NUR 426 Lecture Notes - Lecture 5: Desflurane, Antiemetic, Altered Level Of Consciousness

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3 Oct 2017
Department
Course
Professor
Quinnipiac University School of Nursing
NUR 426
Anesthetic Proto Type Meds
What is Anesthesia?
Absence of feeling
Affects
- The spinal cord
- The brain stems reticular activating system
- Cerebral cortex
Categories of anesthesia
- General anesthesia
Medically induced coma and loss of protective reflexes from the
administration of one or more general anesthetic agents. Analgesia, amnesia
and immobility
- Regional Anesthesia
Anesthesia affecting a large part of the body, such as a limb or lower half of
the body. Regional anesthetic techniques can be divided into central and
peripheral techniques
the central techniques include so called neuraxial blockade (epidural
anesthesia, spinal anesthesia)
the peripheral technique can be further divided into plexus blocks and
single nerve blocks
- Sedation
Reduction of irritability or agitation by administration of sedative drugs,
generally to facilitate a medical procedure or diagnostic procedure
Also referred to as MAC (monitored anesthesia care)
Types: conscious sedation, moderate sedation, heavy sedation
Drugs commonly used: Versed, Precedex, Narcotics, Propofol
Choice of Anesthetic
Co-existing disease
Site of surgery
Position
Elective vs. emergency
Age
Gastric contents / NPO status
Patient preference / provider preference
Duration of the surgery
Discharge criteria/anticipated recovery time
Anticipated airway difficulty
Pharmacology
Pharmacodynamics – the effect of the drug on the body, receptors, potency, response
curves
Pharmacokinetics – what the body does to the drug. Routes, absorption, distribution
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Benzodiazepines
Valium Diazepam
Versed or Midazolam
Rapid onset/relative short duration (IV/oral)
Amnesia (anterograde only)
Anticonvulsant
Antiemetic
Common preoperative medication
Sedative – hypnotic effects
Highly lipophilic
Minimal respiratory depression
(gamma-aminobutyric acid) GABA
Babiturates
Brevital (Methohexital)
Rapid onset works in seconds
IV induction general anesthesia
Respiratory depression apnea
CNS depression (lowers CMRO2 and CBF)
Used in electroconvulsive therapy ECT
Not commonly used as induction agents for general anesthesia propofol most common
Induction agents
Propofol or Diprivan (10mg/ml)
Most common anesthesia induction drug
Rapid onset
Rapid clearance (hepatic) infusion
Highly lipophilic
Sedation
Hypotension
Apnea
Antiemetic
CNS depression (lowers CMRO2 and CBF)
Not an analgesic
Pain on injection but not always
Etomidate (2mg/ml)
Rapid onset
Preserves BP and HR
Highly lipophilic
Adrenocortical depression
Emetic
CNS depression (lower CMRO2 and CBF)
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