Administration of Anesthetics Jeremy Kaplan

Learning Outcomes Recognize ethical issues related to drug administration Explain the nursing role related to pharmacology Apply the nursing process to pharmacologic interventions Describe the role of the registered nurse in drug administration and patient education Predict the action of drugs based on receptor theory and drug classification.

History of Anesthesia Opium Poppy Acupuncture 1659 injection of opium through a goose quill into a dog's vein 1847 chloroform 1884 Freud uses Cocaine https://www.woodlibrarymuseum.org/history-of-anesthesia/

Drug Abuse http://www.scielo.br/pdf/rba/v62n3/en_v62n3a10.pdf

What is the goal of Anesthesia? Control of excessive biologic responses induced by a variety of stressors Protection of patients from stress-induced complications FAST FAST FAST https://www.youtube.com/watch?v=M68GeL8PafE

Local Infiltration Anesthesia Short duration (30-240 min) Esters and Amides Used for: surgical procedures, diagnostic procedures, and post-operative pain relief Factors affecting local anesthesia: Age Weight Allergies part of the body to be operated on current medical condition vascularity of the area of injection

Local Infiltration Anesthesia: Esters rapidly metabolized procaine hydrochloride (Novocain) chloroprocaine hydrochloride (Nesacaine) tetracaine hydrochloride (Pontocaine)

Local Infiltration Anesthesia: Amides more powerful than Esters and longer acting agents lidocaine hydrochloride (Xylocaine) mepivacaine hydrochloride (Carbocaine) bupivacaine hydrochloride (Marcaine)

Neuron Action Potentials https://www.youtube.com/watch?v=OZG8M_ldA1M&t=2s

Local Infiltration Anesthesia: MOA Local anesthetics act on Na+ and K+ currents inhibit depolarization threshold not attained

Local Infiltration Anesthesia: Types of Deliveries Parenteral: IM SQ Topical: Spray Ointment Patch 5% lidocaine patch (Lidoderm)

Novocain Generic Name: Procaine Hydrochloride Short-acting local anesthetic (ester type) Desired results: elimination of pain and numbness o surgical site Side effects: mild bruising, redness, itching, numbness, or swelling where the medication was injected, mild dizziness, nausea considerations: associated with major neurologic and minor neurologic toxicity dose of lidocaine should not exceed 75 mg

Regional Anesthesia anesthetic medication is administered near a cluster of nerves to numb only the area of your body that requires surgery

Regional Anesthesia: Epidural injection into the epidural space between the dura mater and the ligamentum flavum continuous block Contraindications for epidural block: client refusal infection at the site of the needle puncture raised intracranial pressure specific medication allergy to the agent being used hypovolemic shock  Nursing Considerations: patient knowledge/education, vitals, empty bladder, must have full feeling of affected area before ambulation

Continuous Epidural Block more frequent less symptoms epidural catheter breakthrough pain check the integrity of the line notify the analgesia provider

Regional Anesthesia: Spinal small needle is placed in subarachnoid space One time injection 2-6 hour duration Contraindications: Hypovolemia infection over the puncture site Sepsis client refusal  Nursing Considerations: patient knowledge/education, vitals, empty bladder, must have full function/feeling of affected area before ambulation  

Regional Anesthesia: Brachial-plexus Block surgery of the upper extremity

Regional Anesthesia: Paravertebral Block numb a specific area in one part of the body depending on where the block is performed

Regional Anesthesia: Femoral Block front of the thigh and knee procedures that cover the knee

Regional Anesthesia: Sciatic Block back of the thigh and most of the leg below the knee. used for surgery on the knee, calf, Achilles tendon, ankle, and foot

Regional Anesthesia: Nursing Considerations monitor for adverse reactions MILD REACTIONS: palpitations, tinnitus, apprehension, confusion, and a metallic taste in the mouth MODERATE REACTIONS: more severe degrees of mild symptoms plus N/V, hypotension, and muscle twitching, which may progress to convulsions SEVERE REACTIONS: sudden loss of consciousness, coma, severe hypotension, bradycardia, respiratory depression, and cardiac arrest Toxicity ☠️ treatment for a mild toxic reaction: oxygen and Lipid Emulsion Therapy

General Anesthesia significant duration  for patients who are having surgical procedures that require…. skeletal muscle relaxation require uncomfortable operative positions require control of ventilation Nursing considerations: Informed consent Patient Education

General Anesthesia Phases Pre-induction initiation of IV or arterial access application of monitors Induction Initiation of medications that make patient unconscious Airway established Maintenance surgery procedure

General Anesthesia: Types of Deliveries IV AGENTS INHALANTS Inhalation agents enter the body through the alveoli in the lungs Mixed with O2 rapid onset of action A single dose lasts only a few minutes induced IV or by inhalation balanced technique

General Anesthesia: Drug Combos 😴😴 II. Antibiotics III. H2-receptor blockers or anticholinergics IV. Gastric motility agents V. Hypnotic 1. anxiolytic VI. dissociative agent VII. Volatile liquids Antibiotics Aspiration prophylaxis H2-receptor blockers/anticholinergics & Gastric motility agents (Reglan) Hypnotic (propofol (Diprivan)), an anxiolytic (barbituates), or a dissociative agent (Ketamine) Volatile liquids (isoflurane (Forane)

General Anesthesia: RN Role Assist with…. airway management monitor placement surgical timeout consent form pre/post OP assessment adjust position SAFETY

References London, M., Ladewig, P., Davidson, M., Ball, J., Bindler, R., & Cowen, K. (2017).  Maternal & Child Nursing Care (5th ed.). Upper Saddle River, NJ:  Pearson Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 9th Edition. Wood Library-Museum of Anesthesiology. (2017). History of Anesthesia. Retrieved from https://www.woodlibrarymuseum.org/history-of-anesthesia/ American Society of Regional Anesthesia and Pain Medicine . (n.d.). Regional anesthesia for surgery. Retrieved from https://www.asra.com/page/41/regional-anesthesia-for-surgery