Shorter procedures +No airway management required	−Airway obstruction from over-sedation −Respiratory depression (opioid + benzo) −Paradoxical excitement (elderly) −Conversion to general anesthesia	✦Continuous monitoring: ECG, SpO2, BP, capnography ✦Reversal agents at bedside: flumazenil + naloxone ✦Sedation score: target sedated but rousable ✦Same NPO requirements as general anesthesia ✦No driving post-procedure — needs responsible adult

LAST — Local Anesthetic Systemic Toxicity (Any Anesthesia Type)

Symptom Progression

1Perioral / tongue numbness

2Metallic taste

3Tinnitus, dizziness

4Visual disturbances

5Agitation, confusion

6Seizures

7Cardiac arrhythmia (wide QRS)

8Ventricular fibrillation / cardiac arrest

Emergency Management

!STOP local anesthetic infusion immediately
!Call code / anesthesia STAT
!Lipid emulsion (Intralipid 20%) IV — antidote
!Airway management: O2, bag-valve mask
!Advanced cardiac life support (ACLS) if cardiac arrest
!Do NOT use vasopressin or calcium channel blockers

NCLEX Quick Differentiator

Patient unconscious; ET tube placed; general anesthesia — PACU priority #1

Airway maintenance — lateral positioning until reflexes return

Post-spinal: BP drops to 85/55 after surgery — nursing action

IV fluid bolus; vasopressors per order; hypotension = most common spinal complication

Post-spinal: severe headache worse when upright, relieved when supine

Post-dural puncture headache (PDPH) — blood patch if persistent

Epidural: patient reports metallic taste and perioral tingling

Suspect LAST — STOP infusion, call anesthesia STAT, Intralipid ready

Regional nerve block to arm for shoulder surgery — priority nursing concern

Fall prevention and limb protection — patient cannot feel or move blocked arm

Provider orders local anesthetic ring block to finger; anesthetic contains epinephrine

Do NOT use epi in digit ring block — vasoconstriction → digital ischemia/necrosis

MAC patient: sedation score = barely rousable, RR = 7 — nursing action

Stimulate patient; withhold further opioids/sedation; consider naloxone; notify provider

Post-general anesthesia shivering in PACU — first action

Warming blankets; shivering increases O2 consumption and cardiac workload

Related Resources

Anesthesia Types ReferenceFull reference with mechanism, advantages, risks, and nursing implications for each type

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Postoperative Nursing Care GuidePACU priorities, Aldrete score, pain management after anesthesia

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Preoperative Nursing Care GuideNPO status, medication review, consent, and patient preparation

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Standards & sources

Fact-checked Jun 21, 2026

This page is written to align with American Society of Anesthesiologists (ASA) Guidelines; ASPAN PACU Standards; AORN Perioperative Standards. 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 →