Local

1
Local General Anesthetics

• Ch 11

2
General Anesthesia

• Alters responses of the Central Nervous system
• Causes one or more of the following
• Pain relief
• Muscle relaxation
• Relaxation of reflexes
• Deep sleep
• Commonly used during surgery

3
Main Categories

• Inhaled may be liquid or gas
• Nitrous oxide gas
• Halothane liquid
• Several others that end with ane
• Inhaled drugs are used together with IV drugs to
  provide the best level of sedation for the
  patient procedure Balanced Anesthesia

4
Intravenous

• Fentanyl
• Opioid analgesic pain relief
• Versed
• Benzodiazepine - amnesia
• Atropine
• Anticholinergic decreases secretions
• Demerol, morphine
• Opioid analgesics lighter pain relief
• Vistaril, phenergan, seconal
• Sedative/hypnotic lighter amnesia/sedation

5
Local Anesthetics

• AKA Regional anesthetics
• Block nerve conduction in specific area of body
• Prevents pain sensation
• 2 Forms
• Topical
• Parenteral (injected)

6
Topical

• May be patch, cream or lotion, liquid, spray
• Dermoplast
• Lidocaine
• Pontocaine
• EMLA cream

7
Parenteral

• Spinal
• Into the space surrounding the spinal cord
• Epidural
• Through catheter into the epidural space just
  outside the spinal cord
• May remain in place for continuous infusion
• Infiltration to numb area to be sutured
• Nerve block stop impulses from specific nerve
  (example chronic back pain)

8
Neuromuscular Blockers

• Used during surgery
• Paralyze respiratory and skeletal muscles
• Requires artificial ventilation
• Also used in ICU with ventilator patients

9
CNS Depressants Muscle Relaxants

• Ch 12

10
Sedatives

• Reduce nervousness
• Reduce excitability
• Reduce irritability
• Do Not cause sleepiness

11
Hypnotics

• Reduce nervousness
• Reduce excitability
• Reduce irritability
• Do cause sleep

12
Sedative-Hypnotics

• Drugs that can have either sedative or hypnotic
  effect
• 3 classifications
• Barbiturates
• Benzodiazepines
• Miscellaneous agents

13
Barbiturates

• Are Habit-forming (addictive)
• Rapidly lead to toxicity
• Depress respirations
• Used for
• Anesthesia
• Control convulsive conditions
• Prevent epileptic seizures

14
Barbiturates, contd

• Phenobarbital
• Most commonly prescribed
• Forms
• Tablets
• Capsules
• Elixirs
• Injections
• Suppositories

15
Benzodiapines

• Relatively safe
• Most commonly prescribed
• Used for
• Sedation
• Sleep induction
• Skeletal muscle relaxation
• Reduce anxiety

16
Benzodiazapines, contd

• Examples
• Temazepam restoril
• Zolpidem ambien
• Antidote is flumazenil romazicon

17
Muscle Relaxants

• Act on the CNS
• Benefit is more from sedation than from
  relaxation of muscles
• Primarily used for relief of muscle spasms
• Best when used with physical therapy
• No specific antidote

18
Miscellaneous agents

• Chloral hydrate Noctec
• Oldest in this category
• Relatively short duration of action
• Does not suppress REM sleep
• Tizanidine zanaflex
• Treats muscle spasms

19
Antiepileptic Agents

• Ch 13

20
Epilepsy

• Common name for seizure disorder
• Not a disease
• CNS dysfunction
• Momentary lapses to total body convulsions
• Action not completely known
• Alter electrolytes

21
Treatment

• Diazepam valium
• to stop seizure once it has started
• Phenytoin dilantin
• to prevent future seizure activity