I.

Definition of terms A. Anesthesia loss of the ability to feel pain, resulting from the administration of an anesthetic drug or other medical intervention. B. Anesthetics drug that depress the central nervous system (CNS) to produce diminution of consciousness, loss of responsiveness to sensory stimulation, or muscle relaxation. C. Balanced Anesthesia the practice of using combinations of drugs rather to produce a single drug to produce anesthesia. A common combination is a mixture of a sedative-hypnotic, an antianxiety drug, an analgesic, an antiemetic, and an anticholinergic. D. General Anesthesia a drug induced state in which the CNS is altered to produce a varying degrees of pain relief throughout the body as well as depression of consciousness, skeletal muscle relaxation, and diminished or absent reflexes. It is most commonly induces for performance of surgical procedure. E. General Anesthetic a drug tat induces a state of anesthesia. Its effects are global in that they involve the whole body, with loss of consciousness being one of those effects. F. Local Anesthetics drugs that render a specific portion of the body insensitive to pain at the level of the peripheral nervous system, normally without affecting consciousness. Also call regional anesthetic. G. Parenteral Anesthesia any anesthetic drugs that can be administered by injection via any route (e.g., intravenously, spinally/epidurally, as a local nerve block). Depending on the specific site of injection the drug may anesthetize all or parts of the central or peripheral nervous system or both. H. Topical Anesthesia a class of local anesthesia that are applied directly to the skin and mucous membranes. They consist of solutions, ointments, gels, creams, powders, ophthalmic drops, and suppositories.

II.

Types of Anesthesia:

There are many mechanisms by which anesthetics accomplish these responses, but in general they do so by interfering with nerve conduction. Anesthetics are most commonly classified as either general anesthetics or local anesthetics, depending on where in the CNS or PNS the particular anesthetic drug works. Functions of the autonomic nervous system, which is a branch of the PNS, may also be affected. A. General Anesthesia

Advantages of general anesthesia include rapid excretion of the anesthetic agent and prompt reversal of its effects when desired. Additionally, general anesthesia can be used with all age groups and any type of surgical procedure. It produces amnesia. Disadvantages of general anesthesia include risk associated with circulatory, respiratory, hepatic and renal side effects. Clients with serious respiratory or circulatory diseases, such as emphysema or congestive heart failure, are at greater risk for complications. Clients with renal and hepatic disease cannot metabolize and eliminate anesthetics effectively. o Two Main Categories: Inhaled anesthetics are volatile liquids or gases that are vaporized in oxygen and inhaled to induce anesthesia through a mask or through an endotracheal tube inserted in the trachea. E.g. nitrous oxide laughing gas and isoflurane (Forane) is an inhaled volatile liquid. Injectable anesthetics - are administered intravenously. These drugs are used for induction or maintenance of general anesthesia, inducing amnesia, and as an adjunct to inhalation-type anesthetics. Common intravenous anesthetic drugs include general anesthetics such as ketamine (Ketalar) and barbiturates such as thiopthal. o Mechanisms of Action ad Drug Effects The overall effect of general anesthetics is an orderly and systematic reduction of sensory and motor CNS functions. They produce a progressive depression of the cerebral and spinal cord functions. Therapeutic (anesthetics) does cause minimal depression of the medullary centers that govern vital functions. o Indications General anesthetics are used to produce unconsciousness, skeletal muscular relaxation, and visceral smooth muscle relaxation for surgical procedures. o Contraindications Adverse Effects Contraindications to use of anesthetic drugs include known drug allergy and, depending on the drug type, may include pregnancy, narrow-angle glaucoma, and known susceptibility to malignant hyperthermia from prior experience with anesthetics. B. Regional/Local Anesthesia Local anesthetics are also called regional anesthetics because they render a specific portion of the body insensitive to pain without major reduction of CNS functions and level of consciousness. They do this by interfering with the nerve transmission in specific area of the body, blocking nerve conduction only in the area in which they are applied without causing loss of consciousness. They are most commonly used in those clinical setting in which loss of

consciousness, whole body relaxation, and loss of responsiveness are either undesirable or unnecessary. Other uses for local anesthesia include dental procedures, the suturing of skin lacerations, spinal anesthesia, and diagnostic procedures such as lumbar puncture or thoracentesis. o Types of Local Anesthesia Central - Spinal or intraspinal analgesia: anesthetic drugs are injected into the area near the spinal cord within the vertebral column. Intraspinal anesthesia is commonly accomplished by one or two injection techniques: Intrathecal anesthesia involves injection of anesthetic into the subarachnoid space. Intrathecal anesthesia is commonly used for patients undergoing major abdominal or limb surgery for whom the risk of general anesthesia are too high or patient who prefer this technique instead of complete loss of consciousness during their surgical procedure. More recently, intrathecal injection of anesthetics through implantable drug pumps is even being used on an outpatient basis in patients with severe chronic pain symdromes. Epidural anesthesia involves injection of anesthetics via a small catheter into the epidural space without puncturing the dura. Epidural anesthesia is commonly used to reduce maternal discomfort during labor and delivery and to manage postoperative pain management after a major abdominal or pelvic surgery. The route is becoming popular for the administration of opioids for pain management. Peripheral Infiltration: small amount of anesthetic solution are injected into this tissue that surrounds the operative site. This approach to anesthesia is commonly used for such procedures as wound suturing and dental surgery. Often drugs that cause constriction of local blood vessels (e.g. epinephrine, cocaine) are also administered to limit the site of action of the local area. Nerve Block: anesthetic solution is injected at the site where a nerve innervates a specific area such as a tissue. This allows large amount of anesthetic drug to be delivered to a very specific area without affecting the whole body. This method is often reserved for more difficult-to-treat pain syndromes such as cancer pain and chronic orthopedic pain. Intravenous Block (Bier block): is used most often for procedures involving the arm, wrist, and hand. An occlusion tourniquet is applied to the extremity to prevent infiltration and absorption of the injected intravenous agent beyond the involved extremity. Topical Anesthesia: the anesthetic drug is applied directly onto the surface of the skin, eye or any other mucous membrane to relieve pain or prevent it from being sensed. It is commonly used for diagnostic eye examinations and skin suturing.

o Mechanisms of Action Local anesthetics block both the generation and conduction of impulses through all types of nerve fibers (sensory, motor, and autonomic) by blocking the movement of certain ions (sodium, potassium, and calcium) important to this process. They do this by making it move difficult for these ions to move in and out of the nerve fiber. In terms of paralysis, usually autonomic activity is affected first, and then pain and other sensory functions are lost. Motor activity is the last to be lost. When the effects of the local anesthesia wear off, recovery occurs in reverse order: motor activity returns first, then sensory, and finally autonomic activity. o Indications Local anesthetics are used for surgical, dental, or diagnostic procedures, as well for the treatment of various types of chronic pain. Infiltration anesthesia is commonly used for minor surgical and dental procedures. It involves injection of the local anesthetic solution by ID, SQ or IM routes and across the path of nerves supplying the area to be anesthetized. The local anesthesia may be administered in a circular pattern around the operative field. Nerve block anesthesia is used for surgical, dental, and diagnostic procedures and for the therapeutic management of chronic pain. It involves the injection of the local anesthetic directly into or around the nerve trunks or nerve ganglia that supply the area to be numbed. o Contraindications Contraindications for local anesthesia include known drug allergy. Only specially designed dosage forms are intended for ophthalmic use. C. Conscious Sedation An increasing number of surgical and diagnostic procedure are being performed using conscious sedation. This type of anesthesia provides analgesia, amnesia, and moderate sedation. The pharmacologic effects are produced by administering a combination of intravenous medications with opioids (such as morphine sulfate, meperidine hydrochloride [Demorol], and fentanyl [Sublimaze]) or sedatives (such as diazepam [Valium] and midazolam [Versed]). During conscious sedation the client is able to independently maintain an open airway. This allows the client to respond to verbal and physical stimulation. Physician supervision is always required and registered nurse must be prepared to initiate rescue if sedation becomes too deep. Conscious sedation increases the clients pain threshold and includes degree amnesia but allows for prompt reversal of its effects and a rapid return to normal activities if daily living. Procedures such as endoscopes, incision and drainage of abscesses, and even balloon angioplasty maybe performed under conscious sedation.