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