1. Introduction to Clinical Pharmacology
Chapter 17 Anesthetic Drugs

2. Introduction to Anesthesia and Types of Anesthesia
Induced by various drugs to bring about partial or complete loss of sensation
Types of anesthesia:
Local anesthesia
Regional Anesthesia
Spinal Anesthesia
General anesthesia
Anesthesiologist
Trained physician to administer anesthesia

3. Local Anesthesia and Types #1
Topical anesthesia: application of the anesthesia to surface of skin, open area, mucous membrane
Local infiltration anesthesia: injection of anesthesia into tissue
Epinephrine might be used for vasoconstriction but not used on extremities
Dental procedures, suturing of small wounds, making an incision into a small area

4. Local Anesthesia and Types #2
Local anesthesia (cont.):
Regional anesthesia: injection of anesthesia around nerves to prevent sending pain signals
Spinal anesthesia: injection of anesthesia into the subarachnoid space of the spinal cord-loss of sensation in lower abdomen and lower extremities
Conduction blocks: injection of anesthesia into or near a nerve trunk include epidural and transsacral blocks

5. Preparing Patient for Local Anesthesia
Take patient’s allergy history
Explain how anesthetic will be given and how it works
Prepare the area to be anesthetized:
Cleaning the area with antiseptic, shaving the area
Requires fasting
May administer intravenous sedative

6. Administering Local Anesthesia
Mixed with epinephrine to cause local vasoconstriction
Be aware of when to and when not to use epinephrine
Epinephrine contraindicated when used on an extremity

7. Nursing Responsibilities When Caring for Patient Receiving Local Anesthesia
Applying dressing to the appropriate surgical area
Observe area for bleeding, oozing, other problems after administration

8. Preanesthetic Drugs Given before administration of anesthesia
May consist of one drug or a combination of drugs

9. Preanesthetic Drugs: Uses
Used to decrease anxiety and apprehension immediately before surgery
Used to decrease secretions of the upper respiratory tract
Used to lessen the incidence of nausea and vomiting during the immediate postoperative recovery period

10. Selection of Preanesthetic Drugs
May consist of one or more drugs
Opioid agonists or barbiturate/antianxiety agents may be given to relax the patient-by depressing CNS
Antiemetics given to prevent vomiting when coming out of sedation
Cholinergic blocking drug such as atropine is given to dry secretions in the upper respiratory tract
Drug diazepam (valium) used for preoperative sedation

11. Nursing Responsibilities #1
Assess the physical status of the client-check the chart for lab values to ensure provider is aware of any abnormal values
Describe or explain the preparations for surgery ordered by the physician
Describe or explain immediate postoperative care
Demonstrate, describe, and explain postoperative patient activities
Emphasize the importance of pain control using PCA pump and demonstrate use of pump

12. General Anesthesia The choice of anesthetic drug depends on:
General physical condition of the patient
Area, organ, system being operated on
Anticipated length of surgical procedure

13. Drugs Used for General Anesthesia #1
Barbiturates and similar agents:
Methohexital; etomidate; propofol
Benzodiazepines: midazolam-
a short-acting benzodiazepine CNS depressant, is used as a preanesthetic drug to relieve anxiety (not prevent vomiting); for induction of anesthesia; for conscious sedation before minor procedures, such as endoscopy; and to supplement nitrous oxide and oxygen for short surgical procedures
Ketamine-
rapid-acting general anesthetic ketamine will exhibit profound analgesia, cardiovascular stimulation, respiratory stimulation, and enhanced skeletal muscle tone
Gases and volatile liquids:
Nitrous oxide; sevoflurane (Ultane); isoflurane (Forane); desflurane (Suprane)

14. Drugs used for General Anesthesia #2
Opioids
Analgesic fentanyl; droperidol; remifentanil; neuroleptic drug
Skeletal muscle relaxants-help produce relaxation of skeletal muscles during certain types of surgeries involving the chest or abdomen and are used to facilitate the insertion of an endotracheal tube
Anectine; Nimbex

15. Stages of General Anesthesia
Stage I: Analgesia; Anesthesia
Stage II: Delirium and excitement
Stage III: Surgical analgesia
Stage IV: Respiratory paralysis

16. Nursing Responsibilities #2
Preanesthesia
Performing the required tasks and procedures as prescribed
Checking the chart for any recent, abnormal laboratory tests
Placing a list of known or suspected drug allergies
Administering the preanesthetic drug

17. Nursing Responsibilities #3
Postanesthesia
Admitting the patient to the unit according to hospital procedure or policy
Positioning the patient to prevent aspiration of vomitus and secretions
Checking the airway for patency, assessing the respiratory status, respiratory tract for irritation, and giving oxygen as needed

18. Nursing Responsibilities #4
Postanesthesia (cont.)
Check blood pressure and pulse, IV lines, catheters, drainage tubes, surgical dressings, and casts
Review the patient’s surgical and anesthesia records
Monitor the blood pressure, pulse, and respiratory rate every 5 to 15 minutes until the patient is discharged from the area

19. Nursing Responsibilities #5
Postanesthesia (cont.)
Check the patient every 5 to 15 minutes for emergence from anesthesia. Suctioning is provided as needed
Exercise caution in administering opioids
Discharge the patient from the area to his or her room or other specified area

20. Question #1 Is the following statement true or false?
Anesthesia is the loss of feeling or sensation.

21. Answer to Question #1 True
Anesthesia is the loss of feeling or sensation. Local and general anesthesia are provided for pain relief and to perform otherwise painful procedures.

22. Question #2 Is the following statement true or false?
General anesthesia includes topical, local infiltration, and regional pain relief and is used when dealing with a specific area of the body and the patient can remain conscious.

23. Answer to Question #2 False
Local anesthesia includes topical, local infiltration, and regional pain relief and is used when dealing with a specific area of the body and the patient can remain conscious. General anesthesia requires multiple drugs and stages to achieve a state where surgical procedures can be performed without pain, movement, or memory.

24. Question #3 Is the following statement true or false?
Nursing responsibilities include tasks to assist, maintain, and recover a patient who has been given an anesthetic.

25. Answer to Question #3 True
Nursing responsibilities includes tasks to assist, maintain, and recover a patient who has been given an anesthetic.