Anesthetics Medication

-Intended to reduce or eliminate sensation

Local and Topical MOA

Anesthesisa -interfere with nerve signaling, thereby reducing permeability
-Ester or Amides of voltage-gated sodium channels; when sodium cannot pass
-Ester classes mostly through these channels, ability to conduct signals is reduced
induce allergic responses -drugs take effect more rapidly in excited neurons
-work faster in patients who have rash or sunburn/ damaged
skin integrity

Infiltrative Anesthesia
-via direct injection to the nerves that require blockade
1. Infiltrative nerve
2. Intra-articular
3. Spinal
4. Epidural
5. Subcutaneous
6. Submucousal
7. Wound Infiltration

Adverse Effects
-Cardiac complications, CNS toxicity,tinnitus, disorientation,
convulsions
-Malignant Hyperthermia-treated with Dantrolene Sodium
and Sodium Bicarbonate

Inhalational 1. Nitrous Oxide-odorless, colorless gas

Anesthetics -cannot be used alone to produce general anesthesia due to the
-maintenance of general fact that the patient would be hypoxic
anesthesia and induce
anesthesia in the brain Adverse Effects:
and spinal cord -Not used in patients with air embolism, pneumothorax,
-degree of suppression bowel obstruction, intracranial air
of consciousness and -Chest pains, hypertension and indications of stroke
autonomic and motor -produce B12 deficiency
reflexes
-Pungency- strong, 2. Isolflurane-oldest of the three currently modern
ethereal odor that can inhalational anesthetic agents; pungent and unsuitable for
make patient breath- inhalational induction of general anesthesia
hold, cough with -cardiac stable agent
inhalational induction -high solubility means desired effects are realized slowly

Adverse Effects:
-potential for neurodegeneration and possible cognitive
effects, particularly in young children and older adults
 -potential significant respiratory depression
-younger that 10 years and older than 65 years might use
another anesthetics

NC:
-monitor patient’s oxygen intake and blood oxygen
-supportive oxygen supplementation must be available
-potentiate muscle relaxants simultaneously

3. Desflurane
-onset and offset is very rapid
-pungency is major drawback
-preffered for outpatient procedures

NC:
-Tachycardia, hypertension, myocardial ischemia

Adverse Effects:
Malignant Hyperthermia and Tachycardia

4. Sevoflurane
-modern agent that is not pungent
-ideal for inhalational induction of general anesthesia
-mainly for pediatric patients
- not associated with liver injury

Adverse Effects:
-Malignant Hyperthermia
Intravenous Induction Anesthetics
Anesthetics 1. Propofol-alkyl phenol hypnotic amnestic agent
-offers an adjuct or -most commonly used intravenous induction/ sedation
alternative to
medication in anesthesia
inhalational agents -rapid onset and offset
-general or partial
-induces anesthesia in 40sec
anesthesia -produces uniform CNS depression in subcortical centers
-significant alterations of
-considered bronchodilator and anticonvulsant
respiration, heart rate
and blood pressure Nursing Consideration
-ideal choice for majority of procedures and patient
populations
-does not alter heart rate
-can burn on administration
-cause hypotension and apnea

2. Ketamine-potent bronchodilator
-asthma
-cause hallucinations and out of body
 -produces local anesthetic
-used in hemodynamically compromised patients
-SNS stimulant
-can increase heart rate, cardiac output, blood pressure
-contraindicated with head trauma
-caution in psychiatric patients
-especiallyuncooperative patients and help preserve airway
reflexes

Adverse Effects
-Dysphoria, Hallucinations
-Coadministration with Benzodiazepine is useful to prevent
awareness

3. Etomidate
-short-acting, nonbarbiturate anesthetic drug produces
hypnosis, amnesia, inhbition of sensory responses via agonist
actions at GABA-A receptors
-does not increase heart rate
-good choice for patients with poor cardiac health

4. Barbiturates
-class of CNS depressants, produce sleepiness and relaxation
via GABA-A agonism
-primary intravenous induction

Adverse Effects
-increase heart rate, lower blood pressure , respirations, and
cerebral blood flow
-decrease intracranial pressure, potentially increasing risk of
seizure

NC:
-caution in elderly patients
Anesthetic Adjucts 1. Benzodiazepines
-anxiolytics
-patients to relax before surgery

Midazolam
-shortest-acting benzodiazepine available, ideal choice in
anesthesia setting