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ANESTHETICS
I. II.
Local Anesthesia
Is the condition that results when sensory transmission from a local area of the body to the CNS is blocked
Local Anesthetics
Esters Long-acting Tetracaine Short-acting Procaine (Novocain) Chloroprocaine (Nesacaine) Surface-acting Cocaine Benzocaine (Cetacaine) Amides Long-acting Bupivacaine (Marcaine) Ropivacaine Mepivacaine (Polocaine/Carbocaine) Etidocaine (Duranest) Prilocaine Medium-acting Lidocaine (Xylocaine)
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Epinephrine
Reduced systemic absorption by about 33% (advantage: absorption rate more likely to match metabolic rate resulting in less local anesthetic systemic toxicity)
Increased cardiac irritability which may cause an increased risk of cardiac arrhythmias Increased possibility of hypertensive response in susceptible patients
Dextran
Low-molecular-weight When added to local anesthetic solutions result in increased peripheral nerve block anesthesia duration
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GENERAL ANESTHETICS
- Are CNS depressants which abolish pain by inhibiting the function of the CNS through an unknown mechanism
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INDUCTION OF ANESTHESIA
Is the time required to take the patient from consciousness to stage 3.
MAINTENANCE OF ANESTHESIA
Is the ability to safely keep the patient in stage 3
TYPES OF ANESTHETICS
I. INHALATIONAL ANESTHETICS VOLATILE LIQUIDS HALOTHANE ISOFLURANE DIETHYL ETHER GASEOUS NITROUS OXIDE
HYDRATE THEORY
Anesthetic molecules form gas hydrates or structured water which inhibit brain function
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INHALATIONAL ANESTHETICS
Primarily used for the maintenance of anesthesia Produce all stages of anesthesia except Nitrous oxide Excreted through the lungs Depth of anesthesia can be rapidly altered by changing the concentration and providing hyperventilation Dont cause respiratory depression
DISADVANTAGES
No muscle relaxation Must be used with other anesthetics for surgical anesthesia
HALOTHANE
Best agent in pediatric Lowers blood pressure patients Reduces renal and hepatic Bronchial smooth muscle blood flow relaxation; good for patients Hepatic toxicity with asthma Arrhythmias Good muscle relaxation Rapid recovery Does not raise intracranial pressure No sensitization of heart to Epinephrine
ISOFLURANE
INTRAVENOUS ANESTHETICS
IV Anesthetics Thiopental Advantages Rapid onset Potent anesthesia Disadvantages Poor analgesia Little muscle relaxation Laryngospasm
INTRAVENOUS ANESTHETICS
BARBITURATES Produce residual CNS depression, mental disorientation and nausea May cause laryngospasm/bronchospasm Accumulate in adipose tissue BENZODIAZEPINES Midazolam and Lorazepam are more potent than diazepam Facilitate amnesia while causing sedation
Good analgesia Good analgesia Rapid onset Lowers intracranial pressure Poor analgesia
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INTRAVENOUS ANESTHETICS
ETOMIDATE Hypnotic Lacks analgesic property Can cause uncontrolled skeletal muscle activity OPIOIDS Morphine + Nitrous oxide provide good anesthesia for cardiac surgery Are not good amnesics Can cause hypotension, respiratory depression and muscle rigidity as well as post op. nausea and vomiting
INTRAVENOUS ANESTHETICS
KETAMINE Produces dissociative anesthesia ( patient appears awake but is unconscious and does not feel pain) Provides sedation, amnesia and immobility Increase BP and cardiac output Vivid dreams and hallucinations occur during recovery period Employed mainly in children and young adults
INTRAVENOUS ANESTHETICS
FENTANYL CITRATE AND DROPERIDOL (Innovar) Narcotic analgesic + neuroleptic = neuroleptanalgesia Produces neurolepthanesthesia (provides excellent analgesia while the patient remains conscious) Can cause extrapyramidal muscle movements
INTRAVENOUS ANESTHETICS
PROPOFOL Sedative-hypnotic used in the induction or maintenance of anesthesia Supplementation with narcotics for analgesia is required Depress CNS, decrease BP without depressing the myocardium Decreases intracranial pressure