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Anesthetics, NMB, Narcotics, Sedatives

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Uses: tonic-clonic, febrile seizures. Half-life 2-6 days ... Carbamazepine (Tegretol): tonic-clonic, partial seizures, related to TCA's, ... – PowerPoint PPT presentation

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Title: Anesthetics, NMB, Narcotics, Sedatives


1
Anesthetics, NMB, Narcotics, Sedatives
Anticonvulsants
  • Georgia Baptist College of Nursing
  • Kathy Plitnick RN PhD CCRN

2
Anesthetics
  • Anesthesia loss of sensation with/without loss
    of consciousness
  • Analgesia - loss of pain sensation
  • Types of Anesthesia
  • General controlled state of unconsciousness
  • Regional nerve conduction is blocked to a
    region of the body
  • Local blocking of pain impulses on peripheral
    nerves
  • Balanced selection of several different drugs,
    without excessive CNS depression

3
Stages of Anesthesia
  • Stage of Analgesia (I) distortion of sight,
    hearing, numbness, analgesia
  • Stage of Delirium (II) loss of consciousness,
    involuntary activity, psychomotor excitement
  • Stage of Surgical Anesthesia (III) end of
    delirium to occurrence of apnea
  • Stage of Medullary Depression (IV) begins with
    apnea, ends with circulatory collapse

4
Parenteral Agents Propofol (Diprivan)
  • Hypnotic without analgesia, amnesia
  • IV rapid induction, short term sedation
  • Rapid acting, rapid emergence
  • Adverse hypotension, bradycardia, apnea
  • Contraindicated soybean, egg, LD
  • Nursing
  • Titrate to sedation level, aseptic technique (fat
    emulsion), emergency equipment, wake up
    assessment, patent airway, analgesics

5
Inhalation Anesthetics
  • Isoflurane (Forane) volatile liquid
  • Induction and maintenance given with Nitrous
    oxide
  • Depresses all levels of CNS, skeletal muscle
    relaxant
  • Potent respiratory depressant
  • Minimal depression of myocardium
  • Potential for malignant hyperthermia
  • Depresses kidney function

6
Isoflurane
  • Post operative shivering
  • IV Demerol, rewarming
  • Monitor vs, temperature frequently
  • Prevent aspiration
  • Monitor U/O

7
Nitrous Oxide
  • Nonflammable, inorganic gas, colorless, odorless
  • Cortical depression
  • Good analgesic, weak anesthetic
  • Rapidly absorbed through lungs
  • Adverse depresses cardiac contractility, hypoxia

8
Local Lidocaine
  • Inhibits transport of ions across neuronal
    membranes
  • Prevents initiation conduction of nerve
    impulses
  • Routes topical, infiltration, mucosal, IV
  • Nursing assess degree of numbness, ensure gag
    reflex intact after oral sprays
  • Infiltration used with Epinephrine to prolong
    local effect

9
Neuromuscular Blockers
  • Cause muscle relaxation, paralyzation
  • Short term use facilitate intubation, procedures
    in mech ventilated
  • Long term use mechanical ventilation, control
    agitation, decrease tissue oxygen demands,
    increased ICP
  • Always administer with an analgesic /or sedative
  • Patient is completely dependent
  • Protect the patient

10
Depolarizing Agents Succinylcholine (Anectine)
  • Depolarization of motor end plates, bind to
    receptors
  • Muscle contraction appear as fasciculations
    (tremors) followed by muscle relaxation
  • Complete paralysis in 2-3 minutes
  • No effect on CNS

11
Succinylcholine
  • Adverse stimulates vagal ganglia
  • Apnea
  • Histamine release
  • Increased intraocular pressure
  • Malignant hyperthermia
  • Never assume a paralyzed patient is asleep
  • Mechanical ventilation support

12
Nondepolarizing Agents
  • Block action of acetylcholine
  • Prevents depolarization of muscle membrane,
    muscle contraction cannot occur
  • Used in OR to expose operative site, close
    wound
  • Anesthesiologist facilitate intubation

13
Tubocurarine (Tubarine)
  • Gradual paralysis over 1-5 minutes without
    fasciculation
  • Sequence of paralysis
  • Persists for 40-60 minutes
  • Reversed by anticholinesterases
  • Effects hypotension, peripheral vasodilatation,
    myocardial depression, reflex tachycardia,
    increased secretions, decreased u/o, GI motility

14
Tubocurarine
  • Toxic prolonged apnea, cardiovascular collapse,
    recurarization
  • Nursing
  • Hypotension profound in hypovolemia
  • Rehydrate
  • Avoid use in asthmatics
  • Excreted by kidneys slower recovery or repeated
    doses of anticholinesterases

15
Narcotics Morphine
  • Opioid analgesic, binds to opiate receptors
  • Alters perception to painful stimuli
  • Produces CNS depression
  • Uses severe pain, pulmonary edema, acute MI
  • Available oral, IM, IV, SC, rectal, epidural,
    intrathecal

16
Morphine
  • Adverse confusion, sedation, respiratory
    depression, arrest, hypotension, constipation,
    urinary retention, itching, dependence
  • Nursing
  • Assess VS, type, location intensity of pain
  • Assess bowel function
  • Co-administration of nonopioid analgesics
  • Discontinue gradually
  • Give IVP slowly, safety precautions

17
Codeine
  • Mild narcotic agonist
  • Decreases cough reflex, GI motility
  • Completely absorbed from IM sites
  • Use Cautiously in head trauma, increased ICP,
    undiagnosed abdominal pain
  • Often combined with analgesic (ASA, tylenol)
    Tylenol 2 15 mg Codeine

18
Pentazocine (Talwin)
  • Narcotic Agonist-Antagonist
  • Antagonist properties may result in opioid
    withdrawal
  • Withdrawal symptoms vomiting, restlessness,
    abdominal cramps, increased BP temperature
  • Additional adverse hallucinations, euphoria,
    lightheadedness
  • IM injections deep into well-developed muscle

19
Narcotic Antagonist Naloxone (Narcan)
  • Antidote for opioid overdose
  • Reverses CNS depression
  • Results in sympathetic stimulation
  • IVP 0.02 0.2 mg q 3-5 minutes
  • Always assess pain after IV Narcan
  • Resuscitation equipment readily available

20
CNS Depressants
  • Benzodiazepines Lorazepam (Ativan)
  • Potentiates GABA inhibitory NT
  • Sedation, amnesia
  • Uses anxiety, seizures, insomnia, diagnostic
    procedures

21
Sleep Stages
  • NREM
  • 1 Relaxed wakefulness
  • 2 Light sleep 50 of sleep
  • 3 4 Slow wave (delta), deep restorative,
    secrete hormones, enhance immune function, 15-50
  • REM
  • Mentally, emotionally restorative
  • Psychological problems from deprivation
  • 90 minute cycles

22
CNS Depressants REM sleep
  • Barbiturates
  • Suppress REM sleep
  • Rebound effect
  • Benzodiazepines
  • Do not suppress REM sleep

23
Lorazepam (Ativan)
  • Available oral, IM, IV (1-5 min)
  • Half-life 10-20 hours
  • Nursing
  • Assess degree of anxiety
  • Psychological, physical dependence
  • Bedrest, safety precautions (IV)
  • Slow IVP
  • Avoid ETOH
  • Seizure management
  • Renal function

24
Anticonvulsant Therapy
  • Seizures abnormal electrical activity in nerve
    cells, discharges occur in cerebral cortex
  • Localized areas or entire brain
  • Idiopathic no specific cause
  • Nonidiopathic abscess, trauma, encephalitis,
    CVA, uremia, ETOH, drug overdoses, sudden
    withdrawal, hypoglycemia, hypocalcemia, fever

25
Anticonvulsants
  • Block movement of sodium ions , less excitable
    membranes
  • Enhance GABA activity
  • Long term therapy
  • Oral use, IV
  • Stop a seizure Lorazepam, Diazepam
  • Prevent seizure phenobarbital, dilantin

26
Phenytoin (Dilantin)
  • Treatment/prevention tonic-clonic seizures
  • Alters ion transport
  • Absorb slowly, 18-24 hours
  • Steady state 1-3 weeks
  • Adverse ataxia, drowsiness, hypotension,
    gingival hyperplasia, slurred speech

27
Phenytoin
  • Nursing
  • Characteristics of seizure
  • Oral hygiene
  • Hypersensitivity reaction
  • Seizure precautions
  • IVP precautions
  • Patient identification
  • Urine pink, red, reddish brown
  • Avoid antacids
  • Therapeutic levels 10-20 mcg/ml

28
Phenobarbital
  • Produces CNS depression
  • Decreases motor activity, alters cerebellar
    function
  • Anticonvulsant activity, sedation
  • Uses tonic-clonic, febrile seizures
  • Half-life 2-6 days
  • Adverse hangover, delirium, drowsiness,
    excitation, hypotension

29
Phenobarbital
  • Frequent VS with IV use
  • Resuscitation equipment
  • Dependence
  • Suicide precautions
  • Seizure assessment, precautions
  • Evaluate hepatic, renal, CBC
  • Therapeutic level 10-40 mcg/ml
  • Slow IVP

30
Anticonvulsants
  • Clonazepam (Klonopin) petit mal, myoclonic, long
    term treatment
  • Ethosuximide (Zarontin) absence seizures, peak
    levels in 3-7 hours, anorexia gastric upset a
    problem
  • Carbamazepine (Tegretol) tonic-clonic, partial
    seizures, related to TCAs, watch LFTs, BUN,
    bilirubin, plt ct.

31
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