Chapter 11 General and Local Anesthetics Flashcards Preview

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Flashcards in Chapter 11 General and Local Anesthetics Deck (21):
1

Anesthetics

Drugs that reduce or eliminate pain by depressing nerve function in the central nervous system (CNS) and peripheral nervous system

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General anesthesia

complete loss of consciousness and loss of body reflexes, including paralysis of respiratory muscles.

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Local anesthesia

no paralysis of respiratory function; elimination of pain sensation in the tissues innervated by anesthetized nerves

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Adjunct anesthetics


Drug that enhances clinical therapy when used simultaneously with another drug

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Balanced anesthesia

The practice of using combinations of different drug classes rather than a single drug to produce anesthesia

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Overton-Meyer theory

-For all anesthetics, potency varies directly with lipid solubility.
-Fat-soluble drugs are stronger anesthetics than water-soluble drugs.
-Nerve cell membranes have high lipid content, as does the blood–brain barrier.
-Lipid-soluble anesthetic drugs can therefore easily cross the blood–brain barrier to concentrate in nerve cell membranes

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Malignant hyperthermia

-Occurs during or after volatile inhaled general anesthesia or use of the neuromuscular blocking drug (NMBD) succinylcholine
-Sudden elevation in body temperature (greater than 104° F)
-Tachypnea, tachycardia, muscle rigidity
-Life-threatening emergency
-Treated with cardiorespiratory supportive care and dantrolene (skeletal muscle relaxant)

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Antihypertensives

increased hypotensive effects

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Beta blockers\

increased myocardial depression

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Dexmedetomidine (Precedex)

-Alpha-2 adrenergic receptor agonist
-Dose-dependent sedation, decreased anxiety, and analgesia without respiratory depression
-Use: procedural sedation, surgeries of short duration.
-Short half-life, and the patient awakens quickly upon withdrawal of the drug.
-Sedation of mechanically ventilated patients in the intensive care unit (ICU)

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Ketamine

-Intravenous administration use for both general anesthesia and moderate sedation
-Rapid onset of action
-Low incidence of reduction of cardiovascular, respiratory, and bowel function
-Adverse effects: disturbing psychomimetic effects, including hallucinations

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Nitrous Oxide

-“Laughing gas”
-Only inhaled gas currently used as a general anesthetic
-Weakest of the general anesthetic drugs
-Used primarily for dental procedures or as a supplement to other, more potent anesthetics

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Propofol (Diprivan)

-Parenteral general anesthetic
-Used for the induction and maintenance of general anesthesia
-Sedation for mechanical ventilation in ICU settings
-Lower doses: sedative-hypnotic for moderate sedation
-Monitor triglycerides if administered with total parenteral nutrition

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Sevoflurane (Ultane)

-Fluorinated ether
-Widely used
-Rapid onset and rapid elimination
-Especially useful in outpatient surgery settings
-Nonirritating to the airway
-Greatly facilitates induction of an unconscious state, especially in pediatric patients

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Moderate Sedation

-Also called conscious sedation and procedural sedation
-Does not cause complete loss of consciousness and does not normally cause respiratory arrest.
-Combination of an IV benzodiazepine (e.g., midazolam) or propofol and an opiate analgesic (e.g., fentanyl or morphine)
-Anxiety and sensitivity to pain are reduced, and the patient cannot recall the procedure.

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Moderate Sedation uses

-Used for diagnostic procedures and minor surgical procedures that do not require deep anesthesia
-Preserves the patient’s ability to maintain own airway and to respond to verbal commands
-Rapid recovery time and greater safety profile than general anesthesia

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Types of Local Anesthesia

-Spinal or intraspinal
-Intrathecal
-Epidural
-Infiltration
-Nerve block
-Topical
-Peripheral nerve catheter attached to a pump containing the local anesthetic: Pain Buster and On-Q pump

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Local anesthetics are used for:

-Surgical, dental, and diagnostic procedures
-Treatment of certain types of chronic pain
-Spinal anesthesia: to control pain during surgical procedures and childbirth

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Local anesthetics are given by:

Infiltration anesthesia
Nerve block anesthesia

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“Spinal headache”

-70% of patients who either experience inadvertent dural puncture during epidural anesthesia or undergo intrathecal anesthesia.
-Usually self-limiting
-Treatment: bed rest, analgesics, caffeine, blood patch

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Neuromuscular Blocking Drugs

-Also known as NMBDs
-Prevent nerve transmission in skeletal and smooth muscle, resulting in muscle paralysis
-Also paralyze the skeletal muscles required for breathing: the intercostal muscles and the diaphragm
-Used with anesthetics during surgery
-When used during surgery, artificial mechanical ventilation is required.