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NRSG Pharm CH 19
Local and General Anesthesia
| Question | Answer |
|---|---|
| Local Anesthesia | Loss of sensation to body part/area, no LOC |
| General Anesthesia | Loss of sensation to entire body --> LOC Total analgesia, LOC, no memory, no body movement Depress neural activity in brain Achieved with multiple meds |
| Methods of local anesthetic admin | Topical, infiltration, nerve block, spinal (CSF), epidural |
| 2 major classes of local anesthetics | Esters - 1st widely used (cocaine, benzocaine) Amides - longer duration, fewer side effects (lidocaine (Xylocaine)) |
| lidocaine (Xylocaine) classes, mech | Anesthetic (local/topical), antidysrhythmic (Class IB), Na channel blocker, amide Injectable, blocks Na influx, prevents AP - blocking neuronal impulses brief med use, Cardiac dysrhythmias when used systemically |
| lidocaine (Xylocaine) adverse | Often related to systemic absorption - Early s/s of tox is CNS excitement = irritability and confusion Late CNS depression, resp dep, cardiac arrest |
| Gen anesthetics | Block flow of Na into neurons, delay nerve impulses, GABA receptors activated, LOC, lack of response to pain, given as inhalation agent or IV |
| 4 stages anesthesia | 1- loss of pain 2- excitement and hyperactivity 3- surgical anesthesia 4- paralysis of medulla region in brain (controlling respiratory and cardiovascular activity) |
| IV Gen anesthetics examples | Benzos - diazepam (Valium), lorazepam (Ativan), midazolam (Versed) Opioids - fentanyl (Sublimaze, others) Misc IV drugs - etomidate (Amidate), ketamine (Ketalar), Propofol (Diprivan) |
| Gen IV anesthetic use | rapidly induce LOC, used in combination w/ inhalation agents = provide grater analgesia and muscle relaxation, balanced anesthesia |
| Propofol (Diprivan) classes, mech | General anesthetic, IV anesthetic, induction and maintenance of gen anesthesia, - immediate onset of action, rapid emergence - Potentiates inhibitory effect of GABA |
| Propofol (Diprivan) side/adverse | Apnea, resp dep, hypotension, Propofol infusion syndrome (rare, long term use) = cardiac failure, rhabdomyolysis, renal failure, metabolic acidosis, fatal |
| Propofol (Diprivan) considerations: | ONLY ADMIN by trained staff |
| Nitrous Oxide classes, mech | General anesthetic, inhalation gaseous drug. Prevent Na influx in CNS, delaying nerve impulses - Does not produce LOC or profound skeletal muscle relaxation Used for short term, pt can remain conscious and follow instruction w/ full analgesia |
| Nitrous Oxide considerations | Always w/ 25-30% O2, potential abuse |
| Nitrous Oxide adverse | Low-moderate doses produce few adverse At higher dose, pt exhibit adverse s/s of stage 2 anesthesia such as anxiety, excitement, combativeness, Can lower inhaled dose to quickly return to stage 1 |
| Adjuncts | Complement effects of general anesthesia, treat anticipated side effects before, during, after Include anticholinergic, benzo, neuromuscular blockers, opioids, serotonin blocks |
| succinylcholine (Anectine) classes, mech | Skeletal muscle paralytic, neuromuscular blocker Depolarizing blocker, Ach receptor blocking drug Acts on cholinergic receptor sites at NJM, first depolarization and skeletal muscles contract. --> unable to repolarize Drug at receptor --> paralysis |
| succinylcholine (Ancetine) adverse effects | Complete paralysis of diaphragm - mech ventilation Bradycardia/Resp dep expected High dose: tachy, hypo, urinary retention NO ANALGESIA/SEDATION |
| Malignant hyperthermia | Rapid onset of extreme high fever with muscle RIGIDITY |
| Treatment of s/s malignant hyperthermia | Dantrolene (Dantrium) |
Created by:
kmulla
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