ANESTHETICS—GENERAL/LOCAL

Question 1

Action

Answer 1

Anesthetics (general) act on the CNS to produce tranquilization and sleep before invasive procedures. Anesthetics (local) inhibit conduction of nerve impulses from sensory nerves.

Question 2

Uses

Answer 2

General anesthetics are used to premedicate for surgery, induction and maintenance in general anesthesia. For local anesthetics, refer to individual product listing for indications.

Question 3

Contraindications

Answer 3

Persons with cerebrovascular accident, increased intracranial pressure, severe hypertension, cardiac decompensation should not use these products since severe adverse reactions can occur.

Question 4

Precautions

Answer 4

Precautions:
Anesthetics (general) should be used with caution in the geriatric, CVD (hypotension, bradydysrhythmias), renal/hepatic disease, Parkinson’s disease, children <2 yr. The precaution for anesthetics (local) is pregnancy.

Administer:
• Anticholinergic preoperatively to decrease secretions
• Only with crash cart, resuscitative equipment nearby

Question 5

Administer

Answer 5

Administer:
• Anticholinergic preoperatively to decrease secretions
• Only with crash cart, resuscitative equipment nearby

Question 6

Side Effects

Answer 6

The most common side effects are dystonia, akathisia, flexion of arms, fine tremors, drowsiness, restlessness, and hypotension. Also common are chills, respiratory depression, and laryngospasm.

Question 7

Pharmacokinetics

Answer 7

Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted in urine.

Question 8

Interactions

Answer 8

MAOIs, tricyclics, phenothiazines may cause severe hypotension or hypertension when used with local anesthetics. CNS depressants will potentiate general and local anesthetics.

Question 9

Nursing Considerations

Answer 9

Assess:
• VS q10min during IV administration, q30min after IM dose

Perform/provide:
• Quiet environment for recovery to decrease psychotic symptoms

Evaluate:
• Therapeutic response: maintenance of anesthesia, decreased pain

Question 10

Selected Generic Names

Answer 10

General anesthetics:
droperidol
etomidate
fentaNYL
fentaNYL/droperidol
fentaNYL transdermal
fospropofol
midazolam
propofol
thiopental

Local anesthetics:
lidocaine
procaine
ropivacaine
tetracaine