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Pharmacotherapeutics > General Anesthetics, Local Anesthetics & Muscle Relaxants > Flashcards

General Anesthetics, Local Anesthetics & Muscle Relaxants Flashcards

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1
Q

General Anesthesia

A

Used for more extensive surgeries/procedures
Reversible state of unconsciousness

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2
Q

Local Anesthesia

A

Small, defined surgery
Patient remains conscious

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3
Q

Anesthetic agents must be able to…

A
  1. Have a rapid onset
  2. Cause skeletal muscle relaxation
  3. Inhibit sensory/autonomic reflexes
  4. Easily adjustable
  5. Minimal toxic side effects
  6. Rapid, uneventful recovery
  7. Amnesia
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4
Q

General Anesthesia - Stage I

A

Analgesia
Patient begins to lose sensation but is still conscious

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5
Q

General Anesthesia - Stage II

A

Excitement or Delirium
Patient is unconscious and amnesiac, may also be agitated and restless

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6
Q

General Anesthesia - Stage III

A

Surgical Anesthesia
Level is desirable for surgery
Onset of regular, deep respirations

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7
Q

General Anesthesia - Stage IV

A

Medullary Paralysis
Cessation of spontaneous respiration due to inhibition of respiratory control systems
Cardiovascular collapse + altered BP regulation
AVOID this stage at all costs due to risk of death

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8
Q

Order of Administration - General Anesthesia

A

Initially given through IV until patient achieves stage III, then inhaled anesthesia to maintain appropriate level
“Balanced anesthesia”

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9
Q

What is the only inhaled general anesthetic?

A

Nitrous Oxide - Short term procedures (dental work)

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10
Q

Classes of Intravenous Anesthetics (5)

A
  1. Barbiturates
  2. Benzodiazepines
  3. Opioid Analgesics
  4. Ketamine
  5. Propofol (Diprivan)
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11
Q

What happens with the administration of Ketamine Anesthesia?

A

Dissociative anesthesia causing patient to become detached from surrounding environment - appears awake, but is actually sedated and will not recall events

Likely to experience hallucinations, strange dreams, or delusions

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12
Q

What is the drug of choice for general anesthesia?

A

Propofol (Diprivan) - Rapid recovery, good for short term invasive procedures

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13
Q

Mechanism of Action - Anesthetics

A

Inhibit neuronal activity throughout CNS, decrease activity of neurons in RAS (sedation, hypnosis, amnesia), inhibit neuronal function in SC (immobility/inhibit pain response), and bind to receptors in CNS to enhance inhibition

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14
Q

What are anesthetic adjuvants?

A

Drugs administered with general anesthesia to enhance effects

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15
Q

What are the 2 types of adjuvants?

A
  1. Preoperative medications
  2. Neuromuscular blockers
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16
Q

Preoperative Adjuvant

A

Given 1-2 hours before general anesthesia to relax patient and reduce anxiety
Includes barbiturates, benzos, and opioids

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17
Q

Neuromuscular Blocker Adjuvant

A

Ensure skeletal muscle paralysis when used with general anesthetics by blocking post-synaptic ACh receptors. Allows a smaller dose of general

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18
Q

Adjuvant side effects include:

A

Tachycardia, increased histamine release, increased plasma potassium levels, residual muscle pain/weakness, immunological reactions (anaphylaxis)

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19
Q

Rehab Implications for Neuromuscular Blockers

A

Residual paralysis can persist after surgery and depress skeletal muscle contractions for several hours
Long term detrimental effects on memory, attention & cognition (older adults)
Perform early mobilization & breathing exercises for those experiencing bronchial secretions

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20
Q

Mechanism of Action - Local Anesthetics

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A

Produce a loss of sensation to specific body parts by inhibiting the opening of sodium channels & blocking afferent nerve transmission (APs) along peripheral nerve.
Used for minor surgeries, painless
(+) Rapid recovery, little residual effects, no post-op lethargy
(-) Length of time require to establish anesthetic effect

21
Q

Examples of Local Anesthetics

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A

Ending in “-caine”
Lidocaine, Procaine, Benzocaine

22
Q

How do you prevent washout for local anesthetics?

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A

Administer it with a vasoconstrictor

23
Q

When does toxicity result from local anesthetics?

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A

When drug reaches systemic circulation

24
Q

Administration of Local Anesthetics

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A

Topically, transdermally, peripheral nerve block, central nerve block, sympathetic blockade & IV regional blockade

25
What are topical anesthetics used for?
Wound cleaning, circumcision, cataracts surgery
26
What are transdermal anesthetics used for?
Localized musculoskeletal pain - OA, LBP, fractures, neuropathic pain
27
What are peripheral nerve blocks used for?
Dental procedures and foot/hand surgeries Major vs Minor nerve blocks
28
What are central neural blockades used for?
Obstetric operations and chronic pain relief Epidural vs Subarachnoid - Administered L3-4 or L4-5
29
What are sympathetic blockades used for?
Complex regional pain syndrome
30
What is a Differential Nerve Block?
Local anesthetics that blocks specific nerve fiber groups based on size/diameter. Small diameter fibers (Type C pain fibers) are the most sensitive and first affected by anesthesia *Clinically significant that sensory pain fibers can be blocked without affecting motor fibers
31
Local Anesthetic Systemic Toxicity (LAST)
When local anesthetics are absorbed into the general circulation and cause toxic effects on organs/tissues. Can disrupt cardiac and CNS excitability
32
Early S/S of "LAST"
Ringing in ears, agitation, restlessness, decreased sensation in tongue/mouth/skin Can be counteracted by lipid compounds that soak up the molecules to limit their effect
33
Rehab Implications for Local Anesthetics
Be aware of patients with transdermal patch - Do not disturb it during exercise. NO heat over patches. Be cautious of central nerve blocks - LE may buckle May be diminished sensation below level of anesthesia
34
What conditions are Skeletal Muscle Relaxants used for?
Spasticity & Muscle Spasms (Hyperexcitable muscle)
35
What is the goal of Skeletal Muscle Relaxants?
Normalize muscle excitability without decreasing muscle function. They do NOT prevent muscle contractions
36
Types of Antispasm Drugs
Diazepam & Centrally Acting Antispasm Drugs
37
Types of Antispasticity Drugs
Baclofen, Intrathecal Baclofen, Dantrolene Sodium, Diazepam & Tizanidine
38
Diazepam (Valium)
Antianxiety drug, Skeletal muscle relaxant Increase inhibitory effects of GABA on AMN activity in SC
39
Centrally Acting Antispasm Drugs
Mechanism of action not well defined Inhibit neurons in polysynaptic pathways to decrease AMN excitability and cause relaxation. Short term relief.
40
Baclofen
Derivative of GABA - Inhibitory effect on AMN activity causing relaxation of skeletal muscle. Side effects: Transient drowsiness, fatigue, nausea, dizziness, weakness, headache, hyperthermia, hallucinations, and seizures
41
Intrathecal Baclofen
Administered directly into subarachnoid space in smaller doses for greater effect (reduced pain and improved function) on severe spasticity. Can be administered via implantable pump - common for SCI, MS, CP, CVA, and TBI patients
42
Dantrolene Sodium
Effects skeletal muscle cells directly - NOT used to treat spasms caused by musculoskeletal injury. Side effects: Weakness, hepatotoxicity, fatal hepatitis, drowsiness, dizziness, nausea, and diarrhea
43
Gabapentin
Decrease spasticity associated with SCI & MS. Also used for seizure management and neuropathic pain. Side effects: Sedation, fatigue, dizziness and ataxia
44
Tizanidine
Controls spasticity as a result of spinal lesions (SCI, MS) and cerebral lesions. Do NOT use them acutely (slow recovery). Milder side effects and less muscle weakness than baclofen and diazepam Side effects: Sedation, dizziness, dry mouth
45
Botulinum Toxin
Control localized hyperexcitability and decrease muscle excitation by disrupting synaptic transmission at NMJ. Injection needs to be specific to a certain muscle; NOT systemically administered (paralysis with loss of respiratory function) Used for dystonias, torticollis, and strabismus
46
Types of Botulinum Toxin
Type A: Botox Type B: Myobloc
47
Reducing spasticity can improve facilitation of...
Volitional motor function - Improved gait and other functional activities
48
Rehab Implications for Skeletal Muscle Relaxants
Therapy should be AGGRESSIVE so that the patient can discontinue medication ASAP - Address strength, flexibility, posture, lifting techniques, body mechanics, etc to help decrease potential for recurrence Be aware of patients that rely on their spasticity (LE extensor pattern)

Pharmacotherapeutics (13 decks)

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