Escolar Documentos
Profissional Documentos
Cultura Documentos
Anesthetics
Anesthesia
• Divisions of the Nervous
System
• Major Neurotransmitters
• Anesthesia
– General Anesthesia
– Local Anesthesia
Learning Objectives
• Understand the central and peripheral nervous
systems, their functions, and their relationship to
drugs.
• Become aware of the role of neurotransmitters.
• Learn how drugs affect body systems and where
they work in the body.
• Understand the concepts of general and local
anesthesia, and know the functions of these
agents.
Learning Objectives
• The thalamus screens electrical impulses sent up the spinal cord &
sends them to the cerebellum for more interpretation
• The hypothalamus controls the pleasure center, some basic drives -
hunger, sex, and thirst - & body temperature
• The pituitary gland, although located in the brain, is actually part
of the endocrine system
Brain Stem
• The brain stem, the most
primitive structure of the brain,
is the bridge that connects the
brain to the spinal cord
• Less than 1 inch & 3 inches
long, the brain stem has 3
section -- The midbrain, the
pons, & the medulla oblongata
• Acetylcholine
• GABA
• Dopamine
• Epinephrine
• Serotonin
Major Neurotransmitters
• Acetylcholine (ACh)
– Smooth muscle, cardiac muscle, and
exocrine glands
– Anticholinergics block ACh receptors
• GABA
• Dopamine
• Epinephrine
• Serotonin
Major Neurotransmitters
• Acetylcholine
• Dopamine
Acts on the CNS and kidneys
• Epinephrine
• Serotonin
Major Neurotransmitters
• Acetylcholine
• GABA
• Dopamine
• Epinephrine
– Acts on cardiac and bronchodilator
receptors
– Known as Adrenaline
• Serotonin
Major Neurotransmitters
• Acetylcholine
• GABA
• Dopamine
• Epinephrine
• Serotonin
– Acts on smooth muscle and gastric mucosa
(causes vasoconstriction)
– Emotional responses: depression, anxiety
Communication by
Neurotransmitters
• Decreased GI motility
• Decreased sweating
• Decreased urination
• Dilated pupils
• Dry eyes
• Dry mouth
Anesthesia
– Adequate Muscle
Relaxation
Anesthesia
– Adequate Ventilation
Anesthesia
– Pain Control
Discussion
What are some of the indicators
used to assess general anesthesia?
Discussion
What are some of the indicators
used to access general anesthesia?
• General
• Local
Types of Anesthesia
• General
•Local
Local Anesthesia
Answer
– Esters
– Amides
Local Anesthesia
Esters
–Short acting
–Metabolized in the plasma and
tissue fluids
–Excreted in urine
Local Anesthesia
Amides
–Longer acting
–Metabolized by liver enzymes
–Excreted in urine
Drug List
Local Anesthesia
Esters
• benzocaine (Americaine)
• chloroprocaine (Nesacaine)
• dyclonine (Cēpacol Maximum Strength)
• procaine (Novocain)
• tetracaine (Cēpacol Viractin, Pontocaine)
Drug List
Local Anesthesia
Amides
• bupivacaine (Marcaine)
• levobupivacaine (Chirocaine)
• lidocaine (L-M-X, Solarcaine, Xylocaine)
• lidocaine-epinephrine (Xylocaine w/
Epinephrine)
• lidocaine-prilocaine (EMLA)
• mepivacaine (Carbocaine)
Discussion
•General
• Local
General Anesthesia
Preanesthetic Medications
–Control sedation
–Reduce postoperative pain
–Provide amnesia
–Decrease anxiety
General Anesthesia
Malignant Hyperthermia
– Side effect of anesthesia
• Fever of 110°F or more
• Life threatening
– Treatment: dantrolene (Dantrium)
Warning!
Always check
expiration date.
Drug List
Inhalant Anesthetics
• desflurane (Suprane)
• enflurane (Ethrane)
• halothane
• isoflurane (Forane)
• nitrous oxide
Inhalant Anesthesia Side Effects
•Causes reduction in
blood pressure
•May cause nausea and
vomiting
nitrous oxide
• Causes analgesia only; no amnesia or
relaxation
• May be given alone or may be given
with more powerful anesthetics to
hasten the uptake of the other agent(s)
• Commonly used for dental procedures
• Rapidly eliminated
desflurane (Suprane)
• Often dispensed by
IV drip
• Very lipid soluble
Drug List
Injectable Anesthetics
• etomidate (Amidate)
• fentanyl (Duragesic, Sublimaze)
• fentanyl-droperidol
• ketamine (Ketalar)
• morphine
• propofol (Diprivan)
• sufentanil (Sufenta)
Drug List
Injectable Anesthetics
Barbituates
– methohexital (Brevital)
– thiopental (Pentothal)
Benzodiazepines
– diazepam (Valium)
– lorazepam (Ativan)
– midazolam (Versed)
propofol (Diprivan)
• Used for maintenance of anesthesia,
sedation, or treatment of agitation
• Has antiemetic properties
– Drowsiness
– Respiratory depression
– Motor restlessness
– Increased blood pressure
Injectable Anesthesia
Dispensing Issues
Warning!
• Dosage Forms
– IV (Sublimaze)
– patch (Duragesic)
– lozenge (Actiq) for children
• Used extensively for open-
heart surgery due to lack of
cardiac depression
Benzodiazepines
• Used for induction, short procedures, and
dental procedures
• Useful in controlling and preventing
seizures induced by local anesthetics
• midozolam (Versed)
– fastest onset of action
– greatest potency
– most rapid elimination
Antagonist Agents
Antagonist agents
reverse
benzodiazepine and
narcotic overdose.
Drug List
Antagonist Agents
• flumazenil (Romazicon)
• nalmefene (Revex)
• naloxone (Narcan)
flumazenil (Romazicon)
• Antagonizes benzodiazepines
by competing for receptor
site
• Used for complete or partial
reversal
naloxone (Narcan)
• Competes for opiate receptor sites
• Has a shorter duration of action than
narcotics, so it must be given repeatedly
Neuromuscular Blocking Agents
• Causes immediate skeletal muscle
relaxation.
– Short Duration
– Intermediate Duration
– Extended Duration
• Used to facilitate endotracheal intubation.
– Allows for easier insertion of endotracheal
tube.
– Keeps airway open.
Drug List
Neuromuscular Blocking
Agents
• atracurium (Tracrium)
• cisatracurium (Nimbex)
• mivacurium (Mivacron)
• pancuronium
• rocuronium (Zemuron)
• succinylcholine (Quelicin)
• vecuronium (Norcuron)
Neuromuscular Blocking Agents
Dispensing Issues
Warning!
• Very expensive
• Be conscious of storage requirements
• Store away from look-alike and drugs
succinylcholine (Quelicin)
• Often called “sux.”
• Only depolarizing agent. All others work as
competitive antagonists to ACh receptors.
• Persistent depolarization at motor endplate.
• Causes sustained, brief period of flaccid
skeletal muscle paralysis.
Reversal of Neuromuscular Blocking
Agents
• Increases the action of
acetylcholine by inhibiting
acetylcholinesterase
• Used for reversal of
nonpolarizing agents
Drug List
Anticholinesterase Agents
• edrophonium (Enlon)
• neostigmine (Prostigmin)
• pyridostigmine (Mestinon)
Anesthesia is a creek word and
means loss of sensation
This loss of sensation can be total, regional or local
Medications which produce anesthesia are called
anesthetics.
The total loss of sensation caused with anesthetics is
called general anesthesia. It means unconsciousness, a
kind of sleep, but it is more dangerous, because the
patient is no more able to take care of himself. A
patient under general anesthesia is never allowed to be
left alone.
How do anesthetics work?