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PTP 546 Module 15 Pharmacology of Anesthetics Jayne Hansche Lobert, MS, RN, ACNS-BC, NP 1Lobert
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Pharmacology of Anesthetics Anesthetic Agents – Characteristics Produce loss of consciousness and sensation Provide amnesia Relax skeletal muscles Inhibit sensory and autonomic reflexes Possess minimal side effects Rapid onset of anesthesia 2Lobert
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Pharmacology of Anesthetics Stages of Anesthesia – Stage I: Analgesia Somewhat aware but begins to lose somatic sensation – Stage II: Excitement/Delirium Appearance of agitation and restlessness – Stage III: Surgical Anesthesia Overall goal is to reach this stage quickly and maintain this stage for the duration of the surgery – Stage IV: Medullary Paralysis Reduction of Vitals: cessation of spontaneous respirations; BP issues cardiopulmonary collapse Would require intensive support 3Lobert
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Pharmacology of Anesthetics General Anesthetics – Inhaled Anesthetics Volatile Liquids: Desflurane; Isoflurane Gas: Nitrous Oxide – Intravenous Anesthetics Barbiturates Benzodiazepines Opioids Ketamine Propofol 4Lobert
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Pharmacology of Anesthetics Pharmacokinetics of General Anesthesia – Route: IV or Inhaled – Distribution: Widely distributed throughout body Highly lipid soluble deposits in adipose tissues – Metabolism & Excretion: Via Liver and Lungs 5Lobert
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Pharmacology of Anesthetics General Anesthetics – Action: inhibit neuronal activity throughout the CNS unconsciousness and amnesia; produces immobility and inhibits motor responses to painful stimuli – Therapeutic Effect: anesthesia allows for surgical intervention – Side Effects: residual effects may be associated with length of anesthesia, dose, age, adipose tissues 6Lobert
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Pharmacology of Anesthetics Local Anesthetics – Ex: Bupivacaine (Marcaine); Lidocaine (Xylocaine) Action: drug produces a loss of sensation in the specific body part or region Therapeutic Effect and Clinical Use: – Topical Administration & Transdermal administration – Infiltration anesthesia: injection into local tissues to be numbed – Peripheral nerve block: brachial plexus catheters with ropivacaine during and following shoulder arthroplasty – Central neural blockade: injectio into epidural/intrathecal/ spinal sac – Sympathetic block – Intravenous regional anesthesia/block: ex: veins drained and filled with anesthetic: numbing distal to extermity, example hand surgery. 7Lobert
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Pharmacology of Anesthetics Adjuvants in General Anesthesia – Preop Medications Barbiturates: decreases level of consciousness very quickly Benzodiazepines: decrease anxiety Opioids Antihistamines Antacids: position in surgery, no acid refulx. Anticholinergics- decrease secretions to keep from aspirating on own spit. 8Lobert
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Pharmacology of Anesthetics Adjuvants in General Anesthesia – Neuromuscular Blockers (paralyzing agents) Nondepolarizing Blockers – Pancuronium (Pavulon); Vecuronium (Norcuron) Depolarizing Blockers – Succinylcholine (Anectine) – Action: complete muscle paralysis; no analgesia; no anesthesia. – Side Effects: residual paralysis 9Lobert
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Pharmacology of Anesthetics Local Anesthetics – Side Effects: Extension of loss of motor function Potential for systemic effect – CNS symptoms somnolence, confusion, agitation and excitation – CV symptoms 10Lobert
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