preopmeds and anesthesia

8/8/2019 Preopmeds and Anesthesia

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PREPRE- -OPERATIVE MEDICATIONOPERATIVE MEDICATION

ANDAND

ANESTHESIAANESTHESIA

A presentation by: A presentation by:Maria Esperanza R. AlmonteMaria Esperanza R. Almonte BSN III BSN III--B B


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PRE OPERATIVEPRE OPERATIVE

MEDICATIONSMEDICATIONS


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Purpose of PreoperativePurpose of PreoperativeMedicationsMedications

Allay anxiety Allay anxiety

Decrease pharyngeal secretionsDecrease pharyngeal secretionsDecrease the side effects of Decrease the side effects of anesthetic agentsanesthetic agents

Create amnesiaCreate amnesia


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Tranquilizers TranquilizersNAMENAME DESIREDDESIRED

EFFECTSEFFECTSUNDESIREDUNDESIRED

EFFECTSEFFECTS

DiazepamDiazepam

(Valium)(Valium)

DecreaseDecrease

anxietyanxiety

Dizziness,Dizziness,clumsiness orclumsiness orconfusionconfusion

DroperidolDroperidol(Inapsine)(Inapsine)

DecreaseDecreaseanxiety,anxiety,produce anproduce anantiemeticantiemeticeffecteffect

Anxiety, Anxiety,hypotensionhypotension

during andduring andafter surgeryafter surgery


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S edativesS edativesNAMENAME DESIREDDESIRED


EFFECTSEFFECTS

MidazolamMidazolamHClHCl(Versed,(Versed,Dormicum)Dormicum)

To induce To inducedesireddesired

sleepiness andsleepiness anddecrease anxietydecrease anxiety

Hypotension,Hypotension,undesiredundesired

respiratoryrespiratorydepressiondepression

Promethazine PromethazineHClHCl(Phenergan)(Phenergan)

DecreaseDecreaseanxiety, produceanxiety, producean antiemetican antiemeticeffecteffect

HypotensionHypotensionduring and afterduring and aftersurgerysurgery


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S edativesS edativesNAMENAME DESIREDDESIRED


EFFECTSEFFECTS

SecobarbitalSecobarbitalNaNa(Seconal Na)(Seconal Na)

DecreaseDecreaseanxiety andanxiety andpromotepromotesedationsedation

DisorientationDisorientationespecially inespecially inelderly patientselderly patients

Pentobarbital PentobarbitalNaNa(Nembutal(NembutalNa)Na)

DecreaseDecrease

anxiety, andanxiety, andpromotepromotesedationsedation

DisorientationDisorientation

especially inespecially inelderly patientselderly patients


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N arcotics/AnalgesicsN arcotics/AnalgesicsNAMENAME DESIREDDESIRED


EFFECTSEFFECTS

MorphineMorphine

SulfateSulfate

Relieve pain, Relieve pain,decreasedecreaseanxiety, promoteanxiety, promotesedationsedation

Respiratory Respiratorydepression,depression,hypotension,hypotension,circulatorycirculatorydepression,depression,decrease gastricdecrease gastric

w/c may causew/c may cause vomiting vomiting

Fentanyl Fentanylcitratecitrate(Sublimaze)(Sublimaze)

Short acting Short acting analgesic foranalgesic forminor or outminor or out- -patient surgery;patient surgery;adjunct toadjunct to

general generalanesthesiaanesthesia


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Anticholinergics Anticholinergics

NAMENAME DESIREDDESIREDEFFECTSEFFECTS

UNDESIREDUNDESIREDEFFECTSEFFECTS

Atropine AtropineSulfateSulfate

ControlControlsecretionssecretions

ExcessiveExcessivedryness of dryness of mouth,mouth,

tachycardia tachycardiaGlycopyrrolateGlycopyrrolate(Robinul)(Robinul)

ControlControl

secretionssecretions

ExcessiveExcessive

dryness of dryness of mouth,mouth, tachycardia tachycardia


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H2 R eceptor Antagonists H2 R eceptor AntagonistsNAMENAME DESIREDDESIRED


EFFECTSEFFECTS

CimetidineCimetidine

(Tagamet)(Tagamet)

Ranitidine RanitidineHClHCl(Zantac)(Zantac)

Inhibit gastricInhibit gastric

secretionssecretions

Some mildSome mild

dizziness,dizziness,diarrhea,diarrhea,somnolence andsomnolence andrash.rash.


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anesthesiaanesthesia

fromfrom GreekGreek --,, an an- -,,"without";"without";

andand ,, aisthaisth sis sis, ,

"sensation")"sensation")


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Anesthesia Anesthesia

It is an artificially induced state of It is an artificially induced state of partial or total loss of sensationpartial or total loss of sensationoccurring with or without loss of occurring with or without loss of consciousnessconsciousness

This allows patients to undergo This allows patients to undergo

surgery and other procedures withoutsurgery and other procedures without the distress and pain they would the distress and pain they wouldotherwise experience.otherwise experience.


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P urposeP urpose

Produce muscle relaxation Produce muscle relaxation Block transmission of nerve impulses Block transmission of nerve impulses

Suppress reflexesSuppress reflexesMay cause loss of consciousnessMay cause loss of consciousness


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C lassificationsC lassifications

1 .1 . General AnesthesiaGeneral Anesthesia induces depression of induces depression of the central nervous system. It produces the central nervous system. It producesanalgesia, amnesia, and unconsciousnessanalgesia, amnesia, and unconsciousnesscharacterized by loss of reflexes andcharacterized by loss of reflexes andmuscle tonemuscle tone

2.2. Regional Anesthesia Regional Anesthesia blocks the painblocks the painstimulus ( 1 ) at its origin, (2) along afferentstimulus ( 1 ) at its origin, (2) along afferentneurons or (3) along the spinal cord. Itneurons or (3) along the spinal cord. Itproduces loss of sensation in only oneproduces loss of sensation in only oneregion of the body and does not result inregion of the body and does not result inunconsciousness.unconsciousness.


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GENERALGENERAL

ANESTHESIA ANESTHESIA


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Types TypesIV anesthesiaIV anesthesia

Extremely rapid inductionExtremely rapid inductionUnconsciousness occurs about 30 secondsUnconsciousness occurs about 30 secondsafter initial administrationafter initial administrationUsually given prior to induction of inhalationUsually given prior to induction of inhalationanestheticsanestheticsExample : Theopental Na, KetamineExample : Theopental Na, Ketamine

Inhalation anesthesiaInhalation anesthesia Anesthetic liquid in volatilized form Anesthetic liquid in volatilized formInhaled via face mask or ET tubeInhaled via face mask or ET tubeMost common method of induction usedMost common method of induction used

Example: Alothane, EthraneExample: Alothane, Ethrane


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Types Types Rectal Anesthesia Rectal Anesthesia

Administered via rectal tube Administered via rectal tube Rarely used; usually for children Rarely used; usually for children

Absorbed by rectal mucosa and delivered to CNS Absorbed by rectal mucosa and delivered to CNS via circulatory system via circulatory systemExample: Methothexial NaExample: Methothexial Na

Muscle RelaxantsMuscle Relaxants Administered via IV Administered via IV Given to facilitate intubation, relax musclesGiven to facilitate intubation, relax muscleswithin surgical field, ease laryngospasms and relaxwithin surgical field, ease laryngospasms and relaxmuscles for controlled ventilationmuscles for controlled ventilation


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STAGESSTAGES

OFOF



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STA GESTA GE FROMFROM T OT O

I.I. ONSET ONSET (Analgesia)(Analgesia)

Anesthetic Anestheticadministrationadministration

Loss of Loss of consciousnessconsciousness

ASSESSMENT: ASSESSMENT: Client may be drowsy or dizzy. MayClient may be drowsy or dizzy. Mayexperience auditory or visual hallucinationsexperience auditory or visual hallucinationsNURSING INTERVENTION:NURSING INTERVENTION: Close OR doors; keep roomClose OR doors; keep roomquiet. Stand by client to assist if necessaryquiet. Stand by client to assist if necessaryII. EXCITEMENT II. EXCITEMENT (delirium(deliriumexcitementexcitement

Loss of Loss of consciousnessconsciousness

Loss of eyelid Loss of eyelidreflexesreflexes

ASSESSMENT: ASSESSMENT: Increase in autonomic activity, irregularIncrease in autonomic activity, irregularbreathing; client may strugglebreathing; client may struggleNURSING INTERVENTION:NURSING INTERVENTION: Remain at clients side and Remain at clients side andassist anesthesiologist if necessary.assist anesthesiologist if necessary.


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STA GESTA GE FROMFROM T OT O

III.III. SURGICALSURGICAL ANESTHESIA ANESTHESIA

Loss of eyelid Loss of eyelidreflexesreflexes

Depression of Depression of vital organs vital organs

ASSESSMENT: ASSESSMENT: Client is unconscious, muscles areClient is unconscious, muscles arerelaxed. No blink or gag reflexrelaxed. No blink or gag reflexNURSING INTERVENTION:NURSING INTERVENTION: Begin prep only when Begin prep only when

anesthesiologist indicates that stage 3 has been reachedanesthesiologist indicates that stage 3 has been reachedand client is under good control w/ stable vital signsand client is under good control w/ stable vital signsIV. DANGER IV. DANGER Vital functions Vital functions

excessivelyexcessivelydepresseddepressed

Respiratory and Respiratory andcirculatory failurecirculatory failureor arrest.or arrest.

ASSESSMENT: ASSESSMENT: Client is not breathing, may or may notClient is not breathing, may or may nothave a heart beathave a heart beatNURSING INTERVENTION:NURSING INTERVENTION: If arrest occurs, respondIf arrest occurs, respondSTAT in establishing airway. Provide cardiac arrest tray,STAT in establishing airway. Provide cardiac arrest tray,

CPR.CPR.


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REGIONALREGIONAL



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Types Types

Blocks pain stimulus at origin Blocks pain stimulus at origin Local Anesthesia Local Anesthesia

Topical anesthesia Topical anesthesia directly applied onto area to bedirectly applied onto area to bedesensitizeddesensitizedMay be a solution, ointment, cream, gel or powderMay be a solution, ointment, cream, gel or powderShort acting; blocks peripheral nerve endings in mucousShort acting; blocks peripheral nerve endings in mucousmembranesmembranesExample: Cocaine 4Example: Cocaine 4- -1 0%1 0%

Infiltration AnesthesiaInfiltration AnesthesiaInjection of anesthetic agent into the skin andInjection of anesthetic agent into the skin andsubcutaneous tissue of area to be incisedsubcutaneous tissue of area to be incisedCAUTION: needle must not be allowed to slip intoCAUTION: needle must not be allowed to slip into

veins veins--CV collapse or convulsion may occurCV collapse or convulsion may occurExample: LidocaineExample: Lidocaine


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Blocks pain stimulus along afferent neurons Blocks pain stimulus along afferent neurons

Field Block Field BlockInvolves the area proximal to the incision which wasInvolves the area proximal to the incision which wasinfiltrated with local anesthetics which acts as a barrierinfiltrated with local anesthetics which acts as a barrierbetween incision and nervous systembetween incision and nervous system

Walls in area around incision and prevents transmission Walls in area around incision and prevents transmissionof sensory impulses to the brain from the areaof sensory impulses to the brain from the area

Peripheral Nerve Block Peripheral Nerve Block Anesthetizes individual nerves rather than all local Anesthetizes individual nerves rather than all localnervesnervesInjected along the nerves and not into the nerve, toInjected along the nerves and not into the nerve, todecrease risk of nerve damagedecrease risk of nerve damageExample: to anesthesize a finger (digital nerve block)Example: to anesthesize a finger (digital nerve block)


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Blocks pain stimulus along the spinal cord Blocks pain stimulus along the spinal cord

Spinal AnesthesiaSpinal AnesthesiaInjection of anesthetic agent into subInjection of anesthetic agent into sub- -arachnoidarachnoidspacespaceCan be used for any type of major procedureCan be used for any type of major procedure

performed below the level of the diaphragmperformed below the level of the diaphragm ADVANTAGES: ADVANTAGES:1 .1 . It is relatively safeIt is relatively safe2.2. Provides excellent muscle relaxation Provides excellent muscle relaxation

3. 3. Does not cloud patients consciousness orDoes not cloud patients consciousness oralertnessalertness4.4. Can be used for clients with full stomachCan be used for clients with full stomach


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Blocks pain stimulus along the spinal cord Blocks pain stimulus along the spinal cord

Epidural AnesthesiaEpidural AnesthesiaInjection of anesthetic agent into epiduralInjection of anesthetic agent into epiduralspace.space.Needle is positioned into the epidural space viaNeedle is positioned into the epidural space via

the lumbar or sacral region without penetrating the lumbar or sacral region without penetrating the dura or entering subarachnoid space the dura or entering subarachnoid space

Caudal AnesthesiaCaudal Anesthesia

Injection of anesthetic agent into the caudal orInjection of anesthetic agent into the caudal orsacral canal.sacral canal.


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P otential Anesthesia C omplicationsP otential Anesthesia C omplications

Nausea & Vomiting Nausea & Vomiting May affect patients intraoperativelyMay affect patients intraoperativelyIf it does occur, patient is turned to the side, the headIf it does occur, patient is turned to the side, the headof the table lowered and a basin provided to collect theof the table lowered and a basin provided to collect the

vomitus. vomitus.Suction is used to remove saliva and vomited gastricSuction is used to remove saliva and vomited gastriccontentscontents

Anaphylaxis Anaphylaxis

Nurses must be aware of the type and method of Nurses must be aware of the type and method of anesthesia given because anaphylaxis may occur at anyanesthesia given because anaphylaxis may occur at anymoment.moment.


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P otential Anesthesia C omplicationsP otential Anesthesia C omplicationsHypoxia and other respiratory complicationsHypoxia and other respiratory complications

Hypoventilation, inadequate ventilation, occlusion of Hypoventilation, inadequate ventilation, occlusion of the airway and hypoxia are potential complications the airway and hypoxia are potential complicationsassociated w/ general anesthesia.associated w/ general anesthesia.

Respiratory depression caused by anesthetic agents may Respiratory depression caused by anesthetic agents may

compromise gas exchangecompromise gas exchange

HypotensionHypotensionMay occur due to preoperative hypovolemia orMay occur due to preoperative hypovolemia oruntoward reaction to anesthetic agent.untoward reaction to anesthetic agent.

HypothermiaHypothermiaCore body temp lower than normalCore body temp lower than normalCause by cold environment, advanced age,Cause by cold environment, advanced age,

pharmaceutical agents, decreased muscle activitypharmaceutical agents, decreased muscle activity

preopmeds and anesthesia

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