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Pharm chapter 11
Terms in this set (34)
Drugs used in combination with anesthetic drugs to control the adverse effects of an anesthetics or to help maintain the anesthetic state in the patient.
The loss of the ability to feel pain resulting from the administration of an anesthetic drug.
- A state of depressed CNS activity
- 2 types
--- General anesthesia
--- Local anesthesia
Drugs that depress the central nervous system or peripheral nerves to produce decreased or loss of consciousness, or muscle relaxation.
Anesthetics: Adverse effects
- Vary according to dosage and drug use.
- Sites primarily affected:
--- Heart, Peripheral circulation, Liver, Kidneys, Respiratory tract
- All halogenated anesthetics are capable of causing hepatotoxicity.
- Malignant Hyperthermia is uncommon, but potentially fatal, genetically linked adverse metabolic reaction to general anesthesia.
Anesthetics: Mechanism of action
- Varies according to drug
- Overall effect:
--- Orderly and systematic reduction of sensory and motor CNS functions.
--- Progressive depression of cerebral and spinal cord functions.
- Rapid onset; quickly metabolized.
- General anesthetics are used during surgical procedures to produce:
--- Skeletal muscular relaxation
--- Visceral smooth muscle relaxation
--- Electroconvulsive therapy for severe depression
The practice of using combinations of different drug classes rather than a single drug to produce anesthesia.
Drug effects: Paralysis
- First, autonomic activity is lost.
- Then pain and other sensory functions are lost.
- Last, motor activity is lost.
- As local drugs wear off, recovery occurs in reverse order (motor, sensory, then autonomic activity are restored).
A drug-induced state in which the CNS nerve impulses are altered to reduce pain and other sensations throughout the entire body. It normally involves complete loss of consciousness and depression of normal respiratory drive.
- Pain relief, Depression of consciousness, Skeletal muscle relaxation, Reflex reduction.
General anesthesia: Contraindications
- Drug allergy
- Narrow-angle glaucoma
- Known susceptibility to malignant hyperthermia
- A type of general anesthesia.
- Volatile liquids or gases that are vaporized or mixed with oxygen and inhaled to induce anesthesia.
- Inhaled gas:
--- Nitrous oxide (laughing gas)
- Inhaled volatile liquids:
--- Enflurane (Ethrane)
--- Isoflurane (Forane)
--- Methoxyflurane (Penthrane)
- A drug-induced state in which peripheral or spinal nerve impulses are altered to reduce or eliminate pain and other sensations in tissues innervated by these nerves.
- Used to render a specific portion of the body insensitive to pain.
- Interfere with nerve impulse transmission to specific areas of the body.
- Does not cause loss of consciousness.
----- Spinal or intraspinal
----- Nerve block
- Local anesthetics are given by:
--- Infiltration anesthesia.
--- Nerve block anesthesia.
Local anesthesia: Toxicity and management of overdose
- Have little opportunity to cause toxicity. But systemic reactions are possible if sufficiently large quantities are absorbed into the systemic circulation.
--- prevention is through coadministration of a vasoconstrictor such as epinephrine combined with the local anesthetic to maintain localized drug activity.
- Extreme cases such as inadvertent injection of drug into a major blood vessel, symptomatic and supportive cardiovascular and/or respiratory therapy may be required until the drug is metabolized and eliminated.
- A genetically linked major adverse reaction to general anesthesia characterized by a rapid rise in body temperature, as well as tachycardia, tachypnea, muscle rigidity, and sweating.
- Associated with the use of volatile inhalational anesthetics as well as the depolarizing NMBD succinylcholine.
- A milder form of general anesthesia that causes partial or complete loss of consciousness but does not generally reduce normal respiratory drive.
- Also referred to as conscious sedation and procedural sedation.
- Combination of an IV benzodiazepine and an opiate analgesic.
- Anxiety and sensitivity to pain are reduced, and patient cannot recall the procedure.
- Preserves the patients ability to maintain own airway and respond to verbal commands.
- Used for diagnostic procedures and minor surgical procedures that do no require deep anesthesia.
- Rapid recovery time and greater safety profile than general anesthesia.
Nerve block anesthesia
- Used for surgical, dental, and diagnostic procedures.
- Also used for therapeutic management of pain.
- The anesthetic drug is injected directly into or around the nerve trunks or nerve ganglia that supply the area to be numbed.
Neuromuscular blocking drugs (NMBDs)
- Also known as NMBDs
- Prevent nerve transmission in certain muscles, resulting in muscle paralysis.
- Used with anesthetics during surgery.
- When used during surgery, artificial mechanical ventilation is required:
--- These drugs paralyze respiratory and skeletal muscles.
--- Patient cannot breathe on their own.
--- Do not cause sedation or pain relief.
--- Patient may be paralyzed yet conscious.
Neuromuscular Blocking Drugs (NMBDs)
- First sensation is muscle weakness, followed by total flaccid paralysis.
- Small, rapidly moving muscles affected first (finger, eyes), then limbs, neck, trunk.
- Finally, intercostal muscles and diaphragm affected, resulting in cessation of respirations.
- Recovery of muscular activity usually occurs in reverse order.
- Transient muscle fasciculation's may result in later muscle soreness.
Neuromuscular blocking Drugs (NMBDs): Adverse effects
- Few when used appropriately.
- Hypotension (blockade of autonomic ganglia).
- Tachycardia (blockade of muscarinic receptors)
- Hypotension (release of histamine).
- Effects vary according to site.
Neuromuscular blocking drugs (NMBDs): contraindications
- Known drug allergy.
- Previous history of malignant hyperthermia.
- Penetrating eye injuries.
- Narrow-angle glaucoma.
- Cirrhosis with ascites.
- Clostridial infections.
- Peripheral nerve transection and peripheral neuropathies
- Thermal burns.
Neuromuscular binding drugs (NMBDs):
- Main use: facilitating controlled ventilation during surgical procedures.
- Endotracheal intubation (short acting)
- To reduce muscle contraction in an area that needs surgery.
- Diagnostic drugs for myasthenia gravis.
- Other uses.
Neuromuscular blocking drugs (NMBDs): Safety and Overdose
- Respiratory muscle paralysis occurs with these drugs.
- Emergency ventilation equipment must be readily available.
- Causes prolonged paralysis requiring prolonged mechanical ventilation.
- Cardiovascular collapse may occur.
- Several conditions may increase sensitivity to NMBDs.
Neuromuscular blocking drugs (NMBDs): toxicity and management of overdose
- Primary concern is prolonged paralysis requiring prolonged mechanical ventilation.
- Cardiovascular collapse may be seen and is thought to be the result of histamine release.
- Anticholinesterase drugs.
Neuromuscular blocking drug (NMBDs) types:
--- works similarly to neurotransmitter acetylcholine, causing depolarization.
--- metabolism is slower than acetylcholine, so as long as succinylcholine is present, repolarization cant occur.
--- result: flaccid muscle paralysis.
- Impaired gas exchange related to the general anesthetics CNS depressant effect with altered respiratory rate and effort (decreased rate, decreased depth).
- Decreased cardiac output related to the systemic effects of anesthesia.
- Acute pain related to the adverse effect of spinal headache from epidural anesthesia.
- Deficient knowledge related to lack of information about anesthesia.
- Risk for injury related to the impact of any form of anesthesia on the CNS (CNS depression and decreased sensorium)
A theory that describes the relationship between the lipid solubility of anesthetic drugs and their potency.
- A type of general anesthesia.
- Administered intravenously and are used for induction and/or maintenance of general anesthesia, induction of amnesia, and as adjuncts to inhalation-type anesthetics.
--- Etomidate (Amidate)
--- Ketamine (Ketalar)
--- Methohexital (Brevital)
--- Propofol (diprivan)
--- Thiopental (Pentothal)
- Local anesthesia induced by injection of an anesthetic drug near the spinal cord to anesthetize nerves that are distal to the site of injection.
- Also called intraspinal anesthesia
- Used for dental procedures, suturing of skin lacerations, and diagnostic procedures.
- Blocks all peripheral nerves that branch out distal to the injection site.
- eliminates pain and paralysis of the skeletal and smooth muscles of the corresponding innervated tissues.
- Does not depress the CNS at a level that causes loss of consciousness.
- Can result in a drop of blood pressure and vasodilation.
The nurse is reviewing operative cases scheduled for the day. Which of these patients is more prone to complications from general anesthesia?
A. A 79 year old woman who is about to have her gallbladder removed
B. a 49 year old male athlete who quit heavy smoking 12 years ago
C. A 30 year old woman who is in perfect health but has never had anesthesia
D. A 50 year old woman scheduled for outpatient laser surgery for vision correction
Which nursing diagnosis is possible for a patient who is now recovering after having been under general anesthesia for 3 to 4 hours during surgery?
A. Impaired urinary elimination related to the use of vasopressors as anesthetics
B. Increased cardiac output related to the effects of general anesthesia
C. Risk for falls related to decreased sensorium for 2 to 4 days postoperatively
D. Impaired gas exchange due to the CNS depressant effect of general anesthesia
A patient is recovering from general anesthesia. What is the nurses main concern during the immediate postoperative period?
B. Pupillary reflexes
C. Return of sensations
D. Level of consciousness
A patient is about to undergo cardioversion, and the nurse is reviewing the procedure and explaining moderate sedation. The patient asks " I am afraid of feeling it when they shock me?" What is the nurses best response?
A. "You wont receive enough of a shock to feel anything"
B. "You will feel the shock but you wont remember any of the pain"
C. "The medications you receive will reduce any pain and help you to not remember the procedure"
D. "They will give you enough pain medication to prevent you from feeling it"
The nurse is administering an NMBD to a patient during a surgical procedure. Number the following phases of muscle paralysis in the order in which the patient will experience them:
A. Paralysis of intercostals and diaphragm muscles
B. Muscle weakness
C. Paralysis of muscles of the limbs, neck, and trunk
D. Paralysis of small rapidly moving muscles
B, D, C, A
During a patients recovery from a lengthy surgery, the nurse monitors for signs of malignant hyperthermia. In addition to a rapid rise in body temperature, which assessment findings would indicate the possible presence of this condition? (select all that apply):
A. Respiratory depression
D. Seizure activity
E. Muscle rigidity
B, C, E
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