General/ Local Anesthetics Chapter 11

Question 1

lidocaine (Usage)

Answer 1

Therapeutic: Control of ventriclar arrhythmias; LOCAL ANESTHESIA

Question 2

lidocaine (dosage)

Answer 2

IM: 300mg; may be repeated in 60-90 minutes.

IV: 1-1.5mg/kg bolus; may repeat doses of 0.5-0.75mg/kg 1 5-10min up to 3mg/kg.

Question 3

lidocaine (adverse effects)

Answer 3

SEIZURES, confusion, drowsiness, CARDIAC ARREST, stinging, ANAPHYLAXIS

Question 4

lidocaine (Nursing Implications)

Answer 4

Monitor ECG continuously and BP and respiratory status frequently during administration.

Lab Test Consideration: Serum electrolyte levels should be monitored periodically during prolonged therapy.

Question 5

lidocaine (interactions)

Answer 5

Drug-Drug: increased cardiac depression and toxicity with phenytoin, amiodarone, quinidine, procainamide, or propranolol. Cimetidine, azole antifungals, clarithromycin, erythromycin, fluoxetine, nefazodone, paroxetine, protease inhibitors, ritonavir, verapamil, and beta blockers may decrease metabolism and increase risk of toxicity. Lidocaine may increase levels of calcium channel blockers, certain benzodiazepines, cyclosporine, fluoxetine, lovastatin, simvastatin, mirtazapine, paroxetine, ritonavir, tacrolimus, theophylline, tricyclic antidepressents, and venlafaxine. Effectos of lidocaine may be decreased by carbamazepine, phenobarbital, phenytoin, and rifampin.

Question 6

lidocaine (contraindications)

Answer 6

Hypersensitivity; cross-sensitivity may occur; third-degree heart block

Question 7

propofol (Diprivan)

Usage

Answer 7

Therapeutic: general anesthetic

Pregnancy category B

Question 8

propofol (Diprivan)

dosage

Answer 8

40mg q 10 seconds until induction acheived. 2-2.5mg/kg total

Question 9

propofol (Diprivan)

Adverse effects

Answer 9

APNEA, bradycardia, hypotension, burning, pain, stinging, PROPOFOL INFUSION SYNDROME

Question 10

propofol (Diprivan)

Nursing Implications

Answer 10

Assess respiratory status, pulse, and BP continuously throughout propofol therapy. Frequently causes apnea lasting >60 seconds. Maintain patient airway and adequate ventilation. Propofol should be used only by individuals experienced in endotracheal intubation, and equipment for this procedure should be readily available. Monitor for propofol infusion syndrome (severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, cadiac and renal failure).

Toxicity and overdose: If overdose occurs, monitor pulse, respiration, and BP continuously. Maintain pt. airway and assist ventilation as needed. If hypotension occurs, treatment includes IV fluids, repositioning, and vasopressors.

Question 11

propofol (Diprivan)

Interactions

Answer 11

Drug-Drug: Additive CNS and respiratory depression with alcohol, antihistamines, opioid analgesics, and sedative/hypnotics (dose decrease may be required). Theophylline may antagonize the CNS effects of propofol. Propofold may increase levels of alfentanil. Cardiorespiratory instability can occur when used with acetazolamide. Serious brady cardia can occur with concurrent use of fentanyl in childrenn. Increased risk of hypertriglyceridemia with intravenous fat emulsion.

Question 12

propofol (Diprivan)

Contraindications

Answer 12

Hypersensitivity to propofol, soybean oil, egg lecithin, or glycerol; OB: Crosses placenta; may cause neonatal depression; Lactation: Enters breast milk; effects on newborn unknown.

Question 13

succinylcholine (Anectine)

Usage

Answer 13

Therapeutic: Neuromuscular blocking drugs (NMBD)

Relaxes skeletal muscles during surgery.

Question 14

Succinylcholine (Anectine)

dosage

Answer 14

IV: 0.3-1.1mg/kg

IM: 3-4mg/kg

Question 15

succinylcholine (Anectine)

adverse effects

Answer 15

muscle spasms, increase and decrease in BP and H.R, Bronchospasm, hypotension, excessive bronchial and salivary secretion, constipation, hyperkalemia, dysrhythmias, fasciculations, muscle pain, myoglobinuria, increased intraocular, intraoastric, intracranial pressure, malignant hyperthermia.

Question 16

succinylcholine (Anectine)

Nursing implications

Answer 16

Lab tests: obtain baseline serum electrolytes. Electrolyte imbalance (particularly K, Ca, Mg) can potentiate effects of neuromuscular blocking agents. Monitor vital signs and keep airwary clear of secretions. Have immediately available: Facilities for emergency endotracheal intubation, artificial respiration, and assistend or controlled respiration with oxygen. Be aware the transient apnea usually occurs at time of maximal drug effect (1-2 min); spontaneous respiration should return in a few seconds or, at most, 3 or 4 minutes.

Question 17

succinylcholine (Anectine)

interactions

Answer 17

Aminoglycoside antibiotics, cyclosporine, dantrolene, furosemide, Inhalation anesthetics, Local Anesthetics, magnesium, quinidine all have additive effects.

Opposing effects come from Carbamazepine, Corticosteroids, phenytoin.

Question 18

succinylcholine (Anectine)

contraindications

Answer 18

Known drug allergy, history of malignant hyperthermia, penetrating eye injuries, narrow-angle glaucoma.

Question 19

vecuronium (Norcuron)

Usage

Answer 19

Therapeutic: nondepolarizing Neuromuscular Blocking Drug (non-NMBD)

provides skeletal muscle relaxation during surgery or mechanical ventilation

Question 20

vecuronium (Norcuron)

dosage

Answer 20

0.08-0.1mg/kg IVP over 60 sec.

Maintain: 0.01-0.015mg/kg IVP 20-45 min post initial PRN

Question 21

vecuronium (Norcuron)

Adverse effects

Answer 21

Prolonged paralysis and difficulty weaning from mechanical ventilation if used too long. Atelectasis.

Question 22

vecuronium (Norcuron)

Nursing Implications

Answer 22

Lab Tests: basline serum electrolytes, acid-base balance, and kidney, liver function.

Monitor VS q 15 min until stable, then q 30 min for the next 2 hr. Note rate, depth, and pattern of respirations.

Evaluate pt for recovery as evidenced by ability to breathe, cough, keep eyes open, lift head keeping mouth closed and adequate hand strength. Notify physician if recovery is delayed.

NOTE: Recovery time may be delayed in pt with CV disease, edematous states, and in older adults.

Question 23

vecuronium (Norcuron)

interactions

Answer 23

Drug- drug: general anesthetics increase neuromuscular blockade and duration of action; aminoglycosides, bacitracin, polymyxin B, clindamycin, lidocaine, parenteral magnesium, quinidine, quinine, trimethaphan, verapamil increase neuromuscular blockade; diuretics may increase or decrease neuromuscular blockade; lithium prolongs duration of neuromuscular blockade; narcotic analgesics increase possibility of additive respiratory depression; succinylcholine increases onset and depth of neuromuscular blockade; phenytoin may cause resistance to or reversal of neuromuscular blockade.

Question 24

vecuronium (Norcuron)

contraindications

Answer 24

known drug allergy

Question 25

What is the order for DRUG EFFECT PARALYSIS?

Answer 25

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

Question 26

NMBD’s: what is the order in which these effect the body?

Answer 26

First sensation is muscle weakness, followed by total flaccid paralysis
Small, rapidly moving muscles affected first (fingers, eyes), then limbs, neck, trunk
Finally, intercostal muscles and diaphragm affected, resulting in cessation of respirations
Recovery of muscular activity usually occurs in reverse order
Transient muscle fasciculations may result in later muscle soreness