Chapter 11 General and Local Anesthetics

Question 1

anesthesia

Answer 1

state of reduced neurological function

Question 2

general anesthesia

Answer 2

-involves complete loss of consciousness and loss of body reflexes, including the respiratory muscles
-allows for surgical procedures under controlled conditions by anesthesia providers
-inhalation and parenteral

Question 3

adjunct general anesthetic

Answer 3

enhances therapy when used with other drugs

Question 4

general anesthetic mechanism of action

Answer 4

-each has a different chemical makeup and potency
-related to fat solubility in drugs, makes it easier to cross the blood brain barrier
-progressive reduction of sensory and motor CNS function
-lose senses, then consciousness
-cardiac and respiratory are last to be interrupted

Question 5

general anesthetic indications

Answer 5

Unconsciousness, relaxation of skeletal and smooth muscles

Question 6

general anesthetic contraindications

Answer 6

known allergy, pregnancy, narrow angle glaucoma, malignant hyperthermia (genetic metabolic reaction to general anesthesia)

Question 7

general anesthetic adverse effects

Answer 7

dose dependent, can negatively affect cardiac, renal, respiratory, and neurological functions

Question 8

malignant hyperthermia

Answer 8

-genetic metabolic reaction to general anesthesia
-S/S- rapid increase in body temp, tachycardia, tachypnea, muscular rigidity
-High Risk- children, adolescents, muscular/skeletal abnormalities

Question 9

treatment for malignant hyperthermia

Answer 9

Dantrolene and supportive care

Question 10

general anesthesia drug examples

Answer 10

-Dexmedetomidine (Precedex) - can cause hypotension
-Ketamine- hallucinations, can bump up BP
-Nitrous Oxide - laughing gas, weak, dental
-Propofol- used for intubated patients, could decrease BP
-Sevoflurane - quick to sleep, quick to wake up

Question 11

moderate sedation drugs

Answer 11

-does not cause complete loss of consciousness or respiratory distress
- Midazolam with Fentanyl or Morphine, Propofol, Ketamine

Question 12

local anesthesia

Answer 12

-does not involve paralysis of respiratory function, elimination of pain sensation in the tissues innervated by the anesthetic agent
-reduce pain sensation at peripheral nerve level

Question 13

local anesthesia routes

Answer 13

-Parenteral- injectable or spinal injection
-Topical- directly on skin and mucous membranes
-Central- spinal, intrathecal, epidural
-Peripheral- infiltration, nerve block

Question 14

local anesthesia mechanism of action

Answer 14

interfere with nerve transmission at local site, block generation and conduction of impulses through nerve fibers

Question 15

local anesthesia indications

Answer 15

surgical, dental, diagnostic procedures, childbirth

Question 16

local anesthesia contraindications

Answer 16

known allergy

Question 17

local anesthesia adverse effects

Answer 17

-limited mostly related to increased plasma concentrations of drug
-spinal headaches - blood patch to treat
-allergic reactions are rare

Question 18

types of local anesthetics

Answer 18

-Ester Type
-Amide Type (amides have an “I” before “cain, Esters do not)

Question 19

Ester Type examples

Answer 19

Benzocaine, Procaine, Tetracaine

Question 20

Amide Type examples

Answer 20

Bupivacaine, Lidocaine, Prilocaine

Question 21

Lidocaine (amide)

Answer 21

-most common local anesthetic
-often combined with epinephrine
-infiltration, nerve block
-Topical- EMLA cream
-IV-not local, used for non opioid pain management

Question 22

Neuromuscular Blocking Drugs (NMBDs)

Answer 22

-prevents nerve transmission in skeletal and smooth muscles, leading to muscle paralysis-including respiratory muscles
-causes paralysis, not sedation or loss of consciousness
-DO NOT give these with paralytics

Question 23

NMBDs mechanism of action

Answer 23

depolarizing and non depolarizing
-Depolarizing: bind in place of Ach to cholinergic receptors at endplates of neuromuscular junctions and mimic action of Ach- agonists
-Phase 1: depolarizing phase- muscles twitch
-Phase 2: muscle becomes paralyzed
-Non depolarizing: binds to Ach receptors at neuromuscular junction but block the action of Ach-antagonist

Question 24

NMBD effects

Answer 24

muscle weakness or total flaccid paralysis

Question 25

NMBD indications

Answer 25

maintaining skeletal paralysis during surgery or to facilitate intubation

Question 26

NMBD contraindications

Answer 26

known allergy, history of malignant hyperthermia, penetrating eye injuries, narrow angle glaucoma, burns, crash injuries

Question 27

NMBD adverse effects

Answer 27

muscle spasms, hyperkalemia, bronchospasms, hypotension, excessive bronchial and salivary secretion, increased intraocular pressure, increased intracranial pressure

Question 28

NMBD toxicity

Answer 28

-can cause prolonged paralysis which means prolonged ventilation
-cardiac collapse die to histamine release

Question 29

Anti cholinesterase Drugs

Answer 29

displace non depolarizing NMBD molecule and return it to original state

Question 30

NMBD examples

Answer 30

-Succinylcholine
-Rocuronium
-Vecuronium