1. Administration of Anesthetics
Jeremy Kaplan

2. 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.

3. 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

4. Drug Abuse

5. 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

6. Local Infiltration Anesthesia
Short duration ( 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

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

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

9. Neuron Action Potentials

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

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

12. 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

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

14. 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

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

17. 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

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

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

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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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)

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

29. 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
American Society of Regional Anesthesia and Pain Medicine . (n.d.). Regional anesthesia for surgery. Retrieved from