Chpt 11 Anesthetics

General & Local Anesthetics Assigned book reading: pages 166-168, 169-170, 172-173, 175-182 Objectives  Identify two major categories of anesthetics;  Define how these anesthetics are utilized in the acute care or clinical setting;  Identify adverse effects related to anesthetics and the events leading to the effects; and  Establish nursing consideration and ongoing nursing assessments needed to support patient care. Key definitions:  Anesthetics  Anesthesia  General anesthesia  Local anesthesia  Monitored anesthesia care (MAC) General anesthetics o Drugs to produce a profound neurosensory depression to allow for surgical procedure o Anesthesia providers – CRNA/DNAP; an anesthesiologist, or anesthesia assistant o Inhalational anesthetics – volatile liquids or gases that are vaporized or mixed with oxygen/medical air to induce anesthesia, o Parenteral anesthetics – given IV and used for inductions/maintenance of general anesthesia, induction of amnesia, and adjuncts to inhalation-type anesthetics. (etomidate, propofol) o Adjunct anesthetics – used simultaneously with anesthetics for induction, sedation, reducing anxiety. General Anesthetics  Mechanism of Action: o Overton-Meyer theory to base assumptions. Fat-soluble drugs are stronger anesthetics than water-soluble drugs. Potency varies with lipid solubility. o Nerve cell membranes, brain, spinal cord, and blood brain barrier have high lipid content. Lipid soluble drugs penetrate faster. o The general anesthetic effect is a progressive reduction of sensory and motor CNS functions. The degree and speed vary by drug, dose, and route. o Initially produces loss of senses and consciousness o Cardiac and pulmonary are last. Mechanical ventilation is a must and monitoring of vital signs . o Make sure you have mechanical ventilation and you are monitoring (heart rate, respiratory, blood pressure).******

Adverse effects:  Hypotension – decreases CO creating issues of perfusion of organs.  Nausea, vomiting, and confusion.  PONV – post op nausea and vomiting  Recovery in PACU  Malignant hyperthermia – potential complication with ANY KIND OF GENERAL ANESTHETIC; genetic condition o Potentially fatal o Associated with use of volatile inhalational anesthetics. Depolarizing NMBD succinylcholine (can cause MH as well). o S/S- rise in temp, tachycardia, tachypnea, and muscular rigidity. o High risk in children, adolescents, and persons with muscular/skeletal abnormalities. o Treat using skeletal muscle relaxant dantrolene – hospitals that provide surgical procedures much have a MH cart. Propofol aka “mother’s milk”  Mechanism of Action  Administered as a bolus or injection. Nurse cannot push propofol but can hang a bag.  Strict aseptic technique used when drawing due to emulsion/bacterial growth.  Onset within less that one minute of administration.  Side Effects o Pain at injection site (lidocaine), hypotension, apnea, myoclonus, EKG (QT prolongation), discolored urine o Due to high fat content and potential bacteria growth, important for the RN to change the IV tubing if giving a continuous infusion every 12 hours (CDC recommends) to 24 horus (hospital guidline).********* o Bradycardia, hypotension o GI – N & V, cramping  Adverse Effects o Apnea  Nursing Considerations : monitor for CNS effects, cardiovascular, and respiratory effects. ASA recommends monitoring of oxygenation, BP, ventilation, and temperature. Sedation vacation should be scheduled to reduce oversedation.  Rescue equipment (bag valve mask, two sources of oxygen, intubation kit, code cart (ACLS meds), and defibrillator. NPO strict guidelines. Examples  Dexmedetomidine  Ketamine  Nitrous oxide  Sevoflurane

 Parenteral form for cardiac dysrhythmias  Post operative pain management.  Pregnancy category B Neuromuscular Blocking Drugs  Mechanism of action o Depolarizing o Nondepolarizing  Artificial mechanical ventilation is required o Paralyze respiratory & skeletal muscles – have your ventilar or ambu bag they cannot breathe on their own. o Don’t cause sedation or pain relief. o Patient may be paralyzed yet conscious.  This is what caused the issue for the nurse at vandy… always check the medications that sound familiar. This cause paralysis and the patient couldn’t move or breathe and died***** Succinylcholine  Mechanism of action o Quick onset- facilitates endotracheal intubation o Contraindicated- malignant hyperthermia o Train of Four Monitoring – (don’t need to know for exam)  Mostly used to facilitate endotracheal intubation**** Nursing Process  Assess ABCs  Assess for alcohol use/abuse  Respiratory assessment  Renal function  Liver function  Assess for potential pregnancy if unknown  Neuro assessment  Assess for risks of malignant hyperthermia