Balanced Anesthesia
-The use of a combination of drugs, each
with a specific effect, to achieve analgesia,
muscle relaxation, unconsciousness, and
amnesia
Involves the following:
 Preoperative medications: includes the use
of anti-cholinergics that decrease secretions
to facilitate intubation and prevent
bradycardia associated with neural
depression.
 Sedative-hypnotics: to relax the patient,
facilitate amnesia, and decrease
sympathetic stimulation
 Anti-emetics: decreases nausea and
vomiting associated with GI depression
 Antihistamine: decrease the chance of
allergic reaction and help dry the secretions
Narcotics: aid analgesia and sedation
Stages-of-Anesthesia.pdf(base on the
succeeding paper)
Types of General Anesthetic Agents:
 Barbiturates
 Non-Barbiturates
 Volatile liquids
 Gas anesthetics
1. Barbiturate Anesthetics
-Intravenous drug that is used to induced
rapid anesthesia combined together with
other gas anesthetics
Examples:
 Thiopental (Pentothal): very rapid onset of
action and an ultrashort recovery period, no
analgesic properties, additional analgesic is
needed after surgery.
 Methohexital (Brevital): rapid onset and a
recovery period of more ultrashort , cannot
come in contact with silicone for it can
cause breakdown of the silicone, lacks
analgesic effects, its rapid onset can cause
respiratory depression and apnea.
2. Nonbarbiturate Anesthetic
-Anesthetic drug that is administered
intravenously
Examples:
 Midazolam (Versal): rapid onset, peak does
not reach effectiveness for 30-60 minutes,
causes nausea and vomiting than other non
barbiturates
 Droperidol (Inapsine): rapid onset,
ultrashort recovery period, used cautiously
for patients with renal or hepatic failure,
may cause hypotension, chills,
hallucinations and drowsiness after surgery.
 Etomidate (Amidate): ultrashort onset,
rapid recovery period, commonly used for
sedation of patients on ventilators, may
cause myoclonic and tonic movements,
nausea and vomiting during the recovery
phase, not recommended for use in
children younger than 10 y.o
 Ketamine (Ketalar): rapid onset and a very
slow recovery period of (45 minutes),
associated with a bizarre state of
unconsciousness , causes sympathetic
stimulation: increase BP & HR, crosses the
blood brain barrier:hallucinations, dreams
and psychotic episodes.
 Propofol (Diprivan): very short-acting
anesthetic, rapid onset of action, often used
for short procedures, causes burning
sensation @ injection site, bradycardia,
hypotension, pulmonary edema (extreme
cases)
3. Anesthetic Gases
-enters the respiratory system through the
bronchi and alveoli and rapidly into capillary
system for absorption
Examples:
 Nitrous Oxide (Blue cylinder): most potent,
weakest among and less toxic, rapid onset
and recovery, adminstered in combination
with other anesthetics, can cause hypoxia
(block reuptake of oxygen)-given together
with oxygen
 Cyclopropane (orange cylinder): rapid
onset of action and recovery, not good
analgesic: can cause pain, headache,
nausea, vomiting, and delirium during
recovery phase
 Ethylene (red Cylinder): less toxic than any
other agents, rapid onset and recovery, can
cause headache and unpleasant taste in
mouth
4. Volatile Liquids:
-Either gas or volatile liquids those are
unstable @ room temp and release gas.
 Examples:
 Halothane (Fluothane): rapid onset and
recovery, associated with vomiting,
bradycardia, hypotension, risk for hepatic
toxicity, metabolized in liver, causes
recovery syndrome: fever, anorexia,
nausea, vomiting, eventual hepatitis
 Desflurane (Suprane): rapid onset and
recovery, causes respiratory reactions:
cough, increased secretions and
laryngospasm, not used for induction in
pediatric patients.
 Enflurane (Ethrane): rapid onset and
recovery, causes renal toxicity, cardiac
arrhythmias, respiratory depression
 Isoflurane (Generic): rapid onset and
recovery, causes muscle relaxation,
associated with hypotension, hypercapnia,
muscle soreness, bad taste in mouth.
 Methoxyflurane (Penthrane): slow onset
and prolonged recovery, causes renal
toxicity, respiratory depression,
hypotension, rarely used except during
labor & delivery
 Sevoflurane (Ultane): very rapid onset of
action and very rapid clearance, very
minimal adverse effects
Therapeutic Action and Indication
Action:
 Not known
 Depression of reticular activating system
and cerebral cortex
Indications:
 To produce sedation, hypnosis, anesthesia,
amnesia, unconsciousness to allow
performance of painful surgical procedures.
Pharmacokinetics:
 Systemically absorbed throughout the body
including CNS
 Metabolized: liver
Contraindications & Cautions
Contraindications:
 Status asthmaticus: difficulty in providing
ventillatory support and risk of
exacerbation of the problem with CNS
depression
 Absence of suitable veins for IV
administration
Cautions:
 Droperinol: with hepatic or renal failure
 CV disease, hypotension or shock
 Myasthenia gravis and conditions that may
prolonged hypnotic effect
 Myasthenia gravis is a
neuromuscular disorder.
Neuromuscular disorders involve
the muscles and the nerves that
control them.
 Myasthenia gravis causes
weakness of the voluntary
(skeletal) muscles. Voluntary
muscles are those that are under
your control. In other words, you
think about moving your arm, and
it moves. The muscle weakness of
myasthenia gravis worsens with
activity and improves with rest.
The muscle weakness can lead to
a variety of symptoms, including:
 Breathing difficulty because of
weakness of the chest wall muscles
 Chewing or swallowing difficulty,
causing frequent gagging, choking,
or drooling
 Difficulty climbing stairs, lifting
objects, or rising from a seated
position
 Difficulty talking
 Drooping head
 Facial paralysis or weakness of the
facial muscles
 Fatigue
 Hoarseness or changing voice
 Double vision
 Difficulty maintaining steady gaze
 Eyelid drooping

Adverse effects
 Circulatory depression: hypotension, shock,
decreased C/O, arrhythmias
 Respiratory depression: apnea,
laryngospasm, hiccups, coughing, nausea,
vomiting, prolonged somnolence, delirium
 Nursing management
Interventions and Rationale
1. Must be administered by a trained personnel
RATIONALE: Due to its potentially risk
associated use
2. Have equipment on standby to maintain airway
and provide ventilation.
RATIONALE: Patient is not able to maintain
respiration due to CNS depression
3. Monitor for temperature
RATIONALE: Prompt detection and treatment
of malignant hyperthermia. Dantrolene on
standby
4. Monitor for PR, RR, BP, RCG, CO
RATIONALE: Dosage adjustment may be
needed to alleviate potential problems and to
maximize overall benefit with least toxicity,
5. Monitor client until recovery phase is complete and
client is conscious and able to move and
communicate
RATIONALE: Ensure patient safety
6. Provide comfort measures, provide pain relief as
appropriate, skin care and turning, supportive care.
RATIONALE: Helps patient tolerate drug
effects. To deal with effects of anesthesia and
loss of control, to prevent skin breakdown.
7. Provide thorough patient teaching preoperatively
RATIONALE: Ensures patient knowledge
about the condition realizing that most
patients who will be receiving these drugs will
be unconscious or will be receiving teachings
about a particular procedure.
 Infiltration: involves injecting of the drug
directly into the tissues to be treated
 Field block: involves injecting the drug all
around the area that will be affected by the
surgical procedure.
 Nerve block: involves injecting the drug at
the point along the nerve or nerves that run
to and from the region in which the loss of
pain sensation or muscle paralysis is
desired.
Therapeutic Actions & Indications:
Action: temporary interruption in the
production and conduction of nerve
impulses
Indications: for infiltration anesthesia,
peripheral nerve block, spinal anesthesia
and the relief of pain
Contraindications and Cautions:
Contraindications: known allergy, heart
block, shock
Adverse effects:
 CNS: headaches, restlessness, anxiety,
dizziness, tremors, blurred vision, and
backache
 GI effects: nausea, vomiting
 CV effects: peripheral vasodilation,
myocardial depression, arrhythmias, BP
changes that may lead to cardiac arrest and
respiratory arrest.

LOCAL ANESTHETIC DRUGS

 Drugs that only cause a loss of sensation to
a specific part of the body.
 Used primarily to prevent the patient from
feeling pain for a certain period of time
 Very powerful nerve blockers

Modes of administration
 Topical: involves application of a cream,
lotion, ointment or drop of a local
anesthetic
 Nursing management
Intervention and Rationale
1. Have an equipment on standby
RATIONALE: To maintain airway and provide
mechanical ventilation if needed

2. Ensure that drugs for managing hypotension,

cardiac arrest and CNS alterations are on standby
RATIONALE: In cases of severe reaction and
toxicity

3. Ensure that patients receiving spinal anesthesia are

well hydrated and remain lying down for up to 12
hours after anesthesia
RATIONALE: Minimize headache

4.Establish safety precautions

RATIONALE: To prevent skin breakdown and
injury during the time that the patient has a
loss of sensation and/or mobility

5. Provide comfort measures. Provide pain relief as

appropriate; reassurance and support, skin care and
turning and supportive care for hypotension.
RATIONALE: Helps patient tolerate drug effect,
deals with the effects of anesthesia and loss of
control, prevent skin breakdown, prevent
shock or serious hypoxia

6. Provide thorough patient teaching

RATIONALE: To explain what to expect, safety
precautions that will be needed and when to
expect return of function.

Neuromuscular Junction Blocking Agents

 Affect the normal functioning of muscles by
interfering with the normal processes that
occur at the nerve and muscle cell.