Applying nursing theory to the practice of
nurse anesthesia
SUSAN A. MARTIN, CRNA, MSN
Destin, Florida
With the currentmovement of anesthesia
education into graduateprograms, changes
in curriculumare inevitable. These changes
will include advanced nursingtheory. How
the issues of nursingtheory apply to the
practiceof nurse anesthesiaare examined.
Applications of Betty Neuman's systems
theory are used in specific examples of the
anesthesia role. The profession of nurse
anesthesia may benefit significantlyfrom the
contributionsof nursing theory.
Key words: Graduate education,
Neuman systems model, nursing,
nursing theory.
Introduction
The practice of nurse anesthesia has been histori-
cally defined from a functional perspective. This
is readily illustrated by reviewing the Scope of
Nurse Anesthesia Practice as defined by the Amer-
ican Association of Nurse Anesthetists. (AANA).P 2)
This publication summarizes 11 functions that out-
line and define the scope of practice of the nurse
anesthetist. The majority of functions described
are primarily "technical" in orientation, such as
item f, which states that the scope of nurse anesthe-
sia practice includes managing a patient's airway
and pulmonary status using endotracheal intuba-
tion, mechanical ventilation, pharmacological sup-
port, respiratory therapy, or extubation.
August 1996/Vol. 64/No. 4
Other functions addressed by the AANA re-
flect judgment-related challenges for the nurse an-
esthetist, such as selecting the appropriate anes-
thetic technique. When compared with current
nursing practice acts, the scope of practice as de-
fined by the AANA in 1992 is devoid of a concep-
tual or theoretical framework. The AANA has
stated in its Standards for Nurse Anesthesia
Practice its belief that "Standards, based upon
sound philosophy, theory, science and principles,
serve to upgrade clinical practice."'1 p4)
The goal of this article is to explore existing
theoretical principles of nursing and their poten-
tial application in nurse anesthesia education and
practice. The significance of this goal is accentu-
ated by the Council on Accreditation of Nurse An-
esthesia Educational Programs' Standards for Ac-
creditation, which states that accredited programs
must "design a curriculum that will award a mas-
ter's or higher degree level to students who will
enter the program on or after January 1, 1998, and
who successfully complete graduation require-
ments." 2 The National Commission on Nurse An-
esthesia Education explains that the AANA has
gradually increased the educational requirements
in response to the demand for more complex ser-
vices [which require] expanded knowledge and
technological capabilities." 3 This Council further
requires that a program must adopt a curriculum
plan and/or program design that is within the con-
struct of graduate education. Requirements for
graduate nursing education as determined by the
369
National League for Nursing include a mandate
"to expand knowledge of nursing theory as a basis
for advanced nursing practice." 4 Subsequently,
nursing theory courses are becoming mandatory
curriculum in nurse anesthesia programs that are
housed in colleges of nursing.
The appropriateness of the medical model tra-
ditionally used as a framework in nurse anesthesia
programs is now being questioned, just as in the
past nursing professionals and educators had ques-
tioned the use of the medical model in nursing.
The medical model is described by Englehardt as
"rejecting philosophical speculation and giving
way to rational or logical decision making. Physi-
cians use their clinical experience and observation
of patients as a basis for developing reliable diag-
noses and treatments. The goal has been in the
'tacit knowing' of medicine." 5 Englehardt goes on
to support the notion that medical practice, too,
can benefit from a theoretical basis which may add
an "analytic regard" to the tacit knowledge.
The question is simple: if the AANA feels that
graduate education is important enough to man-
date it as a curriculum requirement, should not we
then consider changes in the framework within
which CRNAs practice? Unfortunately, the answer
or solution is not so simple because nurse anesthe-
tists must first recognize a theoretical void in their
practice (considering that one of the problems our
profession faces is the notion that we are techni-
cians and further considering that any profession
must, by definition, be supported by a conceptual
framework) and decide that it may be filled by the
inclusion of a theoretical framework. Developing
theory is not a simple undertaking. Perhaps the
profession of nurse anesthesia would be better
served by adopting and adapting theoretical
nursing models on which the practice of nursing
has been based. To facilitate a better understand-
ing of nursing theory and nursing practice, it is
necessary to review nursing theory in practice.
Review of literature: Nursing theory in practice
Practice is sometimes viewed as the "down to
earth action carried out by the doers," while the-
ory is viewed as somewhat esoteric, in some cases
unnecessary or at best, marginal. 6 Nursing theory
influences nursing practice in a variety of ways.
Fawcett suggests that nursing theory distinguishes
nursing from medicine by directing our actions
and controlling the clinical environment. 7 This is
accomplished through the ability of the theory to
define the arena of nursing by defining clinical
problems to be considered, settings in which nurs-
ing practice occurs, legitimate recipients of nurs-
ing care, and nursing process, format, and content.
370
Nursing models serve as the basis for clinical infor-
mation systems (admission forms, care plans, and
discharge summaries, to name a few). Conceptual
models also guide the development of patient clas-
sification systems. Fawcett states emphatically that
"nursing models were devised to move nursing
away from ritualistic and task-oriented care to
thoughtful practice." 7 They were created to "shape
nursing into what it ought to be." 7
Speedy claims that nursing theory explains
our practice by changing the way nursing is
understood. 6 This is accomplished through the
testing of nursing theory in the clinical arena.
Adapting basic scientific knowledge (validated by
research) is the primary determinant of nursing
practice. "Nursing practice so based in theory and
research has a firm foundation far removed from
trial and error, guesswork or intuition."6
Allen asserts that nursing theory empowers
nurses to question the status quo. He points out
that the aim of critical theory is to expose the con-
tradictions, oppression, and power imbalances that
inhibit the freedom and autonomy needed to de-
velop as a profession. 8 This requires the establish-
ment of open, unconstrained communications,
which will better assist patients in making in-
formed choices about their care.
Critics of nursing theory argue that the pro-
cess of incorporating nursing theory into practice
may be too difficult to realistically achieve at the
bedside. The application of theory may require
greater conceptual sophistication of theoretical
ideas, 8 theories are often too vague and abstract to
apply,8 the models are limited by the values and
beliefs of their originators, 9 and the credibility of
nursing models is challenged when the patients
see no difference in nursing care when a theoreti-
cal framework is used. 10 Although the criticisms
may be valid for generalists in nursing whose prac-
tice incorporates a wide range of specialties and
skills, advanced specialty practitioners may bene-
fit from an easier application of conceptual frames
of reference by virtue of the more narrow focus of
their practice. Benner defends nursing theory in
practice by asserting that nurses are using theory
in their daily practice but are unaware of the basis
for their competence."
With these arguments and assertions in mind,
Betty Neuman's nursing thoretical framework will
be applied to the practice of nurse anesthesia.
Neuman's theory is only one of several nursing
theories that could be appropriately applied to an-
esthesia. Neuman has been chosen due to her ori-
entation with systems theory, an approach that in-
volves processes and outcomes and, thus, seems
most appropriate to the practice of anesthesia.
Journalof the American Association of Nurse A nesthetists
The Neuman systems model
Neuman's model is based on an individual's
relationship to stress, the reaction to it, and recon-
stitution factors that are dynamic in nature. 12 The
aim of this model, called the total person approach,
is to provide a unifying focus for approaching var-
ied nursing problems and for understanding the
basic phenomenon: man and his environment.
Neuman's theory is neatly classified as a systems
theory that evaluates processes and outcomes to-
ward greater organization. The person is defined
by Neuman as an open, holistic system interacting
with and to the environment. The environment is
defined as "all that interfaces with the person."' 2
The environment is the source of stressors for
the person that has the potential of disrupting the
person's normal lines of defense (a normal range
of responses to stress). Stressors may be beneficial
or noxious depending on the strength of the flexi-
ble line of defense (an individual's combination of
responses to stress). With humans in a constant state
of change, interacting with the environment, vary-
ing degrees of wellness exist. If a person's total
needs are met, that person is in a state of optimal
wellness. Conversely, a reduced state of wellness is
the result of unmet needs.
Three key concepts in Neuman's theory are
stress, homeostasis, and patient perceptions. The
nurse's role is to focus on variables affecting the
person's response to stressors, allaying risk factors
associated with them. The nurse assesses, manages,
and evaluates the patient, acting to impede states
of disorder. Interventions by the nurse, "can begin
at any point at which a stressor is either suspected
or identified. One would carry out the interven-
tion of primary prevention since a reaction had
not yet occurred, though the degree of risk or haz-
ard was known or present. The intervener would
attempt to reduce the possibility of the individual's
encounter with the stressor or in some way attempt
to strengthen the individual's flexible line of de-
fense to decrease the possible reaction."12
The impact of multiple stressors can reduce
the effectiveness of the person's buffer system al-
lowing a reaction to a stressor to occur.
Discussion: Applying the Neuman systems model
to anesthesia
Nurse anesthetists are nurses first, and as such
view their role in terms of assessing, planning, im-
plementing, and evaluating the care of the client.
The unique scope of practice of the nurse anesthe-
tist differs significantly from the other nursing spe-
cialties in that its primary focus includes:
1. Preanesthetic preparation and evaluation.
August 1996/ Vol. 64/No. 4
2. Anesthesia induction, maintenance, and
emergence.
3. Postanesthesia care.
4. Perianesthetic and clinical support func-
tions. 2)
These functions of the nurse anesthetist, when
considered in light of Neuman's framework, strive
to support the normal line of defense of the client
by impeding the stressors the client experiences
(or remembers). The majority of actions carried
out by the nurse anesthetist are directed at decreas-
ing physical and emotional stress from the initial
preoperative counseling, through the administra-
tion of anxiolytics, vagolytics, and anesthetics, to
the postoperative follow-up visit. Neuman's theory
also emphasizes the promotion of homeostatic bal-
ance in the maintenance of the person's whole sys-
tem. Homeostasis is a concept that is well inte-
grated in current anesthesia practice as evidenced
by the constant vigilance required of the anesthe-
tist during the delivery of anesthesia nursing care.
Neuman believes that although nurses receive
training in the natural and behavioral sciences,
they are expected to conceptualize it in their own
way. She has developed many applications of her
theory in order to provide meaningful ways of in-
corporating conceptual frames of reference into
practice. One such way is in her assessment tool.
This tool relates to the total person and considers
three basic principles:
1. Good assessment requires knowledge of all
the factors influencing a patient's perceptual field.
(The identification of these factors takes place dur-
ing the preanesthetic assessment.)
2. The meaning that a stressor has to the pa-
tient is validated by the patient as well as by the
caregiver. (This is demonstrated in the preopera-
tive classification of anxiety that serves to identify
three distinct coping patterns in patients facing
surgery. Nurse anesthetists may choose to give spe-
cial counseling to patients classified with high- or
low-level anticipatory anxiety, since these are asso-
ciated with lack of participation by the patient dur-
ing the postoperative period.)
3. Factors in the caregiver's perceptual field
that influence assessment of the patient's situation
should become apparent. (This principle is obvi-
ated by the use of the preanesthetic evaluation in
developing the perioperative care plan.)
These few examples illustrate the ease and
appropriateness of applying nursing theory to the
practice of anesthesia.
Summary
Since nurse anesthesia programs have pro-
gressed to the realm of graduate education, it is
371
fitting that theoretical frames of reference be in-
corporated into the practice of nurse anesthesia.
As demonstrated in this article, this task can be
easily accomplished and appropriately applied to
the practice of nurse anesthesia. The primary ob-
stacle with using nursing theory is not its complex-
ity but the reluctance of the practitioners to accept
nursing theory as a vital part of their professional
development. This reluctance seems inconsistent
with the usual dialogue of professionalism. A
stronger foundation in nursing and a conceptual
framework from which to practice are only a cou-
ple of the contributions made by nursing theory to
nurse anesthesia. Further contributions have yet to
be explored in the new marriage of anesthesia and
graduate education.
REFERENCES
(1) Guidelines and Standards for Nurse Anesthesia Practice. In: Pro-
fessionalPractice Manualfor the Certified Registered Nurse Anesthetist. Park
Ridge, Illinois: American Association of Nurse Anesthetists. 1992.
(2) Annual Report of the President, 1989. 56th AANA Annual Meet-
ing, Boston, Massachusetts. AANA NewsBulletin. Special Supplement.
1989;43(10):11-15.
(3) Report of the National Commission on Nurse Anesthesia Educa-
tion. Introduction. AANA Journal.1990;58:389-393.
372
(4) Council on Accreditation of Nurse Anesthesia Education Pro-
grams. Official Council Listings. AANA Journal.1993;61:630-638.
(5) Engelhardt H. Tristam EH, Jr. ClinicalJudgement: A Critical Ap-
praisal Boston, Massachusetts: D. Riedel Publishing Company. 1979.
(6) Speedy S. Theory-practice debate: Setting the scene. The Austra-
lian Journalof Advanced Nursing. 1989;6:12-20.
(7) Fawcett J, Archer CL, Becker D, et al. Guidelines for selecting a
conceptual model of nursing: Focus on the individual patient. Dimen-
sions of Critical Care Nursing. 1992;11:268-277.
(8) Allen DG. Nursing research and social control: Alternative mod-
els of science that emphasize understanding and emancipation. Image J
Nurs Sch. 1985;17:58-64.
(9) McKenna HP. The selection by ward managers of an appropriate
nursing model for long-stay psychiatric patient care. J Adv Nurs.
1989;14:762-775.
(10) Fawcett J. Conceptual models and nursing practice: The recipro-
cal relationship. JAdv Nurs. 1992;17:224-228.
(11) Benner P. From novice to expert. Am JNurs. 1982;82:402-407.
(12) Neuman B. The Neuman Systems Model. Norwalk, Connecticut:
Appleton-Century-Crofts. 1982.
AUTHOR
Susan A. Martin, CRNA, MSN, is a recent graduate of Southern
Illinois University at Edwardsville Nurse Anesthesia Program. She
currently practices at Ft. Walton Beach Medical Center and Emerald
Coast Day Surgery Center. She has earned two previous degrees in
nursing: A BSN from Abilene Christian University in Abilene, Texas,
and an MSN from the University of Texas Health Science Center in
Houston, Texas. Her work experience is primarily in intensive care
units, including cardiovascular, liver transplant, and pediatric units in
Houston and Los Angeles.
Journalof the American Association of Nurse Anesthetists
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Etrasystole, Vntricuar
HeartBlock, Tachycardia
administered toanepileptic patientwthere maybea riskofseizure during.nrecoveryphase.adults andchildren, attentionshould
bepaidtominimize pain on adminrtration of DIPRtAN Injectable Emulsion. local
Trnsent minimized
pan canbe ifthe larger veins Hypertension,
oftheforearmorantecubital fossa areusedPainduring intravenous injecton mayalso bereduced byprorinjectionofIVlidocane Myocardial Infarction,
Sedation ICU Sedation MyocrdialIchomia,
(1mltofa 1%solution). Painor injection occurred frequently inpediatric patients (45%)whenasmallveinofthehandwasutilized Cardiovascuiar Bradycardia Bradycordia,
withoutlidocainepretreatment. Withlidocalne pretreatment or whenantecubital veins wereutilized, pan wanminimal(incidence Hyoeso' Decreased
Premature Vntricuiar
lessthan10%)andwelltolerated.Venous sequelae (phetis orthrombosis) nave beenreported rarely(<1%).Intwowell-controlled Contractions, ST
Pd:17%/] Cardiac Output,
SHypertension SegmentDepression,
cliical studies usingdedicated
inductionIntraartenal
patients,
injection
intravenous
in animals
and,otherthanpain,therewerenomajorsequelae.
cathetrs,
didnotinduce
no intancesof venous
localtissueeffectsAccidental
Intentional
sequelae wereobserved
injection
itra-aiterial
injectionintosubcutaneous
up to 14daysfollowing
hanbeenreported
onperivascular tissuesof
in %
Pnds:8%
(seealsoCLINICAL
Hpotension
Supraventricular
Tachycardia, Tchycardia,
animalscausedminimal tissuereaction. During the potmadetingperiod, therehavebeenrarereports of lecalpain,swelling, PHARMACOLOGY) Ventricuiar Fibrillation
blisters,and/or tissuenecrosis folowig accidental eoravasatios ofDIPRIVAN Injectable Emulsion. Pan operativemyoclonia, rarely CentralNervous Central Nerous
including conlsionsandopisthotonos, has occurred intemporal relationship incanes inwhichDIPRPAN Injectable Emulsion han Movement[Peds 17%) System Abnormal Dreams, Chills/Shivering,
System: Amorous Intracranial
beenadministered. Clinical features of anaphytuos, whichmayinclde angioedema, broechospasm, erythema, andhypatension, Site: Buming/Stinging Agitation,
Injection
occur raNlyfollowingDIPRIVAN Injectable Emulsion administration, althogh useof otherdrugs in mostinstances makes the Behavior, Anxiety, Hypertension,
or Pan,17.6% BcigJri Seus,
relationship toDIPRPAN Injectable Emulsion unclearThere havebeerrarerepotsof pulmonary edemaintemporal relationship to (Pods. 1(1%) g Chil
Thrashing, Somnolence,
the administration ofDIPRIVAN Injectable Emulsion, although a causal relationship is unknown. DIPRIVAN Injectable Emulsion han Metaholic/Nutritional: Hyperipomia'
no vagoyticactivity. Reports of bradycardia, anysole, rarely,
and cardiac arresthavebeenassociated withDIPRPJAN Injectable Respiratory: Anes Respiratory Shivering,
Myoclonic
Clonic/
Movement,
Thinking
Abnormal
Emulsion. Theintravenos administation ofantcholinergic agents (og,atropine orgycopynolale) should be considered to modify (seealsoCLINICALAcidosis
potential increaesan vagaltone dueto concomitant agents (a, succanyichotine) orsurgicalstimuli. PHARMACOLOGY) During Combativeness,
leeinleCregeHSedaiOn: ad DOAGEANDAMINISTRATION, Handling Prtcedre.)Theadministration Confusion, Delirium,
(SeeWARNIMGS Weaning* Depression, Dziness,
(>5
of DIPRIVAN Injectable
min)inorderto minimize
Dosage.) Patients
Emulsion

shouldbemonitored
shouldbeiitiatedasacontinuous
hypotension andavoidacuteaverdosage.
for earlysigns of ugniffantl
infusionandchanges

i'V
(SeeCLINICAL
inthe rateofadministration
PhARMACOLOGY
and/orcardiovascuar depression,
madeslowly
- Individualiation
whichmaybe
of
Skinand
Appendages: Rush [Peds: 5%] Emotional
Euhoria,
Lability,
Fatigue,
profound.Theseeffectsare responsive to discontinuation of DIPRN Injectable Emulsion,/ ffuid administration, and/or Eventswithoutan'or % hadanincidence of1%-3% Hallucinations,

vasopressortherapyAs withothersedative medications, thereis wideinterpatient variabilrty inDIPRPVAN Injectable Emulsion Incidenceofevents3%to10% Headache, Hypotonia,
dosagerequirements, andtheserequirements maychangewithtime.Failureto reducethe infusionratein patentsreceiving Hysteria, Insomnia,
DIPR VANInjectable Emulsion forextendedperiodsmayresuRinexcessively high blondconcentrations of the drug.Thus, titration Moaning, Neuropathy,
Incideeseless thn 1%-ProbabhCausally Related
toclinical responseanddailyevaluation of sedation levels areimportantduringuseof DIPRIUAN Injectable Emulsion infusionfor Opisthotonos,
Seizures,
Rigidity,
Somnolence,
CU sedation, especiayoflog duration. Opioids andparalytic agents shouldbedicontinued andrespiratoryfunction optimized
proto wens patients trammechanical vestitation. Infusions ofDIPRraAN ljectable Emubson shouts beadjusted tomaintain a Anesthesia/MAC Tremor,Twitching
level
right ofsedation priortoweaning pahientu froes mechanical vesidatory support. Thmnughoid twweaning processthhr level of Sedation ICU Sedation Digestive: Cramping, Diarrhea, linus,Liver
sedation maybe maintained in theabsence of respiratory depression. Because of the rapidclearance of DIPRIVAN Injectable Bodyas a Whole. Anaphyaxis/ DryMouth,Eniarged Function
abruptdiscontinuation of a patient's infusionmayresultin rapidawaeningofthe patientwithassociated anxiety, Anaphylactoid Parotid,Nausea, Abnormal
Emulsion,
agitation,and resistanceto mechanical ventilation, making weaningfrom mechanical ventiationdificult. I is therefore Reaction, Swallowing, Vomiting
recommended thatudministration of DIPRIVAN Injectable Emulsion be continued in orderto maintain a tightlevelof sedation Perinatal Disorder Hematolugic/
throughout the weaning process until10-15 minutes priorto extubationat whichtimethe infusion canbe discontinued. Since Cardiovacuar Premature Atrial Lymphatic: Coaguation Disorder,
DIPRIANInjectable Emulsionasformulated in an oil-is-water emulsion,elevations in serumtriglycerides mayoccurwhen Contractions, Leukocytssis
DIPRIVAN InjectableEmulsion is administered forextendedperiodsoftime.Patients atriskof hyperiipldemia shouldbemonitored Syncope Injection Site: Hives/ltching, Phlebitis,
for increaesis serum triglycerides orserumtudidty.Administration of DIPRIVAN InjectableEmulsion shouldbeadusted if fatis Central Nerous Redness/Discoloration
beingloadequately cleared fromthebody.Aredaction inthe quatityofcoecurrntlyadministeredlipids isindicated tocompensate System: iypertonialDystoria,
Paresthesia Agitation
Metabolic/
Nutritional: Hyperkalemia, BUNIncreased,
fortheamount of lipidinfused anpartofthe DIPRIVAN Injectable Emulsion formulation; 1 rt of DIPRIVAN Injectable Emulsion

zinc zinc. zinc

approimately 0.1 g of fat(1.1kcal).Inpatients whoarepredsposed to deficiency such asthosewith bums, diarrhea, Digestive: pemalivahon Hyperipemia Creatinine
contains
need for supplemeotal should be considered during prolonged therapy with DIPRIVIt Injectable Mucculosknletal: Malgia Increased,
and/onmajor sepsis, the
Emulsion. EDTA ina strongchetetor oftracemetals - including Calcium disodiom edetate hasbeen usedingramquantities Respiratory: Wenng Decreased Dehydration,
to treatheavymetaltoxicity. Whenusedinthismanner is it possible zinc
thatanmuchas10 mgof elemental cabe lest penday Lung Function Hyperglycemia,
viathismechanism. Although withDIPRIVAN Injectable Emulsion therearesoreports zinc
of decreaned levels orzincdeficlency-
holiday
Skinand
Appedages: ushing, Pruritus Acdosis,
related adverse events, DIPRPAN Injectable Emulsion should not be inused for loger than 5 days withoat providing adrug
to safelyreplaceestimated on measured zinc
urine losses.Athighdoses(2-3gramsperday),EDThasbeenreported, onrare SpecialSenses: Amblyopia
Urugenital: Cloudy Unine GrnenUrine
Osmolality
Increased
occasions, tobetosic to6we rendl tubules. Studoes-to-date, in paents withnormal unimpaired rend lonction have nofshown any
ahleration hrmonat fuschion withDIPRIVAN Injectable Emulsion certaiig t.Ug5% dosodiom edetate. Inpahiests atroleforrendl Respiraory: Bronchospasm, Hypoxia
imponrment urinalysle andurine sedenent shouts bedreckod befame ishtation ofsedation and then bemositmred onatnmate days Incideeceestleoan 1%-CaualRelatnship Unidowe Burning in Throat,
during sedation. Thelong-term admlehrtcahion of DIPRFAN Ijectable Emuo topahients withomnal failure and/or hopatic Cough,Dyspnea,
insidhicwncy han nothben evaluated. Hiccough,
Nernnerglel Aseitesla: When DIPRIVAN Injectable Emulsion is used anpatients withincreaned istracranidl pressure sr AnesthesialMAC
Hypervnntilation,
impaired corebodl carcutation, uigreticast decreanes inmean arterial pomssure shouts beavoided because of6we omsuftat decreases BodyasaWhole. Asthenia, Sedation ICU Sedation
Hypoventitation,
Awareness, Fever, Sepsis, Hypooia, Laryngospasro,
in cerebral perfusion premeure. Toavoid uigodicairt hypoeensioe and decreases an
cerebodl perfusion pressure, aniofusion orsiow ChestPain, Trunk Pan,
bolos ofapprooimately 2itmgevnryig seconds shouts beuliandisstead ofrapid,roam frequent, and/or tarpon bolases of Pharyngitis, Snoozing,
dosage Extremitles Pain, Whole Body Upper
DIPRtrAN Injectable Emulsion. Slower induction titrated toclisical maspoeses willgenerally mshlin reduced inauto Fever, Weakness
Tachypnna,
requirements (1 to 2 mgkg).When increused ICPhrsuspected, hyperenbiation andhypocathia shouts accompany the Increased Drug Effect,
AirwayObstruction
admioistrahion ofDIPRIVAN Inectable Emulsion. (See DOSAGE AND ADMINISTRATION.) NeckRigidity/Stiffness,
Skinand
Can Ameslteel: Slower rates ofadminstation shoots beutiloed anpremedicated pahierts, gesuatric pahients, pahients with TrunkPain
Appendages: Conunctival Rush
recant Void sthat, orpahiests who arehemodynarocally unstable. Anyffuid deticits shouts beconoected priortoadminstrahion of Hyperemia,
Cardiovacuar Arhythmia, Atrial Arrhythmia,
DIPRIVAN lsjectable Emulsion. Inthmse paherts where addithooal ffuldfoerapy maybecoetmaiodicated, othermessuoms, ng, Fibrilahtion, Adial
Daphoresis, Urticaria
elevation oflower eotremeties, ormae of premser agents, may beuseful to offoet 6we hypatenoior which isansociated with6we AtrioventricularHeartFibrilation, SpecialSenses: Diplopia,EarPain,
induction ofasesthesia withDIPRIVAN Intale Emulsion. Block.Bgeminy, Bgeminy,
EyePain,Nytagmus,
leemnose leraPees: Patients shouts beadvhred thatperformance ofactivities requiring reetl aletes, such usoperaig Bleeding, Bundle CardiacAnst
Taste Perversion,
motorvehicle orhacardoos machionry orsigning legal documents, maybeimparred furrome timeafton geneodl anesthesia Tinnitus
oronedaion. Branch Block, Extrasystole, Urogenital: Olagunia, Urine KidneyFailure
Cardiac Arrest, Right Retention
Drg bieretleem: Theinduction doserequiaements of DIPRIVAN ljectatile Emubsion maybereduced in pahients with ECG Abnormal, HeartFailure,
intramuocuter
onintravenous partiuladyl
paemedication, withnarcotics ronpedidine,
lng,murphine, etc.)and
andfnntaoyl,
ceestileaboes andsedatives
ofopleids )ng,bensodiazepenes, chleral
badiurates, hydrate,
dropenidol, agents
etc.)These may
6we
incremseanesthetic
orsedative ofDIPRIVAN
effects Islectable andmay
Emulsion ahso
resuht
inmore decreanes
pronounced an
systolic,diastolic,andmeanarterial andcardiacoutput
pressures Duringmainenance the rateof
or sedation,
of anesthesia RevD06/96
DIPRIVAN InjectableEmulsion should
administration beadjustedaccording andmay
tothe desiredlevelof aesthesiaorsedation Manufactured
for
bereduced of supplemental
inthe presence agents
analgesic (eg,nitrousoide oropioids).Theconcurrent of potent
administration Zeneca
Pharmaceuticals
inhalationalagents)ng,leoffurane, duringmaintenance
enflurane,andhalethane) withDIPRIVAN Injectable
Emulsionhasnot been UnitofZeneca
A Business Inc.
edeesively evaluated.Theseishatational
agentscanalsobe expectedtoincrease
the anesthetic andcardiorespiratory
or sedative Wilmington,
DE19850-5437