General/ Local Anesthetics Chapter 11 Flashcards
lidocaine (Usage)
Therapeutic: Control of ventriclar arrhythmias; LOCAL ANESTHESIA
lidocaine (dosage)
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.
lidocaine (adverse effects)
SEIZURES, confusion, drowsiness, CARDIAC ARREST, stinging, ANAPHYLAXIS
lidocaine (Nursing Implications)
Monitor ECG continuously and BP and respiratory status frequently during administration.
Lab Test Consideration: Serum electrolyte levels should be monitored periodically during prolonged therapy.
lidocaine (interactions)
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.
lidocaine (contraindications)
Hypersensitivity; cross-sensitivity may occur; third-degree heart block
propofol (Diprivan)
Usage
Therapeutic: general anesthetic
Pregnancy category B
propofol (Diprivan)
dosage
40mg q 10 seconds until induction acheived. 2-2.5mg/kg total
propofol (Diprivan)
Adverse effects
APNEA, bradycardia, hypotension, burning, pain, stinging, PROPOFOL INFUSION SYNDROME
propofol (Diprivan)
Nursing Implications
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.
propofol (Diprivan)
Interactions
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.
propofol (Diprivan)
Contraindications
Hypersensitivity to propofol, soybean oil, egg lecithin, or glycerol; OB: Crosses placenta; may cause neonatal depression; Lactation: Enters breast milk; effects on newborn unknown.
succinylcholine (Anectine)
Usage
Therapeutic: Neuromuscular blocking drugs (NMBD)
Relaxes skeletal muscles during surgery.
Succinylcholine (Anectine)
dosage
IV: 0.3-1.1mg/kg
IM: 3-4mg/kg
succinylcholine (Anectine)
adverse effects
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.
succinylcholine (Anectine)
Nursing implications
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.
succinylcholine (Anectine)
interactions
Aminoglycoside antibiotics, cyclosporine, dantrolene, furosemide, Inhalation anesthetics, Local Anesthetics, magnesium, quinidine all have additive effects.
Opposing effects come from Carbamazepine, Corticosteroids, phenytoin.
succinylcholine (Anectine)
contraindications
Known drug allergy, history of malignant hyperthermia, penetrating eye injuries, narrow-angle glaucoma.
vecuronium (Norcuron)
Usage
Therapeutic: nondepolarizing Neuromuscular Blocking Drug (non-NMBD)
provides skeletal muscle relaxation during surgery or mechanical ventilation
vecuronium (Norcuron)
dosage
0.08-0.1mg/kg IVP over 60 sec.
Maintain: 0.01-0.015mg/kg IVP 20-45 min post initial PRN
vecuronium (Norcuron)
Adverse effects
Prolonged paralysis and difficulty weaning from mechanical ventilation if used too long. Atelectasis.
vecuronium (Norcuron)
Nursing Implications
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.
vecuronium (Norcuron)
interactions
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.
vecuronium (Norcuron)
contraindications
known drug allergy
