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NURS 320 > Exam 1: Chapter 11: General And Local Anesthetics > Flashcards

Exam 1: Chapter 11: General And Local Anesthetics Flashcards

1
Q

Anesthetics

A

Drugs that reduce or eliminate pain by depressing nerve function in the CNS and PNS

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2
Q

Anesthesia

A

A state of reduced Neurologic function

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3
Q

Three types of anesthesia

A
  1. General Anesthesia
  2. Local Anesthesia
  3. Balanced Anesthesia
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4
Q

General Anesthesia

A

Complete loss of consciousness and loss of body reflexes including paralysis of respiratory muscles.

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5
Q

Local anesthesia

A

No paralysis of respiratory function

Elimination of pain sensation in the tissues inner gated by anesthetized nerves.

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6
Q

Balanced anesthesia

A

Produced by smaller doses of 2 or more agents to minimize patient risk and maximize patient comfort and safety.

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7
Q

General Anesthetics can cause varying degrees of

A

Pain relief
Depression of consciousness
Skeletal muscle relaxation
Reflex reduction

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8
Q

General Anesthetics include three types

A

Inhalational Anesthetics
Parenteral Anesthetics
Adjunct anesthetics (drug that enhances clinical therapy when used simultaneously with another drug)

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9
Q

General anesthesia Indications

A

Used during surgical procedures to produce:
Unconsciousness
Skeletal muscle relaxation
Visceral smooth muscle relaxation.
Has rapid onset and is quickly metabolized.

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10
Q

Adverse Effects of General Anesthesia

A

Vary according to dosage and drug used.
Myocardial depression is commonly seen.
**Malignant hyperthermia

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11
Q

Sites primarily affected by general anesthesia include

A

the heart, peripheral circulation, liver, kidneys and respiratory tract

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12
Q

Malignant Hyperthermia

A

Occurs during or after volatile inhaled general anesthesia or use of neuromuscular blocking succinylcholine.
Life threatening emergency.

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13
Q

Symptoms of Malignant Hyperthermia

A

Tachypnea
Tachycardia
Muscle rigidity
*Sudden elevation of body temperature (greater than 104 degrees F)

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14
Q

Malignant Hyperthermia can be treated with

A

Cardiorespiratory supportive care and dantrolene (skeletal muscle relaxant)

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15
Q

Toxicity and management of anesthetic overdose

A

In large doses, are potentially life threatening.

Cardiac and respiratory arrest ultimate causes of death in an overdose.

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16
Q

General Anesthetics: Interactions

A 
Anti-hypertensives (it causes increased hypotensive effects)
Beta blockers (increases myocardial depression)
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17
Q

General Anesthetics include

A

Ketamine
Nitrous Oxide
Propofol

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18
Q

Ketamine

A

IV administration used for both general anesthesia and moderate sedation.
Rapid onset of action.
Low incidence of reduction of cardiovascular, respiratory and bowel function.

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19
Q

Ketamine: Adverse Effects

A

Disturbing psychomimetic effects (mimics symptoms of psychosis including hallucinations)

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20
Q

Nitrous Oxide

A

“Laughing gas”
Only inhaled gas currently used as a general anesthetic.
Weakest of the general anesthetic drugs.

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21
Q

Nitrous Oxide Indications

A

Used primarily for dental procedures or as a supplement to other, more potent anesthetics.

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22
Q

Propofol (Diprivan)

A

Parenteral general anesthetic.

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23
Q

Propofol Indications

A

For the induction and maintenance of general anesthesia.

Sedation for mechanical ventilation in ICU settings.

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24
Q

Lower doses of Propofol are used for

A

Sedative-hypnotic for moderate sedation

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25
Q

Propofol: Monitoring

A

Monitor triglycerides if administered with total Parenteral nutrition

26
Q

Moderate Sedation

A

Aka conscious sedation and procedural sedation.
Does not cause complete loss of consciousness and does not normally cause respiratory arrest.
Anxiety and sensitivity to pain are reduced and the patient cannot recall procedure.

27
Q

What is used to cause a moderate sedation?

A

Combination of an IV benzodiazepine or propofol and opiate analgesic.

28
Q

Benefits of moderate sedation

A

Preserves the patient’s ability to maintain own airway and to respond to verbal commands.
Rapid recovery time and greater safety profile than general anesthesia.

29
Q

Local Anesthetics (regional anesthetics)

A

Used to render a specific portion of the body insensitive to pains.

30
Q

Local Anesthetics: MOA

A

Interferes with nerve impulse transmission to specific areas of the body.
Patient does not lose consciousness.

31
Q

What are the types of local anesthesias?

A 
Spinal: Intrathecal and Epidural
Infiltration
Nerve Block
Topical 
Parenteral
32
Q

Local Anesthesia: Intrathecal

A

Injection into the spinal canal or into the subarachnoid space so it reaches management applications.

33
Q

Local Anesthesia: Epidural

A

Injection into the epidural space of the spinal cord.

Popular method of pain relief during labor.

34
Q

Local Anesthesia: Infiltration

A

Local anesthesia produced by injection of the anesthetic solutions directly into the area of terminal nerve ending.
Used for minor surgical and dental procedures.

35
Q

Local Anesthesia: Nerve Block

A

Injection of numbing medication (local anesthetic) near specific nerves to decrease pain in a certain part of the body during and after surgery.

36
Q

Local Anesthesia: Topical

A

Produced by application of a local anesthetic directly to the area involved.

37
Q

Local Anesthesias include

A

“-Caine”

Lidocaine**

38
Q

Local Anesthesia: Drug effects

A

Paralysis
1. First, autonomic activity is lost.
2. Then pain and other sensory function is lost.
3. Last, motor activity is lost.
As local drugs wear off, recovery occurs in reverse order (motor, sensory, then autonomic activity are restored)

39
Q

Local Anesthesia: Indications

A

Surgical dental and diagnostic procedures.
Certain types of chronic pain.
Spinal anesthesia: to control pain during surgical procedures and childbirth

40
Q

Infiltration anesthesia Uses

A

Minor surgical and dental procedures

41
Q

Infiltration Anesthesia can be injected in what ways?

A 
Intradermal
SQ
Submucosal
IM
May be given in circular pattern around operative area.
42
Q

Why are some local anesthetics used for infiltration or nerve block combined with vasoconstrictors?

A

To prevent systemic absorption of anesthetic.
To help confine local anesthetic to injected area.
To reduce local blood loss during procedure.

43
Q

Nerve Block Anesthesia Uses

A

For surgical, dental and diagnostic procedures.

Therapeutic management of pain.

44
Q

Adverse Effects of nerve blocks result if

A

Inadvertent intravascular injection
Excessive dose or rate of injection
Slow metabolic breakdown
Injection into highly vascular tissue

45
Q

Spinal Headache

A

Usually self-limiting

Treatment: bed rest, analgesics, caffeine, blood patch.

46
Q

Neuromuscular Blocking Drugs: MOA

A

Prevent nerve transmission in skeletal and smooth muscle resulting in muscle paralysis.
Also paralyzes skeletal muscles required for breathing: intercostal muscles and the diaphragm. -> Requires mechanical ventilation.

47
Q

Neuromuscular Blocking Drugs: Uses

A

Used with anesthetics during surgery: DOES NOT cause pain relief or sedation.

48
Q

Neuromuscular Blocking Drugs: Contraindications

A

*Previous history of malignant hyperthermia
*Recent CVA
Burns
Penetrating Eye injuries
Narrow angle glaucoma

49
Q

Neuromuscular Blocking Drugs: Adverse Effects

A

Muscle spasms (could cause K+ release = hyperkalemia)
Cardiovascular: hypotension
Respiratory: release of histamine - bronchospasm, excessive secretions.
GI-RARE- decrease motility and tone

50
Q

Antidotes for neuromuscular blocking drugs

A

Anticholinesterase drugs such as neostigmine, pyridostigmine and edrophonium.

51
Q

Neuromuscular Blocking Drugs include

A

Succinylcholine
Pavulon
Vecuronium (Norcuron)

52
Q

Neuromuscular Blocking Drugs: Succinylcholine Uses

A

To cause short-term paralysis as part of general anesthesia.

Used to help with tracheal intubation

53
Q

Neuromuscular Blocking Drugs: Succinylcholine MOA

A

Works by block the action of acetylcholine on skeletal muscles = flaccid muscle paralysis

54
Q

Common Side Effects of Succinylcholine

A

Low blood pressure and increased saliva production

55
Q

Serious Side Effects of Succinylcholine

A

Malignant Hyperthermia

56
Q

Neuromuscular Blocking Drugs: Pavulon

A

Long-acting nondepolarizing NMBD

57
Q

Neuromuscular Blocking Drugs: Pavulon Uses

A

Used as an adjunct to general anesthesia to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Most commonly used for long surgical procedures that require prolonged muscle paralysis.

58
Q

Neuromuscular Blocking Drugs: Pavulon Serious Side Effects

A

Profound and prolonged skeletal muscle paralysis -> respiratory insufficiency or apnea -> managed by manual or mechanical ventilation until recovery is adequate.

59
Q

Neuromuscular Blocking Drugs: Vecuronium

A

Intermediate-acting nondepolarizing NMBD

60
Q

Neuromuscular Blocking Drugs: Vecuronium Uses

A

Used as an adjunct to enteral anesthesia to facilitation tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

61
Q

Neuromuscular Blocking Drugs: Vecuronium Side Effects of Long term use

A

Long term use in the ICU setting has resulted in prolonged paralysis and subsequent difficulty weaning from mechanical ventilation.

62
Q

Nursing Implications

A

Monitor VS and sudden elevations in body temp (may indicate malignant hyperthermia)
During recovery: monitor for cardiovascular depression, respiratory depression and complications of anesthesia.
Safety measures
Teach turning, coughing and deep breathing.

NURS 320 (28 decks)

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