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

14. Injectable Anesthetics
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. Neuromuscular Blocking Agents
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. Anticholinesterase Agents
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 Ester Amides
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