PHARM chap 19 [drugs 4 anesthesia]
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19 terms
Terms | Definitions |
|---|---|
 Local anesthesia | Loss of sensation to a limited area |
| General anesthesia | a state of total unconsciousness resulting from anesthetic drugs (as for a major surgical operation) stages: 1. Loss of pain, pt is awake 2. Excitement and hyperactivity, irregular vitals, pt may resist. 3. Surgical anesthesia. Skeletal muscle relax, pt becomes still. Surgery begins here 4. Paralysis of medulla. This stage is usually avoided during gen anesthesia |
| Local anesthetics | -aka sodium channel blockers -epinephrine sometimes added to keep anesthetic in area longer -sodium hydroxide sometimes added to areas with infection -adv effects: although rare, drowsiness, unresponsivness, CNS stimulation, cardiovascular |
| Oil of cloves | Natural remedy for tooth pain |
| Esters | Type of local anesthetic, incl Procaine (Novocaine), Cocaine, Benzocaine |
| Amides | Type of local anesthetic, have largely replaced the esters bc of less s.e. and longer action. Lidocaine (Xylocaine) is the most used |
| General anesthetics | -depress most neuronal activity -mult meds usually used to produce muscle relaxation, unconsciousness, anesthesia = balanced anesthesia. Allows lower dose of inhalation anesthetic -IV anesthetics given first, then inhaled to maintain anesthesia (gaseous or volatile) |
| Gaseous general anesthetics | -nitrous oxide (laughing gas) -used for dental procedures or brief obstetric or surgical procedures -caution with myasthenia gravis |
| Volatile liquid general anesthetics | -liquid at room temp but converted into vapor and inhaled -depress cardiovascular and respiratory -excreted entirely by lungs |
| IV anesthetics | -used alone, with inhalation, or for short procedures -barbs, opioids, or benzos |
| Neuroleptanalgesia | -pt is conscious but insensitive to pain and unconnected with surroundings -combo of opioid fentanyl and antipsychotic droperidol (Inapsine) |
| Nonanesthetic adjuncts to surgery | -primary: neuromuscular blockers -depolarizing: succinylcholine (Anectine) -nondepolarizing -phenergan for nausea, Urecholine for urinary tract stimulation after surgery |
| Lidocaine | -aka Xylocaine -anesthetic (local/topical), antidysrhythmic, amide, sodium channel blocker -IM, IV, subq, or topical -alerts: sol containing preservative should only be given local, don't apply to large skin areas or to broken skin bc of absorption, for spinal or epidural block only use IV preps, pcat B -adv effects: rare, but CNS excitement, convulsions, resp dep, cardiac arrest -contraind: sensitivity, severe trauma or sepsis, blood dyscrasias, dysrhythmias, sinus bradycardias, severe hrt block -interactions: barbs, cimetidine, quinidine, beta blockers -lab: increased CPK -overdose: emergency med attn |
| Nitrous oxide | -general anesthetic, inhalation gaseous agent -low potency, does not produce stage 3 so it must be combined, ideal for dental procedures -alerts: est an IV if one isn't already in place -adv effects: stage 2 anesthesia signs, diff breathing, n&v, liver damage, abuse potential (ESP by medical staff) -contraind: impaired LOC, head injury, decompression sickness, abd probs, bowel obstruction, hypotn, shock, COPD, cyanosis, chest trauma -interactions: sumps and phos inhibitors -herbal/food: milk thistle and ginger can benefit! -overdose: metoclopramide for nausea |
| Halothane | -aka Fluothane -inhalation volatile liquid -rapid but usually combined with others -adv effects: dysrhythmias, disables reflux mechanism, liver, lowered bp and resp rate, malignant hyperthermia, intracranial pressure -contraind: hist of malignant hyperthermia after previous halothane exposure, liver impairment, dysrhymias, head injury, myasthenia gravis, pheochromocytoma -interactions: antihypertns, levodopa, polymixin, lincomycin, aminoglycosides |
| Thiopental | -aka Pentothal -general anesthetic, IV agent, short acting barb -brief medical procedures and prior to inhaled, low analgesic properties -alerts: pcat C -adv effects: severe resp dep, dysrhythmias, delirium -contraind: hypersensitivity, bad veins, porphyria -interactions: CNS deps, phenothiazines -herbal/food: kava and valerian -overdose: discontinue and provide ventilation |
| Succinylcholine | -aka Anectine -neuromuscular blocker, depolarizing blocker, muscle relaxant -acts at cholinergic receptors. First muscle contracts, then becomes weak. Then spasms, then becomes paralyzed. Reduces Amt of gen anesthetic needed -alerts: pcat C -adv effects: bradycardia, resp dep, malignant hyperthermia -contraind: severe burns or trauma, neuromuscular diseases, glaucoma, hist of MH, pulm/renal/hepatic/cardiovascular/metabolic -interactions: clindamycin, aminoglycosides, furosemide, quinidine, lithium, lidocaine, phenothiazines, oxytocin, tacrine, thiazide diuretics, Diazepam, narcotics -overdose: therapy for weakness, watery eyes and mouth, tremors, seizures |
| Patients receiving local anesthesia: NPF | -assess vitals, report bp <90/60 or pulse above 100 -assess local or regional area blocked (for numbness or blanching) -assess ability to move limbs distal to the regional anesthetic -assess for and report hrt, bp, or breathing abnormalities -caution pt not to eat, chew gum, or drink until mouth sensation has returned. If u gave throat anesthetic, assess gag reflex -assess areas of abrasion, burns, open wounds -read all labels carefully (ie epinephrine containing sols should never be given IV or local in areas with decreased circ) |
| Patients receiving general anesthesia: NPF | -give any preop drugs -when working with kids, let parents or caregiver stay with the child as long as permitted -when working with older adults, remove assistive devices (ie glasses) -report bp<90/60, resp above 100 -maintain sterility -assess for shivering in post op period -provide adequate pain relief postop -provide quiet, calm env for pts receiving neuroleptanalgesia. Avoid over stimulating them |
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