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Balanced Anesthesia
Balanced Anesthesia
and amnesia Involves the following: Preoperative medications: includes the use of anti-cholinergics that decrease secretions to facilitate intubation and prevent bradycardia associated with neural depression. Sedative-hypnotics: to relax the patient, facilitate amnesia, and decrease sympathetic stimulation Anti-emetics: decreases nausea and vomiting associated with GI depression Antihistamine: decrease the chance of allergic reaction and help dry the secretions
Narcotics: aid analgesia and sedation Stages-of-Anesthesia.pdf(base on the succeeding paper) Types of General Anesthetic Agents: Barbiturates Non-Barbiturates Volatile liquids Gas anesthetics 1. Barbiturate Anesthetics -Intravenous drug that is used to induced rapid anesthesia combined together with other gas anesthetics Examples: Thiopental (Pentothal): very rapid onset of action and an ultrashort recovery period, no analgesic properties, additional analgesic is needed after surgery. Methohexital (Brevital): rapid onset and a recovery period of more ultrashort , cannot come in contact with silicone for it can cause breakdown of the silicone, lacks analgesic effects, its rapid onset can cause respiratory depression and apnea. 2. Nonbarbiturate Anesthetic -Anesthetic drug that is administered intravenously Examples: Midazolam (Versal): rapid onset, peak does not reach effectiveness for 30-60 minutes,
causes nausea and vomiting than other non barbiturates Droperidol (Inapsine): rapid onset, ultrashort recovery period, used cautiously for patients with renal or hepatic failure, may cause hypotension, chills, hallucinations and drowsiness after surgery. Etomidate (Amidate): ultrashort onset, rapid recovery period, commonly used for sedation of patients on ventilators, may cause myoclonic and tonic movements, nausea and vomiting during the recovery phase, not recommended for use in children younger than 10 y.o Ketamine (Ketalar): rapid onset and a very slow recovery period of (45 minutes), associated with a bizarre state of unconsciousness , causes sympathetic stimulation: increase BP & HR, crosses the blood brain barrier:hallucinations, dreams and psychotic episodes. Propofol (Diprivan): very short-acting anesthetic, rapid onset of action, often used for short procedures, causes burning sensation @ injection site, bradycardia, hypotension, pulmonary edema (extreme cases) 3. Anesthetic Gases -enters the respiratory system through the bronchi and alveoli and rapidly into capillary system for absorption
Examples: Nitrous Oxide (Blue cylinder): most potent, weakest among and less toxic, rapid onset and recovery, adminstered in combination with other anesthetics, can cause hypoxia (block reuptake of oxygen)-given together with oxygen Cyclopropane (orange cylinder): rapid onset of action and recovery, not good analgesic: can cause pain, headache, nausea, vomiting, and delirium during recovery phase Ethylene (red Cylinder): less toxic than any other agents, rapid onset and recovery, can cause headache and unpleasant taste in mouth 4. Volatile Liquids: -Either gas or volatile liquids those are unstable @ room temp and release gas.
Examples: Halothane (Fluothane): rapid onset and recovery, associated with vomiting, bradycardia, hypotension, risk for hepatic toxicity, metabolized in liver, causes recovery syndrome: fever, anorexia, nausea, vomiting, eventual hepatitis Desflurane (Suprane): rapid onset and recovery, causes respiratory reactions: cough, increased secretions and laryngospasm, not used for induction in pediatric patients. Enflurane (Ethrane): rapid onset and recovery, causes renal toxicity, cardiac arrhythmias, respiratory depression Isoflurane (Generic): rapid onset and recovery, causes muscle relaxation, associated with hypotension, hypercapnia, muscle soreness, bad taste in mouth. Methoxyflurane (Penthrane): slow onset and prolonged recovery, causes renal toxicity, respiratory depression, hypotension, rarely used except during labor & delivery Sevoflurane (Ultane): very rapid onset of action and very rapid clearance, very minimal adverse effects Therapeutic Action and Indication Action: Not known Depression of reticular activating system and cerebral cortex Indications: To produce sedation, hypnosis, anesthesia, amnesia, unconsciousness to allow performance of painful surgical procedures. Pharmacokinetics: Systemically absorbed throughout the body including CNS Metabolized: liver Contraindications & Cautions Contraindications: Status asthmaticus: difficulty in providing ventillatory support and risk of exacerbation of the problem with CNS depression Absence of suitable veins for IV administration
Cautions: Droperinol: with hepatic or renal failure CV disease, hypotension or shock Myasthenia gravis and conditions that may prolonged hypnotic effect Myasthenia gravis is a neuromuscular disorder. Neuromuscular disorders involve the muscles and the nerves that control them. Myasthenia gravis causes weakness of the voluntary (skeletal) muscles. Voluntary muscles are those that are under your control. In other words, you think about moving your arm, and it moves. The muscle weakness of myasthenia gravis worsens with activity and improves with rest. The muscle weakness can lead to a variety of symptoms, including: Breathing difficulty because of weakness of the chest wall muscles Chewing or swallowing difficulty, causing frequent gagging, choking, or drooling Difficulty climbing stairs, lifting objects, or rising from a seated position Difficulty talking Drooping head Facial paralysis or weakness of the facial muscles Fatigue Hoarseness or changing voice Double vision Difficulty maintaining steady gaze Eyelid drooping Adverse effects Circulatory depression: hypotension, shock, decreased C/O, arrhythmias Respiratory depression: apnea, laryngospasm, hiccups, coughing, nausea, vomiting, prolonged somnolence, delirium
Nursing management
Infiltration: involves injecting of the drug directly into the tissues to be treated Field block: involves injecting the drug all around the area that will be affected by the surgical procedure. Nerve block: involves injecting the drug at the point along the nerve or nerves that run to and from the region in which the loss of pain sensation or muscle paralysis is desired. Therapeutic Actions & Indications: Action: temporary interruption in the production and conduction of nerve impulses Indications: for infiltration anesthesia, peripheral nerve block, spinal anesthesia and the relief of pain Contraindications and Cautions: Contraindications: known allergy, heart block, shock Adverse effects: CNS: headaches, restlessness, anxiety, dizziness, tremors, blurred vision, and backache GI effects: nausea, vomiting CV effects: peripheral vasodilation, myocardial depression, arrhythmias, BP changes that may lead to cardiac arrest and respiratory arrest.
LOCAL ANESTHETIC DRUGS Drugs that only cause a loss of sensation to a specific part of the body. Used primarily to prevent the patient from feeling pain for a certain period of time Very powerful nerve blockers Modes of administration Topical: involves application of a cream, lotion, ointment or drop of a local anesthetic
Nursing management