anesthetics & paralytics

what are some of the meds that make up balanced anesthesia cocktails?

preopterative medications (ex: anticholinergics to decr secretions), sedative hypnotics (want pt to forget traumatic things happening during procedure), antiemetics (d/t slowing down GI tract), antihistamines (help dry out resp secretions), opioids (incr pain control)

what are the names of some non-barbiturate general anesthetics?

midazolam, ketamine, propofol → given IM or IV; pts need to be continoously monitored d/t possibility of resp depression, want to assess vital signs & have emergency airway equipment at bedside

what are the uses for non-barbiturate general anesthetics?

procedural sedation, amnesia before and during procedures, induction of anesthesia, sedation of ventilated patients → want to avoid using other CNS depressants

what are the AEs of non-barbiturate general anesthetics?

drowsiness, sedation, lethargy, disorientation, incontinence, GI distress

what are the names of some local anesthetics?

lidocaine, bupivacaine, ropivacaine → can be given topically, IM, IV, ophtho; used for local pain control, epidural, topical anesthetics (be mindful of altered sensation to keep skin and self safe)

what are the AEs of local anesthetics?

headache, localized burning or irritation, if it gets into systemic circulation can cause CNS depression, arrhythmias, BP changes → want to assess pain and sensation assessment prior to procedure to make sure it is numb

why are paralytics used?

intubation & mechanical ventilation (emergency or procedural) or paralysis in critical illness

what is the main NT at the neuromuscular junction?

acetylcholine → non-depolarizing/aCh antagonists block CONTRACTIONS, depolarizing/aCh agonists blocks RELAXATION

what are the names of some non-depolarizing neuromuscular blocking agents (blocking contractions)?

rocuronium “roc”, pancuronium, cisatracurium → given as continuous IV fusion; used to induce paralysis and are slightly longer acting than depolarizing agents

what needs to be done in order to administer non-depolarizing neuromuscular blocking agents?

pt needs a secure airway → these meds are causing apnea and respiratory depression so there has to be an airway in place prior to administration

what are the AEs of non-depolarizing neuromuscular blocking agents?

respiratory depression, apnea, bronchospasm, cardiac arrhythmias → need to monitor vital signs

what is the name of a depolarizing neuromuscular blocking agent (blocking relaxation)?

succinylcholine “succs” → used for paralysis but is very short acting, usually used for quick procedural intubation/RSI (rapid sequence intubation for emergencies) lasting only 10-15 mins

what are the AEs for depolarizing neuromuscular blocking agents (blocks relaxation)?

respiratory depression, apnea, hyperkalemia, bronchospasm, cardiac arrhythmias

what is important to know about neuromuscular agents in relation to what they can and cannot do?

neuromuscular blocking agents do not provide sedation or pain control, they need to be combined with meds that provide that effect

how does paralysis “move” in the body?

takes effect from head to toes and motor function returns from toes to head