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General vs Local Anesthetics?
General - Surgical Procedures (IV and inhalation)
Local - well defined area or when patient needs to remain conscious
What are two requirements for general anesthesia?
reversible state of unconsciousness
amnesia (no memory of what occured)
What muscles need to be relaxed by general anesthesia?
Skeletal muscle
What 2 reflexes need to be blocked by general anesthesia?
sensory and autonomic reflexes
What are the 4 induction stages of general anesthesia?
Stage 1: Analgesia
Stage 2: Excitement (Delirium)
Stage 3: Surgical Anesthesia
Stage 4: Medullary Paralysis
What is Stage 1 Analgesia?
Begins lose somatic sensation but is still conscious
What is Stage 2 Excitement (Delirium)
Patient is unconscious but appears agitated and restless
What is Stage 3 Surgical Anesthesia?
Desireable fro surgery and begins with regular, deep respiration.
What is Stage 4 Medullary Paralysis?
Cessation of spontaneous respiration because respiratory control centers are inhibited by excessive anesthesia
What are some routes of administration of general anesthesia?
IV, Inhalation, Balanced anesthesia(combo) and selection
What two inhalation anesthetics are preferred for rapid onset, faster recovery and better control during anesthesia?
Desflurane/Sevoflurane inhalation
What inhalation anesthetic is used for short procedures (tooth extraction)?
Nitrous oxide
What 3 inhalation anesthetics are explosive in nature or produce toxic effects (not used currently)?
Ether, Chloroform, Cyclopropane inhalation
When is an advantage of IV anesthetics? Disadvantage?
Fast onset
Lack of control of level of drug
What is an advantage of inhalation? Disadvantage?
Easier to manage level during anesthesia
Length of time for onset
Where are drugs typically stored before being washed out?
Adipose tissue
If a patient received extended periods of anesthesia with large reserves in adipose tissue, what kind of effects may they feel for days to weeks?
Confusion, disorientation and lethargy
What is the pharmacokinetics behind anesthesia?
Lipid soluble, uniformly distributed
Elimination occurs from lungs or biotransformation in liver or combo
If there is decreased neuronal activity in the brain, it produces what 3 things?
sedation hypnosis and amnesia
Decreased neuronal function in the spinal cord produces what 2 things?
immobility and motor response to pain
Preoperative medications relax a patient and reduce anxiety within ____ prior to general anesthesia and are generally given ___ or ___
1-2 hours; orally or intramuscular
For neuromuscular blockers to work and induce skeletal muscle paralysis, the patient must be in Stage ___ or ____ of anesthesia
3 or 4
____ are a type of neuromuscular blocker that are competitive antagonists that bond but do not necessarily cause a change
Nondepolarizing blockers
What are some concerns of rehab patient?
Residual sedation effects
Muscle weakness if neuromuscular blockage used
Accumulation of bronchial secretions if respiratory infections
Postoperative cognitive decline in older adults
How can you prevent accumulation of bronchial secretions?
Breathing exercises
Early mobilization
Postural drainage
