1. Introductory Clinical Pharmacology Chapter 21 Anesthetic Drugs

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

3. Local Anesthesia and Types
Topical anesthesia: Application of the anesthesia to surface of skin, open area, mucous membrane
Local infiltration anesthesia: Injection of anesthesia into tissue
Dental procedures, suturing of small wounds, making an incision into a small area

4. Local Anesthesia and Types
Local anesthesia (cont’d)
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
Conduction blocks: Injection of anesthesia into or near a nerve trunk

5. Preparing Patient for Local Anesthesia
Take patient’s allergy history
Prepare the area to be anesthetized
Clean the area with antiseptic, shave the area if necessary
Require fasting
May administer intravenous sedative

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

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

10. Selection of Preanesthetic Drugs
May consist one or more drugs
Opioid or barbiturate may be given to relax the patient
Cholinergic blocking drug is given to dry secretions in the upper respiratory tract
Drug diazepam (valium) used for preoperative sedation

11. Nursing Responsibilities
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

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 the surgical procedure

13. Drugs used for General Anesthesia
Barbiturates and similar agents
Methohexital; etomidate; propofol
Benzodiazepines: Midazolam
Ketamine
Gases and volatile liquids
Nitrous oxide; enflurane; halothane; isoflurane; methoxyflurane; desflurane; sevoflurane

14. Drugs used for General Anesthesia (cont’d)
Opioids
Analgesic fentanyl; droperidol; remifentanil; neuroleptic drug
Skeletal muscle relaxants
Tracrium; nimbex

15. Stages of General Anesthesia
Stage 1 - Analgesia
Stage 2 - Delirium
Stage 3 - Surgical analgesia
Stage 4 - Respiratory paralysis

16. Nursing Responsibilities
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
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, and giving oxygen as needed

18. Nursing Responsibilities
Postanesthesia (cont’d)
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
Postanesthesia (cont’d)
Check the patient every 5 to 15 minutes for emergence from anesthesia; suctioning provided as needed
Exercise caution in administering opioids
Discharge the patient from the area to his or her room or other specified area

20. End of Presentation