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“
What are the types of
anesthesia?
”
 C A L
L O
 Localanesthesia is loss of sensation to a relatively small part of the body
without loss of consciousness to the patient.
 This procedure may be necessary when a relatively brief medical or dental
procedure is performed.
Classification of Local Anesthetics

 Esters
 Amides
Esters

 Contain an ester chemical linkage

 Incidence of allergic reaction is low
 Method of metabolism is plasma esterases
Amides

 Contain amide chemical linkage

 Incidence of allergic reaction is very low
 Method of metabolism is hepatic enzymes
 Longer duration of action than esters
Local Anesthetics

 Work by stopping axonal conduction

 Block sodium channels
 Stop conduction
Topical (Surface) Anesthesia

 Creams, sprays, suppositories

 Drops and lozenges
 Applied to mucous membranes
 Safe, unless absorbed in the systemic system
Infiltration (Field-Block)
Anesthesia
 Direct injection into tissue immediate to surgical site
 Blocks specific nerves near site
Local Anesthetics

 Prototype drug: lidocaine (Xylocaine)

 Mechanism of action: to stop axonal conduction by blocking sodium
channels
 Primary use: for brief medical or dental procedures
Epinephrine

 Constricts blood vessels

 Increases duration of anesthetic
Sodium Hydroxide

 Alkaline agent
 Increases effectiveness of anesthetic
 Used in areas of infection that may be acidic (from bacteria)
Local Anesthetics

 Adverse effects uncommon: may include

 CNS stimulation with early adverse effects
 CNS depression with later adverse effects
 Rash; allergies to sulfites used as preservative
 AL
I ON
R E G
Nerve-Block Anesthesia

 Direct injection into tissues that may be distant from surgical site
 Affects nerve bundles supplying surgical area
 Used to block sensation in a limb or large area of face
Spinal Anesthesia

 Injected into CSF

 Affects large, regional areas such as lower abdomen and legs
Epidural Anesthesia

 Injected into epidural space of spinal canal

 Used most often in labor and delivery
 R AL
EN E
G
General Anesthetics

 Block flow of sodium into neurons

 Delays nerve impulses and reduces neural activity
 Produces unconsciousness
 Produces lack of responsiveness to painful stimuli
Stages of General Anesthesia

 Stage I: Loss of pain

 Stage II: Excitement and hyperactivity
 Stage III: Surgical anesthesia
 Stage IV: Paralysis of the medulla
Inhalation Anesthesia

 Gases
 Nitrous oxide
 Volatile liquids
General Anesthetics: Inhalation

 Gaseous agents; volatile liquids

 Prevent flow of sodium into neurons in CNS
 Delays nerve impulses
 Produces reduction in neural activity
 Usually combined with IV agents
General Anesthetic: Inhalation Agents

 Prototype drug: nitrous oxide

 Mechanism of action: prevent flow of sodium into CNS; reduce neural
activity
 Primary use: with IV agents to maintain loss of consciousness; used alone
for dental procedures
 Adverse effects: nausea and vomiting, CNS depression, respiratory
difficulty, vital-sign changes, liver damage. Nitrous oxide has the potential
to be abused by users
General Anesthetic:
Inhalation Agents
 Prototype Drug ❘ Isoflurane (Forane)
 ACTIONS AND USES: rapid in onset. Provides excellent muscle
relaxation. Compared to other inhaled general anesthetics, cardiac output is
well maintained.
 ADVERSE EFFECTS: Mild nausea, vomiting, and tremor are common
adverse effects. respiratory depression and a reduction in blood pressure.
Malignant hyperthermia with elevated temperature has been reported.
General Anesthetics:
Intravenous
 Barbiturate and barbiturate-like agents
 Opioids, benzodiazepines
 Used in combination with inhalation agents
 Administered first
 Rapidly induce unconsciousness
Intravenous Anesthetics

 Act within a few seconds

 Used alone or in combination with inhalation agents: balanced anesthesia
General Anesthetic:
Intravenous Agents
 Prototype Drug ❘ Propofol (Diprivan)
 ACTIONS AND USES: indicated for the induction and maintenance of
general anesthesia. Emergence is rapid and few adverse effects occur during
recovery. Propofol has an antiemetic effect that can prevent nausea and
vomiting.
 ADVERSE EFFECTS :pain at the injection site, apnea, respiratory
depression, and hypotension.
Adjuncts to Anesthesia

 Medications given to
 Complement effects of general anesthesia
 Treat anticipated side effects of anesthesia
 May be given prior to, during, or after surgery
Barbiturate and Barbiturate-
Like Agents
 Induce unconsciousness
 Thiopental sodium (Penthonal)
 Methohexital sodium (Brevital)
Adjuncts to Anesthetics

 Prototype drug: thiopental sodium (Penthonal)

 Used in combination with inhalation agents
 Fewer side effects
 Produce unconsciousness quickly and amnesia
 Adverse effects: allergic reactions, dysrhythmias, respiratory depression
 CNS depression, shivering, headache
 Nausea and vomiting, vital-sign changes
 During postoperative period: hallucinations, confusion, excitability may
occur
Benzodiazepines

 Induce unconsciousness and amnesia

 Diazepam (Valium)
 Lorazepam (Ativan)
 Midazolam hydrochloride (Versed)
Opioids

 Fentanyl citrate (Sublimaze)

 Given with antipsychotic agent to produce neurolept analgesia
 a nd
c e ss
pro
rs i ng
Nu
Drugs for Local and
General Anesthesia
 Assessment
 Ascertain allergies to anesthetics
 Obtain complete health and drug history
 Assess for system disorders
 Obtain baseline vitals and labs
 Assess client knowledge and anxiety
 Assess skin
Drugs for Local and
General Anesthesia
 Nursing Diagnoses
 Risk for aspiration
 Risk for injury
 Deficient knowledge related to drug use
Drugs for Local and
General Anesthesia
 Nursing Diagnoses for General Anesthetics
 Anxiety related to surgical procedure
 Impaired gas exchange
 Nausea
 Disturbed sensory perception
 Ineffective breathing pattern
 Decreased cardiac output
Drugs for Local and
General Anesthesia
 Planning
 Goals
 No pain
 No side effects
 No adverse reaction
 Adequate anesthesia
Drugs for Local and
General Anesthesia
 Implementation
 Monitor cardio/respiratory side effects
 Monitor length of anesthetic effectiveness
 Provide client safety
 Monitor vital signs
 Monitor recovery from anesthesia
Drugs for Local and
General Anesthesia
 Evaluation
 Effectiveness of drug therapy
 Goals met
 Expected outcomes met
Thank you
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