DAANCE module 3-anesthetic drugs and techniques Accurate 100%

DAANCE module 3-anesthetic drugs and techniques Accurate 100% analgesia and medications that do it - inability to feel pain fentanyl, ketamine amnesia - loss of memory benzodiazepines: versed®/ midazolam , valium®/ diazepam what drugs provide relaxation and immobility - benzodiazepines: versed/ midazolam , valium/ diazepam propofol/ deprival® brevital®/ methohexital ketamine (everything except fentanyl??) drugs that cause loss of consciousness/ hypnosis - propofol/ deprival® brevital®/ methohexital Pharmacokinetics - The process by which drugs are absorbed, distributed within the body, metabolized, and excreted. Redistribution of drug - The movement of a drug from the site of action to nonspecific sites of action as redistribution occurs the effect of the drug decreases metabolites - breakdown products from metabolism Pharmacodynamics - what the drug does to the body primary effect and secondary effect(side effect) primary target area of benzodiazepines in the brain - center for emotion center of wakefulness in the brain is mainly affected by these anesthetic drugs - propofol/ deprival® brevital®/ methohexital relay center of brain is mainly affected by these anesthetic drugs - ketamine vital centers brain is mainly affected by these anesthetic drugs - almost all there are the side effects - ex: depression of respiration, and decrease of BP - exception: ketamine stimulates cardiovascular system, increasing blood pressure Levels of sedation - 1. Minimal Sedation "Anxiolysis" - normal, patient responds to verbal commands - normal, ventilatory and cardiovascular functions unaffected 2. Moderate Sedation "Conscious Sedation" - purposeful response to verbal/ tactile - normal ventilatory and cardiovascular functions 3. Deep Sedation - purposeful response following repeated, painful stimulation - air way intervention may be required -ventilatory function may be impaired 4. General Anesthesia - patients not arousable by painful stimuli - cannot maintain ventilatory function enteral route - oral, sublingual, buccal, and rectal Parenteral - taken into the body or administered in a manner other than through the digestive tract. usually referring to IV drugs given for Minimal sedation (anxiolysis) and timing - a single enteral (oral route) drug may be given 1 hour before the operation most commonly benzodiazepines ex: halcion®/ triazolam Ativan®/ lorazepam xanax®/ alprazolam valium®/ diazepam Halcion® (triazolam) usage and dosing - most common drug for minimal sedation benzo normal dose: .25-.5 mg elderly dose: .125 mg monitoring for moderate sedation includes - pulse oximeter, ekg, bp monitor, capnography must have at least two people in anesthesia team capnography - procedure to record carbon dioxide levels co2 monitor monitoring for deep sedation includes - pulse oximeter, ekg, bp monitor, capnography, TEMP and ASA classification needed must have at least 3 people in anesthesia team - 1 person responsible for monitoring of patient Preoperative assessment before surgery includes - right patient radiographs referral consents medical, surgical, and social history preoperative physical evaluation/ vital signs includes - HR BP O2 sat Cardiac rhythm ASA classification mallampati classification (airway) auscultation of heart and lungs BMI Fasting Guidelines - Clear liquids - 2 hours Breast milk - 4 hours Nonhuman milk/light meal - 6 hours Regular meal - 8 hours 1% solution equals - concentration measured in mg/mL One gram of medication in 100mL of fluid 1g/100mL 1,000mg/ 100mL 10mg/mL for 2% lidocaine in a 1.7ml carpule, how many mg of lido is there? - 34mg 2%= 20 mg/mL x 1.7mL = 34mg for 3% carbocaine in a 1.7 ml carpule, how many mg carbo is there? - 51 mg 3%= 30mg/mL x 1.7mL= 51 mg vasoconstrictors concentration are expressed as a ratio. ex: 1:100,000. what are the meanings of each number? - 1:100,000 is g:mL soln 1g/100,000mL soln 1,000mg/100,000mL 1mg/100mL .01 mg /mL *** septocaine with concentration 1:50,000 has how many mg septa are there in 1 1ml? - 1g/50,000mL 1,000mg/ 50,000ml 1mg/50mL .1mg/5mL .02mg/ mL septocaine with concentration 1:200,000 has how many mg septa are there in a 1.7mL carpule? - 1g/200,000mL 1,000mg/ 200,000ml 1mg/200mL .01mg/2mL .005mg/ mL x 1.7 mL= .0085mg --or-- 1.7ml x 1g/200,000mL x 1mg/10^-3g = .0085 mg Pseudocholinesterase - A type of enzyme found in the blood that is responsible for the metabolic breakdown of the muscle relaxant succinylcholine and ester anesthetics