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Anesthesia

Anesthesia. In the “old days” the following were used for anesthesia. Alcohol Drugs Ice for numbing Blow to the head Strangulation. Anesthesia. Now, anesthesia is designed to focus on specific systems, such as Nervous system • Skeletal system Respiratory system • GI system

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Anesthesia

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  1. Anesthesia In the “old days” the following were used for anesthesia. • Alcohol • Drugs • Ice for numbing • Blow to the head • Strangulation

  2. Anesthesia Now, anesthesia is designed to focus on specific systems, such as • Nervous system • Skeletal system • Respiratory system • GI system • Endocrine system • Hepatic system • Cardiovascular system

  3. Anesthesia Goals of Balanced Anesthesia • Amnesia (Loss of memory) • Adequate Muscle Relaxation • Adequate Ventilation • Pain Control

  4. Types of Anesthesia • Preansthetics agents • General (inhaled: desflurane, halothane, isoflurane, Nitrous oxide, sevoflurane, enflurane; IV: barbiturate, benzodiazepines, ketamine, opoids, propofol, etomidate) • Local ( Bupivacaine, Lidocaine, Procaine, Tetracaine)

  5. General Anesthesia Preanesthetic Medications (antiemetics, muscle relaxants, Anticholinergics, antihistamines, Benzodazepines, Opioids) • Control sedation • Reduce postoperative pain • Provide amnesia • Decrease anxiety

  6. Discussion What are some of the indicators used to access general anesthesia? Answer: Blood pressure, hypervolemia, oxygen level, pulse, respiratory rate, tissue perfusion, urinary output

  7. General Anesthesia Malignant Hyperthermia • Side effect of anesthesia • Fever of 110°F or more • Life threatening • Treatment: dantrolene (Dantrium)

  8. Drug List Inhalant Anesthetics • desflurane (Suprane) • enflurane (Ethrane) • halothane • isoflurane (Forane) • nitrous oxide

  9. Inhalant Anesthesia Side Effects • Causes reduction in blood pressure • May cause nausea and vomiting

  10. nitrous oxide • Causes analgesia only; no amnesia or relaxation • May be given alone or may be given with more powerful anesthetics to hasten the uptake of the other agent (s) • Commonly used for dental procedures • Rapidly eliminated

  11. desflurane (Suprane) • Has rapid onset and recovery • Often used in ambulatory surgery

  12. Intravenous General Anesthesia • Often dispensed by IV drip • Very lipid soluble

  13. Drug List Injectable Anesthetics • etomidate (Amidate) • fentanyl (Duragesic, Sublimaze) • fentanyl-droperidol • ketamine (Ketalar) • morphine • propofol (Diprivan) • sufentanil (Sufenta)

  14. Drug List Injectable Anesthetics Barbituates • methohexital (Brevital) • thiopental (Pentothal) Benzodiazepines • diazepam (Valium) • lorazepam (Ativan) • midazolam (Versed)

  15. propofol (Diprivan) • Used for maintenance of anesthesia, sedation, or treatment of agitation • Has antiemetic properties • Drowsiness • Respiratory depression • Motor restlessness • Increased blood pressure

  16. fentanyl • Dosage Forms • IV • patch • lozenge for children • Used extensively for open-heart surgery due to lack of cardiac depression

  17. Benzodiazepines • Used for induction, short procedures, and dental procedures • Useful in controlling and preventing seizures induced by local anesthetics • midozolam (Versed) • fastest onset of action • greatest potency • most rapid elimination

  18. Antagonist Agents Antagonist agents reverse benzodiazepine and narcotic overdose.

  19. Drug List Antagonist Agents • flumazenil (Romazicon) • nalmefene (Revex) • naloxone (Narcan)

  20. Neuromuscular Blocking Agents • Causes immediate skeletal muscle relaxation. • Short Duration • Intermediate Duration • Extended Duration • Used to facilitate endotracheal intubation. • Allows for easier insertion of endotracheal tube. • Keeps airway open.

  21. Drug List Neuromuscular Blocking Agents • atracurium (Tracrium) • cisatracurium (Nimbex) • mivacurium (Mivacron) • pancuronium • rocuronium (Zemuron) • succinylcholine (Quelicin) • vecuronium (Norcuron)

  22. succinylcholine (Quelicin) • Often called “sux.” • Only depolarizing agent. All others work as competitive antagonists to ACh receptors. • Persistent depolarization at motor endplate. • Causes sustained, brief period of flaccid skeletal muscle paralysis.

  23. Reversal of Neuromuscular Blocking Agents • Increases the action of acetylcholine by inhibiting acetylcholinesterase • Used for reversal of nonpolarizing agents

  24. Drug List Anticholinesterase Agents • edrophonium (Enlon) • neostigmine (Prostigmin) • pyridostigmine (Mestinon)

  25. Local Anesthesia Relieves pain without altering alertness or mental function.

  26. Local Anesthesia Variety of Dosage Forms • Topical • Superficial injection (infiltration) • Nerve block • IV • Spinal

  27. Under what conditions would a local anesthetic be used over a general anesthetic? Answer: It is chosen when a well-defined area of the body is targeted.

  28. Discussion Local anesthetics are classified by their chemistry into two classes. Ester Amides

  29. Local Anesthesia Esters • Short acting • Metabolized in the plasma and tissue fluids • Excreted in urine

  30. Local Anesthesia Amides • Longer acting • Metabolized by liver enzymes • Excreted in urine

  31. Drug List Local Anesthesia Esters • benzocaine (Americaine) • chloroprocaine (Nesacaine) • dyclonine (Cēpacol Maximum Strength) • procaine (Novocain) • tetracaine (Cēpacol Viractin, Pontocaine)

  32. Drug List Local Anesthesia Amides • bupivacaine (Marcaine) • levobupivacaine (Chirocaine) • lidocaine (L-M-X, Solarcaine, Xylocaine) • lidocaine-epinephrine (Xylocaine w/ Epinephrine) • lidocaine-prilocaine (EMLA) • mepivacaine (Carbocaine)

  33. What functions are lost with local anesthetics? Answer • Pain perception • Temperature • Touch sensation • Skeletal muscle tone

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