Chapter 11 General and Local Anesthetics – Flashcards
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Anesthetics
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Drugs that reduce or eliminate pain by depressing nerve function in the CNS and PNS Causes a state of reduced neurologic function
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Things you want to know before giving anesthetics
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Surgical History, history of malignant hypertheria, normal reaction to anesthetics, know other disease states (ex diabetes) and their regimens.
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Anesthesia types
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General Anesthesia
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complete loss of consciousness and loss of body reflexes, including paralysis of respiratory muscles. (need to be on ventilator)
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Local anesthesia
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no paralysis of respiratory function; elimination of pain sensation in the tissue innervated by anesthetized nerves. (no ventilator) Risk of aspiration bc may feel nauseated.
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Balanced anesthesia
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using several different medications to keep everything in tact.
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Teaching about Surgery.
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Nothing by mouth (NPO) 6-12h before surgery Teach TCDB post op to prevent infection.
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What to remove before surgery?
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Anything thing that can be removed. Dentures, Hearing aids, jewelry.
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General Anesthetics
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Drugs that induce a state in which the CNS is altered to produce a varying degrees of: pain relief depression of consciousness skeletal muscle relaxation reflex reduction and gag reflex Inhalational anesthetics volatile liquids or gases that are vaporized in oxygen and inhaled
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General Anesthetics ct
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Parenteral (IV) anesthetics administered IV Adjunct (added on) anesthetics drug that enhances clinical therapy when used simultaneously with another drug Benzo or opiod
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The nurse anesthetist is planning to use balanced anesthesia during a surgical procedure. A characteristic of this type of anesthesia is the A. administration of minimal doses of multiple anesthetic drugs. B. administration of inhaled anesthetics. C. intravenous (IV) administration of anesthetics. D. administration of anesthetics to cause muscle relaxation.
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Correct answer: A Rationale: The use of a combination of drugs allows less of each drug to be used and a more balanced, controlled state of anesthesia to be achieved.
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Overton-Meyer theory
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For all anesthetics, potency varies directly with lipid solubility. Fat-soluble drugs are stronger anesthetics than water-soluble drugs. Nerve cell membranes have high lipid content, as does the blood-brain barrier. Lipid-soluble anesthetic drugs can therefore easily cross the blood-brain barrier to concentrate in nerve cell membranes.
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When assessing a patient under general anesthesia, which change to organ systems does the nurse expect? a. Nystagmus b. Skeletal muscle contraction c. Hypertension d. Decreased intracranial pressure
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Correct answer: A Rationale: Nystagmus can occur as a result of the use of general anesthesia. Other findings include skeletal muscle relaxation, hypotension, and increased intracranial pressure.
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Indications
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General anesthetics are used during surgical procedures to produce: unconsciousness, skeletal muscular relaxation, visceral smooth muscle relaxation Rapid onset; quickly metabolized Also used in electroconvulsive therapy treatments for depression
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Adverse Effects
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Vary according to dosage and drug used Sites primarily affected Heart, peripheral circulation, liver, kidneys, respiratory tract Myocardial depression is commonly seen
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Adverse Effect: Malignant hyperthermia
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Genetic predisposition (only happens in people who have it) Occurs during or after volatile inhaled general anesthesia or used of neuromuscular blocking drug (NMBD) succinylcholine Sudden elevation in body temperature (Greater than 104) Tachypnea, tachycardia, muscle rigidity Life threatening emergency Treated with cardiorespiratory supportive care and DANTROLENE (skeletal muscle relaxant)
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Adverse effects: Toxicity and management of OD
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In large doses, anesthetics are potentially life threatening. Cardiac and respiratory arrest ultimate causes of death in an OD. Administered in a controlled environment.
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General anesthetics: Interactions
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Antihypertensives: increased hypotensive (<90/60) effects Beta blockers: increased myocardial depression Heart would stop or bradycardia
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During surgery, the anesthetist notes that the patient's heart rate is gradually increasing and becoming more irregular, the patient's blood pressure is becoming unstable, and the patient is starting to sweat profusely. What other assessment should the anesthetist note immediately? a. Pupillary reactions b. Respiratory effort c. Temperature d. Urinary output
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Correct answer: C Rationale: These are indications of malignant hyperthermia, which can progress rapidly.
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Ketamine
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IV administration use of both general anesthesia and moderate sedation Rapid onset of action **Low incidence of reduction of CV, respiratory, and bowel function Adverse effects: distrubing psychomimetic effects, including hallucinations Don't have to worry about respiratory depression with this drug. Want avoid too much dosing for hallucinations effects.
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Nitrous Oxide
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"Laughing Gas" Only inhaled gas currently used as a general anesthetic weakest of the general anesthetic drugs Used primarily for dental procedures or as a supplement to other, more potent anesthetics. If used too long, post op nausea and vomiting.
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Propofol
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Diprivan Used for the induction and maintenance of general anesthesia Sedation for mechanical ventilation in ICU settings Lower doses: sedative-hypnotic for moderate sedation Monitor triglycerides if administered with total parenteral nutrition.
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Moderate Sedation
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Also called conscious sedation and procedural sedation Does not cause complete loss of consciousness and does not normally cause respiratory arrest. Combination of an IV benzo(midazolam) or propofol and an opiate analgesic (fentanyl or morphine) Anxiety and sensitivity to pain are reduced, and the patient cannot recall the procedure. Know difference between moderation sedation- colonoscopy, biopsy. Work fast and wear off
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Moderate sedation ct
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Preserves the pt's ability to maintain own airway and to respond to verbal commands Used for diagnostic procedures and minor surgical procedures that do not require deep anesthesia. Rapid recovery time and greater safety profile than general anesthesia.
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Which statement regarding conscious sedation does the nurse identify as being accurate? a. The IV route of drug administration is commonly used in pediatric patients to provide conscious sedation. b. Mild amnesia is a common effect of midazolam. c. Patients receiving conscious sedation must be intubated with an endotracheal tube. d. Effects of propofol include relief of anxiety and pain.
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Correct answer: B Rationale: Midazolam allows the patient to relax and have markedly reduced or no anxiety yet still maintain his or her open airway and response to verbal commands while producing mild amnesia. The oral route of drug administration for conscious sedation is preferred for pediatric patients; patients receiving conscious sedation are able to maintain their own airway. Propofol will relieve anxiety; however, pain medications must be used along with propofol therapy for situations that can cause a pain response.
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Local Anesthetics
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Also called regional anesthetics Used to render a specific portion of the body insensitive to pain. Interfere with nerve impulse transmission to specific areas of the body Do not cause loss of consciousness Lidocaine patch
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Local Anesthetics ct.
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Topical Applied directly to skin or mucous membranes creams, solutions, ointments, gels, ophthalmic drops, powders, suppositories Parenteral Injected IV or into the CNS by various spinal injection techniques (epidural)
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Types of Local Anesthesia
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Spinal or intraspinal intrathecal epidural Infiltration Nerve block Topical Peripheral nerve catheter attached to a pump containing the local anesthetic: pain buster and On-Q pump Spinal headache- breach in the dural, if it continues, they will take patients own blood and inject it in to spot of area effected. Normally fixes it. LIDOCAINE main one
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Drug Effects: Paralysis
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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).
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Indications: Local anesthetics
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Used for: Surgical, dental, and diagnostic procedures Treatment of certain types of chronic pain Spinal anesthesia: to control pain during surgical procedures and childbirth Given by: Infiltration anesthesia Nerve block anesthesia
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Indications: Infiltration anesthesia
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Minor surgical and dental procedures Inject of the anesthetic solution intradermally, subcutaneously, submucosally, or intramuscularly across the path of nerves supplying target area. May be given in a circular pattern around operative area.
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Indications: Infiltration anesthesia and epinephrine
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Some local anesthetics used for infiltration or nerve block are combined with vasoconstrictors to prevent systemic absorption of anesthetic to help confine local anesthetic to injected area to reduce local blood loss during procedure
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Indications: Nerve block anesthesia
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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.
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Adverse Effects
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Usually limited Adverse effects result if: inadvertent IV injection Excessive dose or rate of injection Slow metabolic breakdown Injection into highly vascular tissue
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Adverse Effects: Spinal Headache
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70% of patients who either experience inadvertent dural puncture during epidural anesthesia or undergo intrathecal anesthesia. Usually self-limiting Treatment: bed rest, analgesics, caffeine, blood patch
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When teaching a patient about spinal headaches, which statement will the nurse include? a. Spinal headaches can be prevented with bed rest after the epidural procedure. b. Patients who have a spinal headache should have very limited fluid intake. c. A graft of skin from the patient's hand can be used to seal the leaking area causing the headache. d. High Fowler's positioning should be used for patients who have a spinal headache.
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Correct answer: A Rationale: Adequate hydration using IV fluids is often used to increase cerebrospinal fluid pressure. A "blood patch" is often used to help close up or seal the leak. A small amount of blood is taken from the patient and injected into the epidural space. The patient should be positioned flat to prevent spinal headache, and if a patient has a spinal headache, relief is often obtained by lying flat.
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Neuromuscular Blocking Drugs
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NMBDs Prevent nerve transmission in skeletal and smooth muscle, resulting in muscle paralysis. Also paralyze the skeletal muscles required for breathing: the intercostal muscles and the diaphragm Used with anesthetics during surgery.
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NMBDs Ct
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When used during surgery, artificial mechanical ventilation is required. these drugs paralyze respiratory and skeletal muscles. The patient cannot breathe on his or her own They do not cause sedation or pain relief. The patient may be paralyzed yet conscious. Antidotes: anticholinesterase drugs such as neostigmine, pyridostigmine, and edrophonium. Except for Succ(bc it's so fast.)
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NMBDs: Indications
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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
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NMBDs: depolarizing drugs
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Succinylcholine Works similarly to neurotransmitter ACh, causing depolarization Metabolism is slower than ACh, so as long as succinylcholine is present, repolarization cannot occur. Result: flaccid muscle paralysis
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Succinylcholine Test Q
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Don't need antidote bc its so gone fast. Onset is 1min so if you stop giving it'll go away quickly. Half life is 60 seconds. TEST Q: How LONG WILL IT TAKE FOR 97% of the DRUG TO BE ELIMINATED FROM THE BODY. 5min
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Vecuronium
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Norcuron Intermediate-acting nondepolarizing NMBD Used as an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation Long-term use in the ICU setting has resulted in prolonged paralysis and subsequent difficulty weaning from mechanical ventilation. Antidote is NEOSTIGMINE
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A patient is to receive a NMBD while on mechanical ventilation. While the patient is receiving this medication, the nurse should expect the patient to be a. sedated. b. resisting the ventilator. c. awake but unable to move. d. pain free.
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Correct answer: C Rationale: NMBDs make the patient unable to move, but they do not cause sedation or relieve pain.
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Nursing Implications
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Always assess past history of surgeries and response to anesthesia Assess past history, allergies, and medications. Assess use of alcohol, illicit drugs, and opioids. Assessment is vital during preoperative, intraoperative, and postoperative phases vital signs Baseline lab work, ECG O saturation Airway Breathing Circulation monitor all body systems Incentosperomiter- ten deep breaths per hour while they are awake. Won't wake in the middle of night to do this. Hold off on aspirin to not increase bleeding. Also NSAID(ibprof) ANO NPO 6-12h before.
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Nursing implications ct.
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Each perioperative phase has its own complex and very specific nursing actions. Provide preoperative teaching about the surgical procedure and anesthesia. Anticholinergics would dry them out. Perform close and frequent observation of the patient and all body systems. During a procedure, monitor VS and ABCs. Watch for sudden elevations in body temp., which may indicate malignant hyperthermia.
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A patient in the ICU will be receiving an NMBD. Which piece of equipment is essential to have nearby when the nurse initiates this therapy? a. Defibrillator b. Sphygmomanometer c. Mechanical ventilator d. Oxygen source
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Correct answer: C Rationale: NMBDs paralyze the respiratory muscles; it is essential to have sufficient ventilator support nearby in case the medication causes the patient to lose the ability to breathe. Oxygen alone is not sufficient.
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Nursing implications ct
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During recovery, monitor CV depression, respiratory depression, and complications of anesthesia. Implement safety measures during recovery, especially if motor or sensory loss occurs because of local anesthesia. Reorient pt to his or her surroundings. Teach the patient about postop turning, coughing, and deep breathing.
