1. Copyright © 2008 Lippincott Williams & Wilkins. Introductory Clinical Pharmacology Chapter 21 Anesthetic Drugs

2. Copyright © 2008 Lippincott Williams & Wilkins. Introduction Anesthesia (loss of feeling or sensation) is induced by various drugs to bring about partial or complete loss of sensation Types of anesthesia –Local anesthesia Pt fully awake, but does not feel pain in area that has been anesthetized –General anesthesia Senstation-free state for the entire body, loss of conscieousness. Anesthesiologist –Trained physician to administer anesthesia

3. Copyright © 2008 Lippincott Williams & Wilkins. Local Anesthesia and Types Local anesthesia –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. Copyright © 2008 Lippincott Williams & Wilkins. Local Anesthesia and Types Local anesthesia (cont’d) –Regional anesthesia: Injection of anesthesia around nerves to prevent sending pain signals Ex: epidurals

5. Copyright © 2008 Lippincott Williams & Wilkins. Medications to Recognize Local Anesthetics – lidocaine HCl (Xylocaine) – procaine HCl (Novocain) – bupivacaine HCl (Marcaine)

6. Copyright © 2008 Lippincott Williams & Wilkins. 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 –May Require fasting May need administration of sedative

7. Copyright © 2008 Lippincott Williams & Wilkins. Administering Local Anesthesia Mixed with epinephrine to cause local vasoconstriction Epinephrine contraindicated when used on an extremity (Fingers,Toes) Aware of when and when not to use epinephrine (Small vessels; nose, penis)

8. Copyright © 2008 Lippincott Williams & Wilkins. 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

9. Copyright © 2008 Lippincott Williams & Wilkins. Preanesthetic Drugs Given before administration of anesthesia May consist of one drug or a combination of drugs

10. Copyright © 2008 Lippincott Williams & Wilkins. Preanesthetic Drugs: Uses Used to decrease anxiety and apprehension immediately before surgery Used to decrease secretions of the upper respiratory tract Used to lessen the incidence of nausea and vomiting during the immediate postoperative recovery period

11. Copyright © 2008 Lippincott Williams & Wilkins. Selection of Preanesthetic 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

12. Copyright © 2008 Lippincott Williams & Wilkins. 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

13. Copyright © 2008 Lippincott Williams & Wilkins. 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

14. Copyright © 2008 Lippincott Williams & Wilkins. Medications to Recognize General Anesthesia Barbiturates and similar agents –Methohexital (Brevital); etomidate (Amidate); propofol (Diprivan) –Used for short surgical procedures; Benzodiazepines: Midazolam (Versed) –Short Acting; conscious sedations Ketamine (Ketalar) Gases –Nitrous oxide;

15. Copyright © 2008 Lippincott Williams & Wilkins. 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

16. Copyright © 2008 Lippincott Williams & Wilkins. 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

17. Copyright © 2008 Lippincott Williams & Wilkins. 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

18. Copyright © 2008 Lippincott Williams & Wilkins. 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

19. Copyright © 2008 Lippincott Williams & Wilkins. End of Presentation