the goal of local anesthesia is
To interfere with sensory nerve endings in the operative area
When local anesthesia is used without an anesthesia care provider present,
an RN needs to be assigned to monitor the patient’s vital signs during the procedure.
Specialized type of local infiltration requiring MAC
Widely used in aesthetic surgery for liposuction
Local agents are chemically classified as either:
- Topical cocaine; injectable procaine (Novocain)
- Benzocaine (topical)
- Tetracaine (local anesthetic; long-acting)
- Lidocaine (Xylocaine)
- Bupivacaine (Marcaine; Sensorcaine)
- Ropivacaine (Naropin)
- Mepivacaine (Carbocaine) Less commonly used
Most common local anesthetic
bupivicane binds to
Approximately four times as potent as lidocaine
Similar in duration to bupivacaine but less cardiotoxic
Similar potency to lidocaine
Adverse reactions to amide local anesthetics are primarily
Systemic toxicity of local anesthetics is most commonly due to
inadvertent intravascular injection during peripheral nerve infiltration.
It blocks nerves—not just nerve endings—at specific locations.
How are local and regional alike?
Many of the same agents are used.
The same vital signs are monitored.
Sedatives may be given by IV.
The patient remains awake.
Regional anesthesia is used when the surgical procedure dictates both
both sensory and motor block.
Most common agents used for spinals
In obstetric anesthesia, concentrations of
0.125% plus very low doses of fentanyl are used to provide “walking epidurals.”
________ is preferred over spinal anesthesia when the surgical procedure duration is variable or extended or when prolonged postoperative analgesia is necessary.
Epidural anesthesia has reduced risk of
Epidural anesthesia has less incidence of
postdural puncture headache.
Epidural anesthesia may be administered at levels
above L3 to L4.
Caudal anesthesia is a type of epidural block that
is injected into the epidural space via the sacral canal.
_______ is used in combination with general anesthesia for lower-extremity procedures in children
Peripheral Nerve Block is also known as
Peripheral Nerve Block
Peripheral Nerve Block is used in what surgeries
Distal arms and legs
Hand and fingers
Feet and toes
Precise location of the nerve(s) to be blocked is necessary to avoid:
Penetration of the nerve sheath
Damage to nearby blood vessels
Unintended intravascular administration of the agent
Biggest disadvantage with peripheral nerve block is
time required to take effect; delays surgery
difficult to time correctly
One of the most common extremity blocks is
IVRA, also called Bier block.
Bupivacaine is contraindicated for IVRA because
toxicity is most closely associated with intramuscular administration.
contraindication to IVRA is
traumatic laceration, which may allow uncontrolled release of the agent from the limb.
Injected behind the eye into the muscle cone
Retrobulbar Block Typical injection
0.5% to 0.75% bupivacaine and 2% lidocaine with 150 units of hyaluronidase
Literally, “without sensation”
A drug-induced temporary loss of consciousness
what happens in the emergence phase?
anesthetic agents are discontinued and allowed to wear off and the patient gradually awakens. The emergence phase ends when the patient is transported to the postanesthesia care unit (PACU).
A mixture of two liquids not mutually soluble
Endotracheal (ET) tube
An airway catheter inserted in the trachea to ensure patency of the upper airway and provide ventilation
Process of removing a previously inserted ET tube
Small involuntary muscle twitches just under the skin
what happens in the Induction phase?
Begins when medications are administered to initiate general anesthesia and concludes when an adequate depth of anesthesia is reached and the patient’s airway is secured
The production of tears
Laryngeal masked airway (LMA)
An airway that is placed over the larynx
what happens in the maintenance phase
Begins as the patient’s airway is established and secured and continues until the surgical procedure has been completed
MAC stands for
Minimum alveolar concentration
A measurement of the concentration of an inhalation anesthetic agent that, at one atmosphere of pressure, stops the motor response to incision in 50% of patients is?
Drugs (natural and synthetic) that produce morphine-like effects
what happens in the Preinduction phase?
Begins as the patient is admitted to the preoperative holding area and continues up to the point of administration of anesthetic agents
Rapid sequence induction; used for patients at greater risk for pulmonary aspiration
general anesthesia is
Systemic state of anesthesia
general anesthesia Interferes with
the brain’s ability to interpret pain impulses coming from anywhere in the body
general anesthesia is Used when
there are multiple operative sites, or for a procedure that is on an area that is difficult to block regionally
Patient Factors for General Anesthesia
Mental or emotional state
Patient preference (when possible)
Components of an anesthesia workstation
Manual/automatic ventilation systems
Oxygen and nitrous oxide central pipeline hoses and backup tanks
Pressure regulators and gas-mixing components
Unaware; does not respond to stimuli
Does not experience pain
retains no memory of the event
No explicit recall
No awareness under anesthesia
Old term: “paralyzed”
Intravenous, inhalation, and a combination of the two—balanced—are
the common methods of giving general anesthesia
Sits on top of larynx
Administers oxygen and inhalation agents
Contraindications for LMA
- Oral procedures
- Hiatal hernia
- Gastroesophageal reflux disease (GERD)
- Low pulmonary compliance
ET tube Used for:
- Maximum airway control
- Administer gases and inhalation agents
- Longer procedures
- When deep muscle relaxation is necessary
- When patient is in prone or lateral position
ET tube Variations
- Rapid sequence induction (RSI)
- Nasal intubation
- Awake intubation
Applied in emergent situations where the NPO status cannot be verified
Reduces the risk of aspiration
- thiopental (Pentothal); methohexital (Brevital)
- Ketamine (Ketalar)
- Etomidate (Amidate)
- Propofol (Diprivan)
Natural opioids include
Synthetic opioids include
_______ is the most widely used inhalation anesthetic in clinical practice.
3 most common liquid Volatile Agents
Disadvantages of inhalation agents
Øncrease potential for cardiovascular depression
Lack of postoperative analgesia
Selection of an inhalation agent is influenced by factors such as
solubility of the gas and the patient’s cardiac output.
For a muscle to contract, it must be stimulated by a
Depolarizing- neuromuscualr agents
Nondepolarizing neuromuscular agents
Pancuronium bromide (Pavulon)
Atracurium besylate (Tracrium)
Vecuronium bromide (Norcuron)
Cisatracurium besylate (Nimbex)
Rocuronium bromide (Zemuron)
Mivacurium chloride (Mivacron)
reversal agents for opioids
ØNaltrexone (ReVia, Trexan)
reversal agents for benzodiazepines
reversal agents For nondepolarizing muscle relaxants