in the “old days” the following were used for anesthesia

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Anesthesia In the “old days” the following were used for anesthesia. – Alcohol – Drugs – Ice for numbing – Blow to the head – Strangulation

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Page 1: In the “old days” the following were used for anesthesia

Anesthesia

In the “old days” the following were used for anesthesia.

– Alcohol– Drugs– Ice for numbing– Blow to the head– Strangulation

Page 2: In the “old days” the following were used for anesthesia

Anesthesia

Now, anesthesia is designed to focus on specific systems, such as

• Nervous system • Skeletal system• Respiratory system • GI system• Endocrine system • Hepatic system• Cardiovascular system

Page 3: In the “old days” the following were used for anesthesia

Anesthesia

Goals of Balanced Anesthesia– Amnesia (Loss of memory)– Adequate Muscle Relaxation– Adequate Ventilation– Pain Control

Page 4: In the “old days” the following were used for anesthesia

Types of Anesthesia• Preansthetics agents• General (inhaled: desflurane,

halothane, isoflurane, Nitrous oxide, sevoflurane, enflurane; IV:barbiturate, benzodiazepines, ketamine, opoids, propofol, etomidate)

• Local ( Bupivacaine, Lidocaine, Procaine, Tetracaine)

Page 5: In the “old days” the following were used for anesthesia

General Anesthesia

Preanesthetic Medications (antiemetics, muscle relaxants, Anticholinergics, antihistamines, Benzodazepines, Opioids)– Control sedation– Reduce postoperative pain– Provide amnesia– Decrease anxiety

Page 6: In the “old days” the following were used for anesthesia

Discussion

What are some of the indicators used to access general anesthesia?

Answer: Blood pressure, hypervolemia, oxygen level, pulse, respiratory rate, tissue perfusion, urinary output

Page 7: In the “old days” the following were used for anesthesia

General Anesthesia

Malignant Hyperthermia– Side effect of anesthesia

• Fever of 110°F or more• Life threatening

– Treatment: dantrolene (Dantrium)

Page 8: In the “old days” the following were used for anesthesia

Inhalant Anesthetics

• desflurane (Suprane)• enflurane (Ethrane)• halothane• isoflurane (Forane)• nitrous oxide

Drug List

Page 9: In the “old days” the following were used for anesthesia

Inhalant Anesthesia Side Effects

• Causes reduction in blood pressure• May cause nausea and vomiting

Page 10: In the “old days” the following were used for anesthesia

nitrous oxide

• Causes analgesia only; no amnesia or relaxation

• May be given alone or may be given with more powerful anesthetics to hasten the uptake of the other agent (s)

• Commonly used for dental procedures• Rapidly eliminated

Page 11: In the “old days” the following were used for anesthesia

desflurane (Suprane)

• Has rapid onset and recovery

• Often used in ambulatory surgery

Page 12: In the “old days” the following were used for anesthesia

Intravenous General Anesthesia

• Often dispensed by IV drip• Very lipid soluble

Page 13: In the “old days” the following were used for anesthesia

Injectable Anesthetics

• etomidate (Amidate)• fentanyl (Duragesic, Sublimaze)• fentanyl-droperidol• ketamine (Ketalar)• morphine• propofol (Diprivan)• sufentanil (Sufenta)

Drug List

Page 14: In the “old days” the following were used for anesthesia

Injectable Anesthetics

Barbituates– methohexital (Brevital)– thiopental (Pentothal)

Benzodiazepines– diazepam (Valium)– lorazepam (Ativan)– midazolam (Versed)

Drug List

Page 15: In the “old days” the following were used for anesthesia

propofol (Diprivan)

• Used for maintenance of anesthesia, sedation, or treatment of agitation

• Has antiemetic properties– Drowsiness– Respiratory depression– Motor restlessness– Increased blood pressure

Page 16: In the “old days” the following were used for anesthesia

fentanyl

• Dosage Forms– IV – patch– lozenge for children

• Used extensively for open-heart surgery due to lack of cardiac depression

Page 17: In the “old days” the following were used for anesthesia

Benzodiazepines

• Used for induction, short procedures, and dental procedures

• Useful in controlling and preventing seizures induced by local anesthetics

• midozolam (Versed) – fastest onset of action– greatest potency– most rapid elimination

Page 18: In the “old days” the following were used for anesthesia

Antagonist Agents

Antagonist agents reverse benzodiazepine and narcotic overdose.

Page 19: In the “old days” the following were used for anesthesia

Antagonist Agents

• flumazenil (Romazicon)• nalmefene (Revex)• naloxone (Narcan)

Drug List

Page 20: In the “old days” the following were used for anesthesia

Neuromuscular Blocking Agents• Causes immediate skeletal muscle

relaxation. – Short Duration– Intermediate Duration– Extended Duration

• Used to facilitate endotracheal intubation. – Allows for easier insertion of endotracheal

tube.– Keeps airway open.

Page 21: In the “old days” the following were used for anesthesia

Neuromuscular Blocking Agents

• atracurium (Tracrium)• cisatracurium (Nimbex)• mivacurium (Mivacron)• pancuronium• rocuronium (Zemuron)• succinylcholine (Quelicin)• vecuronium (Norcuron)

Drug List

Page 22: In the “old days” the following were used for anesthesia

succinylcholine (Quelicin)

• Often called “sux.”• Only depolarizing agent. All others work as

competitive antagonists to ACh receptors.• Persistent depolarization at motor endplate.• Causes sustained, brief period of flaccid

skeletal muscle paralysis.

Page 23: In the “old days” the following were used for anesthesia

Reversal of Neuromuscular Blocking Agents

• Increases the action of acetylcholine by inhibiting acetylcholinesterase

• Used for reversal of nonpolarizing agents

Page 24: In the “old days” the following were used for anesthesia

Anticholinesterase Agents

• edrophonium (Enlon)• neostigmine (Prostigmin)• pyridostigmine (Mestinon)

Drug List

Page 25: In the “old days” the following were used for anesthesia

Local Anesthesia

Relieves pain without altering alertness or mental function.

Page 26: In the “old days” the following were used for anesthesia

Local Anesthesia

Variety of Dosage Forms– Topical– Superficial injection (infiltration)– Nerve block– IV– Spinal

Page 27: In the “old days” the following were used for anesthesia

Under what conditions would a local anesthetic be used over a general

anesthetic?

Answer: It is chosen when a well-defined area of the body is targeted.

Page 28: In the “old days” the following were used for anesthesia

Discussion

Local anesthetics are classified by their chemistry into two classes. EsterAmides

Page 29: In the “old days” the following were used for anesthesia

Local Anesthesia

Esters– Short acting– Metabolized in the plasma and tissue fluids– Excreted in urine

Page 30: In the “old days” the following were used for anesthesia

Local Anesthesia

Amides– Longer acting– Metabolized by liver enzymes– Excreted in urine

Page 31: In the “old days” the following were used for anesthesia

Local Anesthesia

Esters• benzocaine (Americaine)• chloroprocaine (Nesacaine)• dyclonine (Cēpacol Maximum Strength)• procaine (Novocain)• tetracaine (Cēpacol Viractin, Pontocaine)

Drug List

Page 32: In the “old days” the following were used for anesthesia

Local Anesthesia

Amides• bupivacaine (Marcaine)• levobupivacaine (Chirocaine)• lidocaine (L-M-X, Solarcaine, Xylocaine)• lidocaine-epinephrine (Xylocaine w/ Epinephrine)• lidocaine-prilocaine (EMLA)• mepivacaine (Carbocaine)

Drug List

Page 33: In the “old days” the following were used for anesthesia

What functions are lost with local anesthetics?

Answer– Pain perception– Temperature– Touch sensation– Skeletal muscle tone