Chapter 16 - Ford Anesthetic Drugs

Learning Objectives

  • State the uses of local anesthesia, methods of administration, and nursing responsibilities when administering a local anesthetic.

  • Describe the purpose of a preanesthetic drug and the nursing responsibilities associated with the administration of a preanesthetic drug.

  • Identify several drugs used for local, regional, conscious sedation, and general anesthesia.

  • List and briefly describe the four stages of general anesthesia.

  • Discuss important nursing responsibilities associated with caring for a client receiving a preanesthetic drug and during the post-anesthesia care (recovery room) period.

  • 2 SLOs: Nursing Judgment, Safety and Professional Behavior

Introduction to Anesthesia and Types of Anesthesia

  • Anesthesia: Induced by various drugs to bring about partial or complete loss of sensation.

  • Types of Anesthesia:

    • Local Anesthesia

    • Regional Anesthesia

    • Conscious Sedation

    • General Anesthesia

  • Anesthesiologist: A trained physician responsible for administering anesthesia.

  • Nurse Anesthetist: A registered nurse with a minimum of a master’s degree and special training in anesthesia.

Types of Anesthesia Overview

  • General Anesthesia:

    • Involves central nervous system (CNS) suppression.

    • Administration via inhalation leads to loss of consciousness.

  • Regional Anesthesia:

    • Administered through spinal conduction blocks.

    • Involves injection into the subarachnoid space of the spinal cord, specifically at the level of the second lumbar vertebra.

    • Can also involve injection into spine or limb near a nerve trunk leading to absence of sensation.

  • Local Anesthesia:

    • Involves infiltration into tissue or application on the surface of skin or mucous membranes.

Local Anesthesia

  • Topical Anesthesia: Application to the surface of the skin, open area, or mucous membrane, also in transdermal form.

  • Local Infiltration Anesthesia: Injection of anesthesia into tissues, e.g., used for dental procedures, suturing small wounds, and incisions into small areas.

  • Examples of Local Anesthetics:

    • Bupivacaine

    • Lidocaine

    • Xylocaine

Regional Anesthesia

  • Definition: Injection of anesthesia around nerves to block the transmission of pain signals.

  • Types:

    • Spinal Anesthesia: Injection into the subarachnoid space of the spinal cord.

    • Conduction Blocks: Injection around or into a nerve trunk.

    • Examples:

      • Epidural block

      • Transsacral block

      • Brachial plexus block

  • Examples of Regional Anesthetics:

    • Lidocaine

    • Bupivacaine

Preparing a Client for Local Anesthesia

  • Client Education: Explain the administration process and procedure to the client.

  • Allergy History: Take a detailed allergy history from the client.

  • Preparation of Area:

    • Clean the area with antiseptic.

    • Shave the area if necessary.

  • Fasting Requirements: Check if fasting is needed for specific anesthetics/procedures.

  • IV Preparation: Start an IV as directed by the provider.

  • Sedation: May administer an intravenous sedative as part of preparation.

Administering Local Anesthesia

  • Dosage Administration: The provider administers a local injectable anesthetic.

  • Epinephrine Use:

    • Often mixed with the anesthetic to cause local vasoconstriction; caution required.

    • Contraindication: Epinephrine should not be used on extremities.

  • Nursing Role: Nurses may draw up the anesthetic drug for the provider to administer.

Nursing Responsibilities When Caring for a Client Receiving Local Anesthesia

  • Post-Administration Care:

    • Apply a dressing to the appropriate surgical area.

    • Observe the area for potential issues, such as bleeding, oozing, or other complications after administration.

Preanesthetic Drugs

  • Definition: Given before anesthesia administration and may consist of single or multiple drugs.

  • Uses:

    • Antianxiety Agents: Provide slight sedation, reduce anxiety, and promote the induction of anesthesia.

    • Histamine-2 Receptor Antagonists: Decrease gastric acidity and volume.

    • Anticholinergics: Decrease respiratory secretions, dry mucous membranes, and prevent vagal nerve stimulation during intubation.

Preanesthetic Drugs — Additional Uses

  • Neuromuscular Blocking Agents: Facilitate skeletal muscle relaxation, allowing for rapid intubation.

  • Opioids: Provide sedation and reduce the total amount of anesthesia required.

  • Antibiotics: Aim to prevent infection and eliminate enteric microorganisms.

  • Contraindications:

    • Preanesthetic drugs may be contraindicated for clients older than 60 years due to accompanying medical disorders.

Nursing Responsibilities When Caring for a Client Receiving Preanesthetic Drugs

  • Assessment: Evaluate the client’s physical status thoroughly.

  • Explanation: Provide explanations regarding the anesthesia that will be given.

  • Surgical Prep Description: Describe necessary preparations for surgery, such as fasting, enemas, or shaving.

  • Postoperative Care Education: Describe and provide information on immediate postoperative care, including the importance of frequent vital signs monitoring.

  • Demonstration: Demonstrate and explain postoperative activities such as deep breathing and coughing exercises.

  • Pain Control: Emphasize the significance of pain management and teach the client how to use the patient-controlled analgesia (PCA) pump if necessary.

Types of Anesthesia—Conscious Sedation

  • Definition: Used for procedures requiring the client to be relaxed yet awake and able to follow commands.

  • Purpose: Minimize anxiety, create a calm and relaxed state, and reduce pain sensation.

  • Application:

    • Often used alongside local anesthesia in outpatient settings, including ambulatory surgeries, procedural clinics, dental offices, and pediatric care.

  • Examples of Conscious Sedation Agents:

    • Nitrous oxide

    • Sedatives

Levels of Conscious Sedation

  • Table 16.1 - Example Local Anesthetics:

    • Generic Name: Articaine; Trade Name: Septocaine

    • Generic Name: Bupivacaine; Trade Name: Marcaine

    • Generic Name: Chloroprocaine; Trade Name: Nesacaine

    • Generic Name: Lidocaine; Trade Name: Xylocaine

    • Generic Name: Mepivacaine; Trade Name: Carbocaine, Isocaine

    • Generic Name: Prilocaine; Trade Name: Ropivacaine

    • Trade Name: Naropin

Nursing Responsibilities When Caring for a Client Receiving Conscious Sedation

  • Client Awareness: Clients may retain memory and experience during conscious sedation; verbal assurance is important.

  • Monitoring: Monitor vital signs as necessary.

  • Resuscitation Equipment: Ensure resuscitation equipment is on hand in case of emergencies.

Types of Anesthesia—General Anesthesia

  • Influencing Factors: The choice of anesthetic drug is determined by:

    • General physical condition of the client

    • The specific area, organ, or system being operated on

    • The anticipated length of the surgical procedure.

  • Stages of General Anesthesia:

    • Stage I: Analgesia

    • Stage II: Delirium and excitement

    • Stage III: Surgical analgesia

    • Stage IV: Respiratory paralysis

Drugs Used for General Anesthesia

  • Barbiturates and Similar Agents:

    • Methohexital

    • Etomidate

    • Propofol

  • Benzodiazepines:

    • Midazolam

  • Ketamine

  • Gases and Volatile Liquids:

    • Nitrous oxide

    • Sevoflurane (Ultane)

    • Isoflurane (Forane)

    • Desflurane (Suprane)

  • Opioids:

    • Fentanyl

    • Droperidol

    • Remifentanil

  • Skeletal Muscle Relaxants:

    • Anectine

    • Nimbex

Nursing Responsibilities for Preanesthesia

  • Perform Required Tasks: Execute prescribed tasks, such as cleansing the operative area and taking vital signs.

  • Chart Review: Check for abnormal recent laboratory results.

  • Drug Allergies: Document any known or suspected drug allergies.

  • Administering Preanesthetic Drugs: Administer according to protocols.

  • Outpatient Considerations: Ensure a caregiver is available to take the client home following outpatient procedures.

Nursing Responsibilities for Post-anesthesia or Post-anesthesia Care Unit

  • Admittance Procedure: Properly admit the client to the post-anesthesia care unit (PACU) following hospital policies.

  • Client Positioning: Position the client to prevent aspiration of vomitus and secretions.

  • Airway Management: Check airway patency, assess respiratory status, and provide oxygen as needed.

  • Vital Signs Monitoring: Regularly check blood pressure and pulse.

  • Equipment Checks: Monitor IV lines, catheters, drainage tubes, and surgical dressings or casts.

  • Record Review: Review the client’s surgical and anesthesia records.

  • Monitoring Protocol: Track vital signs and respiratory rates every 5 to 15 minutes until the client is stabilized for discharge.

  • Emergence Monitoring: Observe the client every 5 to 15 minutes for signs of awakening from anesthesia. Suctioning should be available as needed.

  • Caution with Opioids: Administer opioids carefully to ensure patient safety.

  • Discharge Protocol: Facilitate the client’s transfer from the PACU to their designated room or area post-stabilization.

Questions?

  • Contact information or note for any questions or clarifications needed.