| Question | Answer |
| anesthetics | drugs that depress the central nervous system (CNS) |
| effects of anesthetics | -depression of consciousness
-loss of responsiveness
-muscle relaxation |
| anesthesia | a state of depressed CNS activity |
| General anesthesia | type of anesthetics that affects entire body (puts you to sleep) |
| Local anesthesia | type of anesthetic that only affects the part of body being worked on
-general conscience |
| balanced anesthesia | combination of anesthetic drugs |
| effects of general anesthetics | -pain relief
-depression of consciousness
-skeletal muscle relaxation
-reflex reduction |
| Inhaled anesthetics | volatile liquids or gases that are vaporized in O2 and inhaled |
| inhaled gas | nitrous oxide- (laughing gas) |
| Inhaled volatile liquids | -enfulrane (Ethrane)
-halothane (Fluothane)
-isoflurane (Forane)
-methoxyflurane (Penthrane)
-others |
| Injectable anesthetics | administered intravenously |
| effects of injectable anesthetics | -induce or maintain general anesthesia
-induce amnesia
-used as adjunct to inhalation-type anesthetics |
| Type of injectable anesthetics | etomidate (Amidate)
ketamine (Ketalar)
methohexital (Brevital)*
propofol (Ciprivan)*
thiamylal (Surital)
thiopental (Pentothal)*
* may also be used as adjunctive drugs at lower dosages |
| sedative-hypnotics | -used as adjunctive drugs
-barbiturates (secobarbital, thiopental)
-benxodiazepines (Diazepam, midazolam) |
| opioids (narcotics) | used as adjuctive drugs
-morphine, fentanyl, sufentanil |
| NMBAs (neuromuscular blocking drugs/agents | used as adjunctive drug to relax skeletal muscles
depolarizing and nondepolarizing drugs |
| Depolarizing drugs | type of NMBAs
-succinylcholine |
| Nondepolarizing drugs | type of NMBAs
-pancuronium, d-tubocurarine, vecuronium |
| anticholinergics | used as adjunctive drug
-atropine, glycopyrrolate, scopolamine |
| Overton-Meyer theory | anesthetics have high lipid soluability and therefore have a high potency |
| How anesthetics work | -orderly and systematic reduction of sensory and motor CNS functions
=progressive depression of cerebral and spinal cord functions |
| Effects of general anesthetics | -unconsciousness
-skeletal muscular relaxation
-visceral smooth muscle relation
-rapid onset and quickly metabolized |
| Adverse effects (AEs) of anesthetics | -vary btwn different drugs
-esp watch for Malignant hyperthermia- idiopathic |
| malignant hyperthermia- idiopathic | a severe AE of anesthetics that:
-occurs during or after general anesthesia
-sudden elevation in body temp over 104 F
-tachypnea, tachycardia, muscle rigidity
-life-threatening emergency |
| Local anesthetics/regional anesthetics | -renders a specific portion of body insensitive to pain
-interferes w/ nerve impulse transmission to specific areas of body
-do not cause loss of consciousness |
| Topical anesthetics | applied directly to skin or mucous membranes |
| Parenteral anesthetics | injected IV or into the CNS by various spinal injection techniques (Epidural) |
| Spinal or intraspinal anesthetics | type of local anesthesia |
| Intrathecal | anesthetics injected into the spinal cord (spinal tap) |
| Epidural | type of local anesthetic |
| Nerve block | type of local anesthetic injected diretly into the nerve area (Dental work) |
| Lidocaine (Xylocaine) | parenteral anesthetic drug that is a blocker and is injected |
| steps to paralysis via anesthetics | -autonomic activity is lost
-pain and other sensory functions are lost
-motor activity is lost last
wears off in reverse order |
| surgical, dental, diagnostic procedures, treatment of certain types of chronic pain | what local anesthetics are used for |
| inflitration anesthesia & Nerve block anesthesia | types/routes of local anesthetics given |
| infiltration anesthesia | used in/for:
-minor surgical and dental proceduress
-injection ID, subcut, or submucosally across the path of nerves supplying the target area
-may be given in a circular pattern around the operative area |
| Nerve block anesthesia | -can cause problems if too high concentration in body
-injected directly into or around the nerve trunks of nerve ganglia that supply the target area |
| Major AEs of infiltration and Nerve block anesthesia | "spinal headache" and epidural blood patch |
| Uses of NMBAs | -to prevent nerve transmission, resulting in paralysis
-used with anesthetics during surgery |
| Special considerations for NMBAs when used during surgery | -cause paralysis of respiratory and skeletal muscles
-client unable to breathe w/o mechanical respiration
-does not cause sedation or pain relief
-client may be paralyzed AND conscious |
| types of NMBAs-nondepolarizing drugs | -short acting (mivacurium-Maacacron)
-intermediate acting (atracurium-Tracrium, vecuronoim-Norcuron, rocuronium-Zemuron)
-long acting (pancuronium-Pavulon, doxacurium-Nuromax, d-Tubocurarine-dTC) |
| Succinylcholine | NMBA- depolarizing drug |
| function of Succinylcholine | -similar to ACh in causing depolarization
-slower metabolism than ACH, repolarization cannot occur while present
-causes flaccid muscle paralysis |
| function of nondepolarizing NMBAs | -prevent ACh from acting at neuromuscular junctions
-muscle fibers are not stimulated bc nerve cell membrane is not depolarized
-skeletal muscle contraction does not occur |
| sequential effects of NMBAs | -muscle weakness initially followed by total flaccid paralysis
-small, rapidly moving muscles 1st affected
-then larger muscles
-finally intercostal muscles and diaphragm are affected resulting in cessation of respiration |
| main uses of NMBAs | -maintaining controlled ventilation during surgical procedures
-endotracheal intubation (short acting)
-reduction of muscle contraction in target area
-diagnostic drugs for myasthenia gravis |
| AEs of NMBAs | Serious:
-Hypotension (blockade of autonomic ganglia
-Tachycardia (Blockade of muscarinic receptors
-Hypotension (release of histamine |
| Overdose of NMBAs symptoms | -Cardiovascular collapse
-conscious sedation, moderate sedation, procedural sedation, a semi-conscious effect |
| Moderate sedation
(conscious sedation, procedural sedation) | used for diagnostic/minor surgical procedures that do not require deep anesthesia
-recovery time better than gen. anesthesia
-greater safety profile than gen. anesthesia
-client may have no memory of experience |
| vital assessment during pre-, intra- and postoperative phases | -vital signs
-baseline labwork, ECG
-Pulse oximeter (PO2)
-ABCs
-all body systems |
| what to watch for during recovery | cardiovascular depression, respiratory depression and Major complications of anesthesia |
| propofol | -IV general anesthetic drug
-used in ICU and other critical care settings for induction and maintenacne of anesthesia/sedation |
| succinylcholine | -only depolarizing NMBA available
-ultra-short-acting, but is more slowly metabolized than ACh
-adjunct to general anestehsia for flaccid paralysis of muscle
-stimulates motor endplate to ongoing depolarizing, repolarization cannot occur and muscles ca |
| vecuronium | -intermediate-acting NONdepolarizing NMBA
-adjunct to gen. anesthesia
-most useful in procedures requiring mechanical ventilation |
