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Anesthesia Agents and Adjuncts

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by

Aimee Wilson

on 7 September 2012

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Transcript of Anesthesia Agents and Adjuncts

Orientation and Review for PACU Nursing Anesthesia Agents and Adjuncts Stage I: Stage of Anesthesia and Amnesia
loss of consciousness
follows simple commands
protective reflexes intact Stages of Anesthesia Stage II: Stage of Delirium (common state on admission to PACU)
loss of consciousness to loss of lid reflex
respirations irregular
excitable state also deemed "danger zone" due to possibility of vomiting, larnygospasm, cardiac arrest, emergence delirium Stage III: Stage of Surgical Anesthesia
cessation of spontaneous respirations
absence of eye responses and swallowing reflex Distribution:via alveoli to blood stream
Uptake: highly perfused regions
Elimination: slowest from poorly perfused Inhaled Agents Recovery takes place in the reverse order
brain: impair CNS transmission
airway: depress spontaneous respirations;
obtund reflexes, dull ventilatory response to hypoxia/hypercarbia
cardio: ectopy, tachycardia, fibrillation all possible
muscular: smooth muscle relaxation used with volatile agents (weak anesthetic)
strong analgesic (inhanced with narcotics)
increased nausea (air trapping)
minimal cardio effects
increases cerebral blood flow/ICP
offset in 5-10 mins. assuming adequate ventilation Nitrous Oxide the "flurane's"
Isoflurane
Desflurane
Sevoflurane Volatile Agents -promotes and potentiates neuromuscular blockade
-peripheral vasodilator (shivering)
-hypercapnic response not blunted
-stabilizing cardio effects; coronary artery vasodilator, less incidence of brady arrhythmias
-absorption/secretion almost exclusively by lungs
-rapid recovery/emergence Isoflurane -least lipid soluable
-can decrease BP (dose dependant)
-no predisposition to arrhythmias
-not recommended for pediatrics (airway irritation)
-absorption/excretion almost exclusively by lungs
-no lingering anesthesia effect-extremely rapid onset/offset Desflurane -least airway irritation
-no predisposition to arrhythmias
-may be useful in patients with hepatic or renal insufficiency
-produces dose related uterine contractility and tone-may contribute to blood loss Sevoflurane -deep breathing and stimulation for offset and to decrease lingering effects
-knowledge of offset to assessment of CNS effects and need for pain medication
-knowledge of potential adverse effects of each agent
-knowledge of level of anesthesia on admission Nursing Considerations of Inhaled Anesthetics Nondepolarizing muscle relaxants Neuromuscular blockade agents bind to postsynaptic receptors of skeletal muscles impairing contraction
do not cross blood-brain barrier so no CNS effects
potentiated by many drugs, physiological imbalances Pharmacodynamics short-acting
no histamine release
appears to have no cardiovascular effects
onset: 1 min.
duration: 15-20mins.
elminated by kidneys/liver Rocuronium Vecuronium intermediate acting
no histamine release
minimal cardiovascular effects
onset: 3-5 mins.
duration: 20-35 mins.
excreted by liver/kidneys ultra-short acting (5 minutes)
used in rapid sequence intubation
Use in children, neuromuscular injury, chronic illness: controversial and potentially dangerous
can cause cardiac standstill due to intracellular release of potassium
no reversal agent Depolarizing Muscle Relaxant:
Succinylcholine over power effects of NDMR's
Neostigmine (most common used at FAHC) Non-Depolarizing Muscle Relaxant Reversal Agents
Onset within 7 minutes
Duration 60 minutes
Can Cause: bradycardia, bronchospasm, enhanced secretions
Given in conjunction with glycopyrrolate Neostigmine Impair communication between peripheral nervous system and CNS
Two Types: Esters and Amides Local Anesthetics Onset:
amides faster
how lipid soluble they are
adding bicarbonate speeds onset Pharmacokinetics Absorption:
dose
blood flow to site
additives (vasoconstrictive) Duration:
directly proportional to lipid solubility and protein binding Influenced by:
Site of injection (intercoastal -caudal-epidural-brachial plexus-spinal-femoral) Potential for Local Anesthetic Toxicity Toxicity:
CNS (circumoral numbness-lightheadedness-tinnitus-slurred speech)
Cardio (hypertension to hypotension, bradycardia, PVC's, prolonged PR and QRS, then collapse) Treatment:
administer O2
administration of IV intralipids
Ephedrine, atropine Cocaine-Duration: 10-55 mins. (local only)
Chloroprocaine-Duration: 15-30 mins. (local, peripheral, epidural)
Tetracaine-Duration:120-240 mins. (topical, spinal)
Lidocaine-Duration: 60-120 mins. (local, topical, IV Block)
Mepivacaine-Duration: 45-90 mins (local, peripheral)
Bupivacaine-Duration: 120-240 mins. (local, peripheral, epidural, spinal)
Ropivacaine-Duration: 240-360 mins. (local, peripheral, epidural, spinal) Common Regional/Local
Anesthetics
Used At FAHC IV Bier Blocks
Peripheral Nerve Blocks
Intrathecal Blocks (Spinals)
Epidurals Regional Anesthesia Bier Blocks
duration related to tourniquet time
no analgesia once circulation restored Nerve Blocks
Cervical Plexus (Carotids)
Supraclavicular (shoulders, ulnar nerve)
Intercostal (TAP)
(thoracic, upper abd.)
Femoral
(total knee) nerve roots and part of spinal cord
agent injected below L1-L2
Usually mixed with dextrose to make solution hyperbaric
patient position can influence level
Spinal level above T-10 worrisome vagal nerve
Level above T-8 possible risk for respiratory/vagal nerve involvement
NO reversal Spinal Anesthesia RISKS
systemic absorption/toxicity
vascular block
other nerves blocked
higher level spinals can cause sympathetic blockade
Hypotension, bradycardia
Treatment: atropine, elevate legs, fluids, vasopressors Spinal Management nerve root, spinal cord, and paravertebral nerve anesthesia
less sympathetic block than spinal
greater amounts (continuous or PCA) needed for anesthesia
higher chance of systemic toxicity than spinal
greater chance of dural puncture headache Epidural Anesthesia Any patient with spinal/epidural needs education
Report severe headache (worsens with position changes)
Usually 24-72 hrs. post
associated with neck ache/stiffness, backache, nausea
Dural Puncture Headache Reverse Order of Loss of Function
1. Proprioception returns
2. Movement returns
3. Feeling of touch returns
4. Pain if felt
5. Sense of temperature returns
6. Autonomic/sympathetic function returns (bladder fx.) Spinal Anesthetic
Resolution Sequence Pharmacodynamics
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