Operating Room: Anesthesia – Flashcards
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Name the anticholinergic drugs
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Atropine, Glycopyrolate (Robinul), Neostigmine (Prostigmin)
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MOA of anticholinergics?
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Block acetylcholine on PNS. (Make it so people don't have a sympathetic response). They're supposed to (-) secretions and (-) bradycardia, (-) muscle tension so it's easier to reach the surgical site.
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Side effects of anticholinergics?
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dry mouth, flushed skin, hot, dilated pupils, hallucinations
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Contraindications for anticholinergics?
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Prostatic hypertrophy, myasthenia gravis, hyperthyroidism, glaucoma, DNG with hiatal hernia repairs
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Name 4 anti-emetic drugs
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Ondansetron (Zofran), Metoclopraminde (Reglan), Promethazine (Phenergan), Scopolamine (Sco-Pace)
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MOA of anti-emetic drugs?
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Block serotonin receptors in CNS and GI. Decreases nausea and vomiting.
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Side effects of anti-emetics?
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Headache and constipation- though is generally thought to be a very "clean" drug, meaning it does what it's supposed to with little side effects.
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Contraindications for antiemetics
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N/A
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Name three benzodiazepines
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Diazepam (Valium), Lorazepam (Ativan), Midazolan (Versed)
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MOA of benzodiazepines
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Binds to GABA receptors and increases in GABA receptor activity, which makes people sedated/tranquil.
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Side effects of benzodiazepines?
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sedative effects (falls risk), conusion, amnesia, respiratory depression. Also very addictive.
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Contraindications for benzodiazepines?
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If there is an overdose use FLUMAZENIL (antagonist for benzos)
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Name the beta blockers
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it all ends in -lol. You should know this by now.
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Side effects of BB?
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bradycardia, hypotension, mask hypoglycemia, can trigger asthma attacks
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Contraindications of BB?
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Diabetes (masks hyperBG), PVD, COPD, asthma
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List the inhaled anesthesia medications
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-ANE (desflurane, enflurane, halothane, isoflurane, sevoflurane) or nitrous oxide Causes twilight sleep
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Side effects of inhaled anesthesia medications?
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(-) BP (except Nitrous Oxide) *Isoflurane and desflurane cause an increase in HR. dysrhythmias
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Contraindications for inhaled anesthesia meds?
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Inability to use a nasal mask.
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Name the general anesthesia IV medications
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Diprivan (Propofol), Etomidate (amidate), Ketamine (Ketalar), Methohexital (Brevital)
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Special considerations for certain gen. anesthesia IV medications?
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Propofol- NEED a protected airway. Ketamine- Use for SHORT procedures. Is also an LSD derivative, so wake up patient in a dark room.
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List local anesthetics
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-caine (bupivicaine, cocaine, lidocaine, procaine) Novocain is the shortest to wear off, whereas cocaine takes the longest to wear off. Produces loss of sensation in a specific area of the body
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Side effect of local anesthetics?
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continual numbness, dizziness, headaches
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List the narcotics
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Codeine, fentanyl (sublimaze), hydrocodone (Vicodin and Tylenol), Hydromorphone (Dilaudid), Meperidine (Demerol), Methadone (Dolophine), Morphine Sulfate, Oxycodone (Percocet and Tylenol), Remifentanil (Ultiva), Sufentanil, Tramadol (Ultram)
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MOA of narcotics
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Essentially block different pain receptor sites to interfere with pain impulses
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Side effects of narcotics?
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respiratory depression, constipation, low BP
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Special considerations for narcotics?
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Old people metabolize drugs slower and feel the effects fuller.
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Name the neuromuscular blockers
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End in either -curium or -onium or is Succinylcholine (Anectine) - Atracurium (Tracrium), cisatracurium (Nimbex) - Pancorium (Pavulon), Rocuronium (Zemuron), Vecuronium (Norcuron) - Succinylcholine--> DEPOLARIZING.
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Difference between depolarizing and nondepolarizing neuromuscular blocking agents?
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Depolarizing--> do not give if patient has pseudocholinesterase syndrome. Some people take hours to metabolize this medication (is genetic.) they'll need help breathing if this is the case. For polarizing medications, you just have to give an anticholinesterase (those are in these slides, too!) and it should be reversed.
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Side effects of neuromuscular blocking agents?
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hypotension, paralysis of the diaphragm, hyperkalemia-->arrhythmias
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Name some NSAIDS
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Acetaminophen (Tylenol), Ibuprofen (Motrin, Advil), Ketorolac (Toradol), Naproxen (Aleve)
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MOA of NSAIDs
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Inhibits prostaglandins, which help with inflammation
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Side effects of NSAIDS
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dont give 'em if you got kidney problems. Toradol should be given 5 days MAXIMUM. Aspirin is the only NSAID that affects the clotting of blood. Stomach ulcers
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Name the reversal meds and what it reverses
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Atropine and Glycopyrolate (Robinul)- reverses muscarinic effects (think of HF) Flumazinil (Romazacon)- Reverses benzodiazepines Narcan- Reverses effects of Opioids Neostigmine and Pyridiostigmine- Reverses neuromuscular blockade
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How to use Narcan
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Give IV, not IM. If IM, you have to watch the patient for four hours! Get a 10 cc syringe--> 1mL narcan (narcan comes in 400mcg/mL) + 9mL saline--> Now you have 40mg/mL--> administer little increments over time (.5mL or 1mL for first dose)--> monitor for 2 hours--> Half life of 90 minutes.
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List sedative medications
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Dexmedetomidine (Precedex), Diazepam (Valium), Fentanyl (Sublimaze), Ketamine (Ketalar), Lorazepam (Ativan), Meperidine (Dewmerol), Midazolam (Versed), Propofol (Diprivan)
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List of asthma medications
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Advair, Albuterol (ProAir, Ventolin, Proventil), Atrovent, Duoneb (ipratropium and albuterol)
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Other drugs to know:
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Epi, dopamine, phenylephrine (Neo-Synephrine), Vasopressin, Norepinepherine, lidocaine (helps treat arrhythmias)--> rescue drugs
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How are meds chosen?
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Age, co-morbidities, type/duration of surgery, discharge plans, patient's airway, anesthesia history, current meds
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Early sx of malignant hyperthermia
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HTN, masseter muscle constriction--> stop surgery if there are sx!
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How to treat malignant hyperthermia:
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Recognize early sx--> admin dantrolene --> d/c triggering agents --> make sure you maintain airway somewhere in there (ABCs, right?) Dantrolene--> 2.5 mg/kg.
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What is a high block spinal anesthesia?
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Medication goes up into the spine and causes respiratory compromise. When giving the anesthesia, don't LAY the patient down because it will make the med go up. Don't be an idiot, dude.
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Problems with spinal block anesthesia?
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Low BP, urniary rtntn, post-spinal headache d/t spinal leak--> keep flat and do a blood patch if sx do not subside within 24 hours
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What to assess in PACU after spinal anesthesia?
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Find out where patient can't feel
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Spinal anesthesia vs Epidural anesthesia?
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Spinal--> Local anesthesia put into subarachnoid space of spine Epidural--> Catheter with local anesthesia is placed into epidural space of spine. Can be used for post-op pain mgmt. If you accidentally pierce the dura, it is now a SPINAL and not an EPIDURAL. Do NOT do this as a nurse. Let anesthesia do it.
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What's a nerve block? How long does it last?
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16-24 hours. Local anesthesia is put into surrounding nerves of the operative site.
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Describe the phases of ASPAN
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Phase I- Q15 vitals, immediately after surgery in PACU. Providing postanesthesia care and prepping them for phase 2. 2 nurses at least. Must meet critical elements to move on, such as maintaining an airway, is hemodynamically stable, assessment complete, no combative behavior Phase 2- Prepping pt/family/SO for care in the home/extended care. VS frequency is institution specific. Phase 3- Extended care. Pt is designated to go to floor.
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PACU care in a nutshell:
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Assess, get report from surgery, initiate post-op orders, pain mgmt, identify surgical probs vs anesthesia probs, post op N/V
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When to discharge from PACU
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VS stable, resp status OK, no obvious bleeding from surgery, pt can call for assistance, pt has IV access, drains/caths are functional
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Respiratory issues
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Bronchospasm, laryngospasm, flash pulm edema (usually young football players. Want to re-intubate--> insert foley--> give diuretics), asthmatics
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When you know you can extubate:
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5 second head lift (Mississippi's.), adequate tital volume (5-10cc/kg), Negative Inspiratory Force is greater than -20, pt pulling at tube
