General and Local Anesthetic Agents Flashcards
What organs do you have to be cautious with when administering anesthetics in children and elderly patients?
Live and Kidney function
What do general anesthetics cause to happen in the brain?
It depresses the CNS producing loss of pain sensation and consciousness.
What is the use for local anesthetics?
To cause loss of pain sensation and feeling in a designated area of the body.
What do local anesthetics not do?
They do not produce the systemic effects associated with severe CNS depression.
What do all local anesthetics have for a prefix?
“caine”
True or False:
You use one drug to get the effects of anesthesia?
False: You have to use multiple drugs.
True or False:
The more medications given to the patient to reach the effects of anesthesia the better?
False: the least amount of medications used the better to reduce adverse effects.
What is analgesia for?
Loss of pain perception
What does the term unconsciousness mean in terms of anesthesia?
The loss of awareness of one’s surroundings.
What is amnesia?
The inability to recall what took place.
True of False:
Asthma does not effect the administration of anesthesia drugs?
False: Some of the anesthesia drugs are given in aerosol form that needs to be inhaled. So, if the patient has asthma it can effect the absorption of the medication.
If a patient has a history of these two things an adverse reaction my occur.
Seizures or stroke.
Why is renal function a risk factor for anesthesia?
If a person has reduced renal function they may not be able to excrete the drug properly leading to toxicity.
Why is hepatic function a risk factor for anesthesia?
If a person has reduced hepatic function they may not be able to metabolize the drug properly leading to toxicity.
What does it mean by balanced anesthesia?
A use of a combination of drugs, each with a different effect, causing the outcome wanted while in surgery.
What is the preoperative medication administered that decreases secretions?
Cimetadine
Why are sedative-hypnotics administered to patients while give anesthesia?
To relax the body during the excitement stage, and to paralyze the body during surgery.
What are antiemetics?
Stoping nausea and vomiting
Why would you administer an antiemetic during anesthesia?
To make sure they do not vomit causing aspiration.
Why would you give an antihistamine during anesthesia?
To reduce allergic reactions.
Why would you administer a narcotic during anesthesia?
To reduce pain and sedate the patient.
What is the first stage of anesthesia?
The analgesia stage
Why happens during the first phase of anesthesia?
Loss of pain
What is the second stage of anesthesia?
The excitement stage
What happens during the second phase of anesthesia?
Patient becomes combative, muscle spasms occur, elevate heart rate and blood pressure.
What is the third stage of anesthesia?
Surgical anesthesia
What happens during the third phase of anesthesia?
A paralytic relaxation of the muscle and loss of reflexes
What is the fourth stage of anesthesia?
Medullary paralysis
What happens during the fourth stage of anesthesia?
Deep CNS suppression; no respiratory rate. May become fatal
True or False:
It is important to reach stage four of anesthesia?
False: you never want to reach stage four of anesthesia. This could become fatal.
What is the induction period of anesthesia?
The period from the beginning of anesthesia until Stage 3 is reached.
What is the maintenance period of anesthesia?
The period from stage 3 until the surgical procedure is complete.
What is the recovery period of anesthesia?
The period of discontinuation of the anesthetic until the patient has regained consciousness.
During the recovery period of anesthesia where does the patient get their care?
In the PACU.
Are barbiturate and nonbarbiturate anesthetics rapid acting?
Yes
What are volatile liquids used for in anesthesia?
To maintain
What do gas anesthetics do?
Keeps the patient unconscious.
True or False:
There are three phases of a general anesthetic?
False: there are 4.
What is the difference between an analgesic and an anesthetic?
An analgesic reduces pain.
An anesthetic reduces the sensation of pain.
What is the prototype for barbiturate anesthetics?
thiopental
How is thiopental administered?
intravenously
What does thiopental do?
It induces rapid anesthesia with an ultra short recovery period. Gets you to sleep.
When is thiopental administered?
After the time out when every one is in the OR
True or false:
Thiopental is lipophilic?
True
True or false:
Thiopental does not diffuse rapidly into the brain.
False
What are the adverse effects of thiopental?
Decreased BP, HR and RR.
What do type of medications do you need to use caution with when using thiopental?
Other CNS suppressants.
What kinds of drugs would thiopental reduce their effectiveness?
Birth control, epilepsy drugs, and anticoagulants.
What is the major adverse effect of thiopental?
Walking up with delirium.
What is the onset time of thiopental?
1 minute
What is the duration of thiopental
20-30 minutes.
What is the non-barbiturate prototype drug?
Midazolam
What class does Midazolam belong to?
benzodiazepines
What is does Midazolam do?
It potentiates GABA; produces amnesia and sedation
True or False:
Midazolam has a slow onset?
False: it has a rapid onset.
What conditions do you need to use caution with when using Midazolam?
*hint- there are 4
COPD, kidney or heart disease, pregnancy, lactation.
What are the adverse effects of Midazolam?
*hint there are 4
Respiratory and CNS depression; decreased BP, N & V
What does Midazolam interact with?
Other CNS depressants
What is Propofol used for?
Short procedures due to it being a short acting drug.
When giving Midazolam by IV what is the onset time?
3-5 minutes
When giving Midazolam by IV what is the peak?
< 30 mins
When giving Midazolam by IV what is the duration?
2-6 h
What is Nitrous Oxide?
An anesthetic gas
How is an anesthetic gas administered?
It is inhaled though a nonrebreather mask
True or false:
Nitrous Oxide is a potent analgesic?
True
True or false:
Nitrous Oxide is lipophobic and produces severe CNS excitement.
False:
It is lipophilic and causes severe CNS depression.
What is a contraindication of nitrous oxide?
pregnancy
What are the adverse effects of nitrous oxide?
*hint there are 5
Hypoxia, bowel obstruction, sinus pain, pneumothorax, inactivates Vitamin B12.
What does nitrous oxide interact with?
*hint there are 2
Other CNS depressants & Halothane
What is the prototype drug for volatile liquids?
Halothane
How is Halothane administered?
It is inhaled
What is the use for Halothane?
To induce or maintain anesthesia
What are the contraindications for Halothane?
*hint there are 4
Hepatic or cardiovascular disease, pregnancy or lactation.
What is the main danger of Halothane?
It can trigger malignant hyperthermia
What do you need to make sure to have in the room just in case when administering Halothane?
Life support just incase malignant hyperthermia sets in.
What is the onset and peak of Halothane?
Rapid
What is the duration of Halothane?
To the end of inhalation.
Identify a contraindication to general anesthetics. A. No suitable veins B. Sickle cell disease C. Status epilepticus D. Anemia
A. No suitable veins
General anesthetics and their antidotes are normally administered by IV.
Why is Halothane normally kept cold?
Because it is unstable at room temperatures
What is the antidote for malignant hyperthermia?
Dantrolene
How often can you administer Halothane?
Once every three weeks.
If a patient has history of this you should not administer Halothane?
Jaundice.
True or false:
Both anesthetic gases and volatile liquids are flammable?
False:
Only anesthetic gases are flammable.
What is the topical administration drug of local analgesics?
EMLA cream
What do you do after applying a topical analgesic?
You cover it with plastic wrap for 45 minutes.
After removal of plastic wrap the skin will appear completely white and it will numb
What local analgesic is given through infiltration?
All the caine drugs. Novacaine, lidocaine etc.
When is a local analgesic through infiltration administered?
For giving stitches
What is a field block?
A specific area block
When is a field block commonly used?
In L&D for a pundendal block of the whole pelvic girdle.
When is a nerve block commonly used?
In ortho surgeries.
When a nerve block is used in orthopedic surgeries what is used after to decrease blood flow so the surgery can begin?
A tourniquet
What is the action of the local anesthetic lidocaine?
A temporary interruption in the production and condition of nerve impulses.
The permeability of these ions get affected by lidocaine.
Sodium
What would indicate the use of lidocaine?
For infiltration anesthesia, peripheral nerve block, spinal anesthesia and the relief of pain
When giving an epidural what part of the spine does it effect?
The medication bathes outside of the spinal sac and the nerves.
When giving a spinal what part of the spine does it effect?
It goes closer to the spinal cord than an epidural and gives total pain relief
When administering an epidural and spinal injection what does the patient have to do so the needle is placed in the spine correctly\?
The patient needs to leave forward with their back fully rounded to separate their vertebrae.
What are the contraindications for lidocaine?
*hint there are 5
Known allergy, heart block, shock, pregnancy and lactation
What are the adverse reactions to lidocaine?
*hint there are 7
headache, restlessness, anxiety, blurred vision, cause, vomiting, myocardial depression.
What are the drug-to-drug interactions with lidocaine?
Succinycholine & epinephrine
What are the two route you can give lidocaine?
IM and topical
What is the onset time of lidocaine when given IM.
5-10 minutes
What is the peak time of lidocaine when give IM?
5-15 minutes
What is the duration time of lidocaine when give IM?
2 h
What important assessment should the nurse make before a patient receives a general anesthesia?
A. Assess skin lesions
B. Assess family support
C. Assess preoperative teaching
A. Assess skin lesions
Make sure to monitor for skin breakdown
