Nitrous Flashcards
Analgesia
A neurologic or pharmacologic state in which painful stimuli are moderated
Anesthesia
Loss of sensation resulting from pharmacologic depression of nerve function or from neurologic dysfunction
Anxiolysis
reduction of fear or apprehension
Minimal sedation
- Retains pts ability to independently and continously maintain an airway and
- Respond normally to tactile stimulation and verbal command
- Ventilatory and cardiovascular functions are unaffected
Minimal sedation Appropriate initial dosing
- Initial dosing of a single enteral drug is no more than the max recommended dose (MRD) of a drug that can be prescribed for unmonitored home use
Minimal Sedation Drugs
- Short procedure 1-2hrs
- Triazolam 0.25mg
- Int procedure 1/2 day
- Apprazolam 0.5 mg
- Long full day
- Lorazepam 2mg
NO2 and sedative agents
- NO2 when used with a sedative agent may produce
- Minimal, moderate, deep sedation
- General anesthesia
Incremental Dosing
Administration of multiple doses of a drug to achieve a desired, but not to exceed MRD
Supplemental Dosing
- During min sedation supp dosing is a single additional dose of the initial dose of the initial drug that may be necessary for prolonged procedures
- The supp dose should not exceed 1/2 of the inital dose
- Should not be administered until the dr has determined the clinical half-life of the intial dose has passed
- Total aggregate dose must not exceed 1.5 X the MRD on the day of treatment
Moserate Sedation
- Patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation
- No interventions are required to maintain an airway
- Spontaneous ventilation is adequate
Titration
- Titration- incremental doses of a drug until desired affect is achieved
- Titration applies to moderate sedation or greater
- One must know whether the previous dose has taken full effect before administering an additional drug increment
Deep Sedation
- Patients cannot be easily aroused by respond purposefully following repeated or painful stimulation
- Ability to independently maintain ventilatory function may be impaired
General Anesthesia
- Patients are not arousable, even by painful stimulation
- Ability to maintain ventilatory function and cardiovascular function is often impaired
Stages of General Anesthesia 4 stages
- Analgesia
- drowsiness to loss of eyelash reflex
- Excitment
- Agitation and delerium
- Surgical
- Subdivided into 4 planes based on eye movements and status of respiratory musculature
- Medullary depression
- Depression of vasomotor and respiratory centers leading to coma and death
4 Planes of Surgical Anesthesia
- Plane I
- rollinf eyes, plane ends when eyes become fixed
- Plane II
- Loss of corneal and laryngeal reflexes
- Plane III
- Pupil starts dilating and light reflex is lost
- Plane IV
- Intercostal paralysis, shallow abdominal respiration, dilated pupil
Enteral
- Agent is absorbed theough the
- GI tract
- Oral Mucosa ( oral, rectal, sublingual)
Parenteral
- Drug bypasses the GI tract
- Intramuscular
- Intravenous
- Intranasal
- Submucosal
- Subcutaneous
- Intraosseous
Transdermal
Drug is administered by patch or ionotophoresis through the skin
Inhalation
Primary effect is due to absorption thru the gas/blood interface
Sedatives and Anxiolytics 3
and effects
- Benzodiazepines (best) (anticonvulsant amnesia)
- Barbiturates (Anticonvulsant)
- Antihistamines (Antiemetic)
- All produce
- Primary effect follows a dose response
- Respiratory depression
- Dependence
- Paradoxical excitation
Metabolism of Triazolam and half-life
- A benzodiazepine short half life of 2-4 hrs
- Metabolized via hepatic microsomal oxidation or glucorondidation
- Any patient with a compromised liver will have a longer half-life of the drug
Patient Assesment for minimal sedation
- Healthy ASA I ASA II
- review of med hx and medications
- ASA III ASA IV
- Consultation with primary physician or med specialist
Pre-op Preparation
Baseline vital signs to be obtained 6
- General activity level
- Respiration
- BP
- Pulse
- Mental status and alertness
- Room air oxygen saturation
ASA Classifications
- ASA I - Healthy
- ASA II
- Mild systemic disease, no functional limitation
- ASA III
- Severe systemic disease, definite functional limitation
- ASA IV
- Severe systemic disease that is constant threat
- ASA V
- Unlikely to survive 24 hrs
Mallampati Classification
- Class I
- Full visibility of tonsils, uvula, SP
- Class II
- Visibility of hard and soft palate
- Upper portion of tonsils and uvula
- Class III
- SP, HP, and base of uvula are visible
- Class IV
- Only HP
Reversal agent for Triazolam
Flumazenil
