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CITY OF MANILA UNIVERSIDAD DE MANILA (Formerly City College of Manila) Mehan Gardens, Manila College of Nursing

A Compilation of Anesthetic Drugs: A Drug Study


In Partial Fulfillment for the Requirements on the Medical and Surgical Nursing(NCM106)- Related Learning Experience (OPERATING ROOM)
Submitted by: Atawneh, Sarah Younes BAcani, Hannah Kaye Baes, Edward Balane, Fatima Grace Barte, Jim Boy NR-42/ Group One Submitted to: Mrs. Marie Chona Balce, RN, MAN

Date Submitted

The Anesthetic Drugs used at Ospital ng Maynila Operating room: Spinal: Nubain Midazolam Bupivacaine Tetracaine Meperidine HCL (Demerol) - optional Epinephrine GETA Nubain Midazolam Tracrium Propofolel Thipental Na Anectine (Succinylcholine chloride) Fentanyl Atropine Sulfate (Optional GEN IV Nubain Midazolam Profolol Fentanyl Demerol GEN MASKO GEN IV + Isoflurane or Sevoflurane

PNB Bupivacaine Isobaric Lidocaine twist top Epinephrine

Clea / CTEA Nubain Midazolam Bupivacaine Isobaric Lidocaine Ampule Epinephrine Demerol (optional)

Anesthesia, or anaesthesia has traditionally meant the condition of having sensation (including the feeling of pain) blocked. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. The word was coined by Oliver Wendell Holmes, Sr. in 1846. Another definition is a reversible lack of awareness , whether this is a total lack of awareness (e.g. a general anaesthestic) or a lack of awareness of a part of a the body such as a spinal anaesthetic or another nerve block would cause. Anesthesia differs from analgesia in blocking all sensation, not only pain. Classification: A. General Anesthesia - is the loss of all sensation and consciousness. Protective reflexes such as cough and gag reflexes are lost. A general anesthetic acts by blocking awareness centers in the brain so that amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial sleep), and relaxation (rendering a part of the body less tense) occur. General anesthetics are usually administered by intravenous infusion or by inhalation of gases through a mask or through an endotracheal tube inserted into the trachea. Advantages: 1. 2. Because the client is unconscious rather then awake and anxious, respiration and cardiac function are readily regulated. The anesthesia can be adjusted to the length of the operation and the client s age and physical status. Disadvantage: 1. 2. It depresses the respiratory and circulatory systems. Some clients become more anxious about a general anesthetic that about the surgery itself. Often this is because they fear losing the capacity to control their own bodies. B. Regional Anesthesia - is the temporary interruption of the transmission of nerve impulses to and from a specific area or region of the body. The client loss sensation in an area of the body but remains conscious. Several techniques are used: Conscious Sedation may be used alone or in conjuction with regional anesthesia for some diagnostic tests and surgical procedures. Conscious sedation refers to minimal depression of the level of consciousness in which the client retains the ability to maintain a patent airway and respond appropriately to commands. Intravenous narcotics such as morphine or fentanyl (Sublimaze) and antianxiety agents such as diazepam (Valium) or midazolam (Versed) are commonly used to induce and maintain conscious sedation. Conscious sedation increases the client s pain threshold and induces a

Topical (surface) Anesthesia

Is applied directly to the skin and mucous membranes, open skin surfaces, wounds, and burns. The most common used topical agents are lidocaine (Xylocaine) and benzocaine. Topical anesthetics are readily absorbed and act rapidly. (Infiltration)is injected into a specific area and is used for minor surgical procedures such as suturing a small wound or performng a biopsy. Lidocaine or tetracaine 0.1% may be used. Is a technique in which the anesthetic agent is injected into and around a nerve or small nerve group that supplies sensation to a small area of the body. Major blocks involve multiple nerves or a plexus (e.g. the brachial plexus anesthetizes the arm); minor blocks involve a single nerve (e.g. a facial nerve) 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. It requires a lumbar puncture through one of the interspaces between lumbar disc 2 (L2) and the sacrum (S1). An anesthetic agent is injected into the subarachnoid space surrounding the spinal cord. Categorized into Low Spinals(saddle or caudal blocks) are primarily used for surgeries involving the perineal or rectal areas. Mild Spinals (below the level of the umbilicus T10) can be used for hernia repairs or appendectomies. High Spinals (reaching the nipple line T4) can be used for surgeries such as cesarean sections. Is an injection of an anesthetic agent into the epidural space, the area inside the spinal column but outside the dura mater.

Local Anesthesia

Nerve Block

Intravenous block (Bier block)

Spinal anesthesia (Subarachnoid block)

Epidural (peridural) anesthesia

degree of amnesia but allows for prompt reversal of its effects and a rapid return to normal activities of daily living. Procedures such as endoscopies, incision and drainage of abcesses, and even balloon angioplastymay be performed under conscious sedation. Risk Factors for Complications During the Procedure:

 

Medication mistakenly injected into a vein; symptoms include dizziness, rapid heartbeat, and funny taste or numbness around the mouth Horner s syndrome (change of pupil size on one side)

            

Current or past health problems Taking medications, supplements, or herbal remedies, blood thinners Allergies (eg, food allergies, medication allergies, latex allergies) Smoking Drinking alcohol Taking recreational drugs Personal or family history of adverse reactions to anesthesia Pain and tenderness around the injection site Bruising, infection, or bleeding of the injection site Hematoma (a mass of clotted blood that forms in a tissue, organ, or body space as a result of a broken blood vessel) Spinal headache (a severe headache that may occur after spinal or epidural anesthesia) Decrease in blood pressure

Possible Complications:

 Ptosis (drooping of the eyelid)  Pneumothorax (air trapped between the lung and rib cage) Call Your Doctor If Any of the Following Occurs:  Signs of infection, including fever and chills  Redness, swelling, increasing pain, or discharge from the injection site  Tingling, numbness, or trouble moving around the affected area  Headache  Persistent coughing  Chest pain      Trouble breathing or shortness of breath Dizziness Heartbeat abnormalities Funny taste or numbness of the mouth Other worrisome symptoms

Nerve damage

Nubain

Generic Name (Brand Name) Generic Name: Nalbuphine

Drug Classification & Indication Drug Classification: synthetic opioid agonistantagonist analgesic

Dosage, Route, Frequency -Adult: 0.150.20mg/kg -SC/IM/IV

Mechanism of Action -Binds with opiate receptors in the CNS: ascending pain pathways in limbic system, thalamus, midbrain, hypothalamus, altering perception of and emotional response to pain .

Adverse Reaction -Sedation, drowsiness, sweating, nausea, dry mouth and dizziness, headache, and vomiting

Contraindication

Nursing Responsibility Assess patient s underlying condition before therapy obtain drug history. Monitor vital signs after parenteral route Monitor allergic reactions: rash, pruritus and Urticaria

Patient Teaching

Hypersensitivity to nalbuphine,

sulfites; lactation. -Use cautiously with emotionally unstable clients or those with a history of narcotic abuse; pregnancy prior to labor, labor or delivery, bronchial asthma, COPD, respiratory depression, anoxia, increased intracranial pressure, acute MI when nausea and vomiting are present, biliary tract surgery.

Brand Name: Nubain Indication: -Relief of moderate to severe pain; for pre-operatively analgesia, supplement to balanced anesthesia, surgical anesthesia.

Discuss in detail all aspects of the drug therapy: reason for taking drug and expected results. Discuss with the patient that dizziness, drowsiness, confusion are common. Instruct patient to change position slowly to prevent orthostatic hypotension and avoid getting up without assistance.

Midazolam

Generic Name (Brand Name) Generic Name: Midazolan Hydrochloride

Drug Classification & Indication Drug Classification: Benzodiazepine (short acting), CNS depressant Indication: . IV or IM: Sedation, anxiolysis, and amnesia prior to diagnostic, therapeutic, or endoscopic or surgery. Induction of general anesthesia Continuous sedation of intubated and mechanically ventilated patients as a component of anesthesia or

Dosage, Route, Frequency Injection5mg/ml IM, IV

Mechanism of Action Exact mechanism of action not understood; acts mainly at the limbic system and reticular formation; potentiates the effect of GABA, an inhibitory neurotransmit ter, anxiolytic and amnesia effects occur at doses below those needed to cause sedation, ataxia; has little effect on cortical function.

Adverse Reaction

Contraindicati on . Contraindicat ed with hypersensitivit y to benzodiazepin es, psychoses, acute narrowangle glaucoma, shock, coma, acute alcoholic intoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, pyloric stenosis have been reported when use in first trimester; neonatal withdrawal syndrome reported in infants);

Nursing Responsibility Assessment: y History: Hypersensitivity to benzodiazepine s, psychoses, acute narrowangle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs, elderly are debilitated patients, impaired liver or renal function, pregnancy lactation. y Physical: Weight skin color, lesions, orientation, affect, reflexes, and sensory

Patient Teaching

Brand Name: ApoMidazalon (CAN)

CNS: Transient, mild drowsiness(initiall y), sedation, depression, lethargy, apathy, fatigue, lightheadedness, disorientation, restlessness, confusion, crying, delirium, difficulty in concentration, vivid dreams, psychomotor retardation, extra pyramidal symptoms, and depressed hearing, nasal congestion. CV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension, palpitation,

y This drug will help you to relax and will make you go to sleep. This drug is a potent amnesiac and you will not remember what has happened to you. y Avoid using alcohol or sleep inducing or over-thecounter drugs before receiving this drug. y Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, visual or hearing disturbances, difficulty voiding.

during treatment in the critical care setting. Unlabeled uses: treatment of epileptic seizure of refractory status epilepticus.

edema. Dependence: drug dependence with withdrawal syndrome when drug is discontinued (more common with abrupt discontinuation of higher dosage used for longer than 4 mo.) Dermatologic: Urticaria, pruritus, skin rush, dermatitis. GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, elevation of blood enzymes; LDH, alkaline phosphatase, AST, ALT, hepatic impairment. GU: incontinence,

neonates. Use cautiously in elderly or debilitated patients; with impaired liver or renal function, lactation.

nerve function, ophthalmologic examination, P, BP, R, adventitious sounds.

urine retention, changes in libido, menstrual irregularities. Hematologic: Decreased Hct, blood dyscrasias Other: Phlebitis and thrombosis at IV injection site, hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomasia, pain, burning.

Bupivacaine Heavy

Generic Name (Brand Name)

Drug Classification & Indication

Dosage, Route, Frequency

Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility

Patient Teaching

Generic Name: Bupivacaine HCl

Drug Classification: Local anesthetic

Dosage: Local injection:


y Individualized,

Brand Name: Bupi Heavy Indication: peripheral nerve block, infiltration, sympathetic blockade, caudal, epidural, pudendal block analgesia via the epidural route spinal anaesthesia route

varying with the anesthetic procedure, the degree of anesthesia required and the patient's response. y Maximum single dose - 175 mg without epinephrine; 225 mg with epinephrine y dose may be repeated at intervals of not less than 3 hours y Maximum daily dose - 400 mg PICRA
y 20mL of 0.25%

Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane' s permeabilit y to sodium ions, which results in inhibition of depolarizati on with resultant blockade of conduction.

Reactions to Bupivacaine are characteristic of those associated with other amide-type local anaesthetics. The most commonly encountered acute adverse experiences which demand immediate countermeasur es following the administration of spinal anaesthesia are hypotension

Contraindicate d in patients with a known hypersensitivit y to it or to any local anesthetic agent of the amide-type. The following conditions preclude the use of spinal anesthesia: y Severe hemorrhage y severe hypotension or shock and arrhythmias, such as complete heart block, which severely restrict cardiac output

solutions containing epinephrine should not be used in the presence of peripheral vascular disease or in areas with limited blood supply i.e. digits, ears, nose, penis resuscitative equipment and drugs for treatment of adverse effects should be readily available when solutions containing epinephrine are used the usual cautions for

This medication is given to reduce sensation in the injected area. You will experience decreased sensation to pain, heat, or cold in the area and/or decreased muscle strength; use necessary caution to reduce incidence of possible injury until full sensation returns. If used in mouth, do

solution injected directly into the nerve sheath, followed by a continuous infusion of 0.2% concentration to infuse at 120-240 mg/24 hours (maximum 400 mg/day) y continue for 72 hours or longer as necessary Epidural (preservative free)
y 5-20 mL of a

0.125% to 0.25% solution with or without epinephrine; may be followed by continuous infusion of 5-10 mL/hr of a 0.0625% to 0.25% solution with or without epinephrine Dosage: adjustments should be considered in

due to loss of sympathetic tone and respiratory paralysis or under ventilation due to cephalic extension of the motor level of anaesthesia. These may lead to cardiac arrest if untreated. In addition, doserelated convulsions and cardiovascular collapse may result from diminished tolerance, rapid absorption from the injection site or from unintentional intravascular

y Local infection at the site of proposed lumbar puncture y Septicemia

epinephrine apply contraindicate d if known allergy to local anesthetics of the amide type Epidural monitoring parameters: heart rate, blood pressure PICRA monitoring parameters: pain level, sedation scale, motor function, blood pressure, respiratory rate, pulse, temperature

not eat or drink until full sensation returns. Immediately report chest pain or palpitations; increased restlessness, anxiety, or dizziness; skeletal or muscle weakness; or respiratory difficulty.

patients with severe liver disease. Route: y local injection for regional and block anesthesia y post-operative infusion of continuous regional analgesia (PICRA) continuous infusion Frequency: Depends on patient s response

injection of a local anaesthetic solution. Factors influencing plasma protein binding, such as acidosis, systemic diseases which alter protein production, or competition of other drugs for protein binding sites, may diminish individual tolerance.

Tetracaine HCl

Generic Name (Brand Name) Generic Name: Tetracaine HCl

Drug Classification & Indication Drug Classification: Anesthetic, local (ophthalmic)

Dosage, Route, Frequenc y Anestheti c, local

Mechanism of Action

Adverse Reaction

Contraindicati on

Nursing Responsibility

Patient Teaching

Brand Name: Pontocaine Ak-T-Caine Ak-Taine Alcaine Diocaine Minims Tetracaine Ocu-Caine Ophthaine Ophthetic

Indication: Anesthesia, local Proparacaine and tetracaine are indicated to produce local anesthesia of short duration for ophthalmic procedures including measurement of intraocular pressure (tonometry),

Topical, to the lower conjunctiv al fornix, approxim ately 1.3 to 2.5 cm (approxim ately 1/2 to 1 inch) of a 0.5% ointment.

Topical, to the conjunctiv a, 1 or 2 drops of a 0.5% or 1%

After topical application to the eye, local anesthetics penetrate to sensory nerve endings in the corneal tissue. These medications block both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions. This reversibly stabilizes the membrane and inhibits depolarization,

Localized Erythema, blanching, edema, or abnormal sensation at the site

Contraindicate d to patients with Hypersensitivit y, low plasma cholinesterase concentrations , complete heart block, pyrogenic infection. Caution to Patients sensitive to other estertype local anesthetics (such as benzocaine, butacaine, butamben, chloroprocaine , procaine, or propoxycaine) or to aminobenzoic acid (para-

Monitor ECG, blood pressure and respiratory status frequently.

Allergic Urticaria, angioedema, bronchospasm, and possible shock Systemic Reactions CNS excitation and/or depression (lightheadedness,

Assess degree of numbness of the affected part. IM injections are recommende d if ECG monitoring is not available. Explain the purpose of the medication.

Report for signs of infection, including fever and chills, redness, swelling, increasing pain, or discharge from the injection site, tingling, numbness, or trouble moving around the affected area, headache, persistent coughing, chest pain, trouble breathing or shortness of breath, dizziness, heartbeat

Opticaine Pontocaine Spectro-Caine

removal of foreign bodies and sutures, and conjunctival and corneal scraping in diagnosis and gonioscopy. Proparacaine and tetracaine are also indicated to produce local anesthesia prior to surgical procedures such as cataract extraction and pterygium excision, usually as an adjunct to locally injected anesthetics. Ophthalmic solutions used

solution.

resulting in the failure of a propagated action potential and subsequent conduction blockade.

nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousne ss, respiratory depression and arrest). Cardio Bradycardia, hypotension and cardiovascular collapse leading to arrest

aminobenzoic acid; PABA) or parabens may be sensitive to tetracaine also.

Notify Physician if adverse reaction occurs.

abnormalities, funny taste or numbness of the mouth or other worrisome symptoms

for intraocular procedures should be preservativefree. Preservatives may cause damage to the corneal epithelium if a significant quantity of solution enters the eye through the incision.

Meperidine hydrochloride

Generic Name (Brand Name) Generic Name: Meperidine hydrochloride Brand Name: Demerol

Drug Classification & Indication Drug Classification: Opioid agonist analgesic

Dosage, Route, Frequency Adult: Relief of pain: individualiz e dosage; 50-150mg Im, SQ, or PO every 34 hours as needed Preoperativ e medication :50-100 mg IM or SQ Obstetric anesthesia: when contraction s become regular, 50100mg IM or SQ;

Mechanism of Action Acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria. Sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).

Adverse Reaction CNS: dizziness, Lightheaded ness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucination s, disorientatio n CV: facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, palpitations, chest wall

Contraindic ation Contraindica ted with hypersensiti vity to opioids, diarrhea caused by poisoning, BA, COPD, respiratory distress, anoxia, seizure. Contraindica ted to premature infants Use cautiously with acute abdominal conditions, CV disease, myxedema, delirium tremens, ulcerative

Nursing Responsibility

Patient Teaching Take drug exactly as prescribed Avoid alcohol, antihistami nes, sedatives, tranquilizier s and OTC drugs Do not take leftover medication for other disorders, and do not let anyone else take this prescription Report severe nausea and vomiting,

Indication: Oral, parenteral: relief of moderate to severe pain Parenteral: Preoperative medication, support of anesthesia and obstetric analgesia.

Administer to lactating women 4-6 hrs before next feeding to minimize the amount of milk Keep opioid antagonist and facilities for assisted or controlled respiration readily available during parenteral administration. Use caution when injecting SQ into chilled areas of the body or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive when the circulation is restored.

every 13hrs.

rigidity Derma: pruritus, urticaria, laryngospas m, edema GI: Nausea, vomiting, dry mouth, anorexia, constipation Major Hazards: Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest

colitis.

Reduce dose of meperidine by 25% 50% in patients receiving phenothiazines or other tranquilizers Give each dose of the oral syrup in half glass of water. If taken undiluted, it amy exert a slight local anesthetics effect on mucous membranes. Reassure patient that addiction is unlikely; most patients who receive opiates for medical reasons do not develop dependence syndromes Use meperidine with extreme caution in patients with renal impairment or those requiring repeated dosing due to accumulation of normeperidine, a toxic metabolite that may cause seizures

constipatio n, shortness of breath, or difficulty of breathing Side effects such as loss of appetite, constipatio n, dizziness, sedation, drowsiness, impaired visual acuity may experience.

Epinephrine

Generic Name (Brand Name) Generic Name: Epinephrine

Drug Classification & Indication Drug Classification: Sympathomimet ic drug, Alphaadrenergic agonist, Beta1 and beta2adrenergic agonist, Cardiac stimulant, Vasop ressor, Broncho dilator,Antiasth matic drug, Nasal decongestant, M ydriatic, Antiglaucoma dr ug Indication: - In ventricular standstill after other measures have failed to restore circulation, given by trained personnel

Dosage, Route, Frequency IV Advance d cardiac life support As 1:10,000 soln: 10 mL, repeat every 2-3 mins if needed. Anaphylact ic shock As 1:10,000 soln: 5 mL infused slowly until a response is achieved. I M Anaphyl actic shock As 1:1,000 soln: 0.5 mL, repeat every 5 mins as needed. Ac ute

Mechanism of Action -Binds with opiate receptors in the CNS: ascending pain pathways in limbic system, thalamus, midbrain, hypothalamus, altering perception of and emotional response to pain .

Adverse Reaction -Sedation, drowsiness, sweating, nausea, dry mouth and dizziness, headache, and vomiting

Contraindicati on Contraindicate d with allergy or hypersensitivit y to epinephrine or components of preparation narrow-angle glaucoma; shock other than anaphylactic shock; hypovol emia; general anesthesia with halogenated hydrocarbons or cyclopropan e; organic brain damage, cerebral arteriosclerosis ; cardiac dilation and coronary insufficiency;ta chyarrhythmia

Nursing Responsibility Use extreme caution when calculating and preparing doses; epinephrine is a very potent drug; small errors in dosage can cause serious adverse effects. Doublecheck pediatric dosage Use minimal doses for minimal periods of time; "epinephrinefastness" (a form of drug tolerance) can occur with prolonged use. Protect drug solutions from light, extreme heat, and freezing; do not

Patient Teaching

Brand Name: epinephrine b itartrate

Instruct patient to take medication exactly as directed. If on a scheduled dosing regimen, take a missed dose as soon as possible; space remaining doses at regular intervals. Do not double doses. Caution patient not to exceed recommend

byintracardiac p uncture and intramyocar dial injection; treatment and prophylaxis of cardiac arrest and attacks of transitory AV heart block with syncopal se izures (StokesAdams syndrome); syncope due to carotid sinus syndrome; acute hypersensitivity (anaphylactoid) reactions, serum sickness, urticari a, angioneurotic edema; in acute asthmatic attacks to relieve bronchos pasm not controlled by inhalation or SC injection; relaxation of uterine musculature; additive to local anesthetic solutions for

asthmatic attacks As 1:1,000 soln: 0.30.5 mL. -SC/IV

s; ischemic heart disease; hypertension; renal dysfunction (drug may initially decrease renal blood flow); COPD patients who have developed degenerative heart disease; diabetes mellitus; hyperthyroidis m; lactation.

use pink or brown solutions. Drug solutions should be clear and colorless (does not apply to suspension for injection). Shake the suspension for injection well before withdrawing the dose. Rotate SC injecti on sites to prevent necrosis; monitor injection sites frequently. Maintain a rapidly acting alphaadrenergic blocker (phentolamine) or a vasodilator (a nitrate) on standby in case of excessive hypertensive reaction. Maintain an alpha-

ed dose; may cause adverse effects, paradoxical bronchospas m, or loss of effectiveness of medication

injection to prolong their duration of action and limit systemic absorption - Relief from respiratory distress of bronchial asthma, chronic bronchitis, emphysema, other COPDs - Temporary relief from acute attacks of bronchial asthma, COPD -Temporary relief from nasal and nasopharyngeal mucosal congestion due to a cold, sinusitis, hay fever, or other upper respiratory allergies; adjunctive therapy in middle ear infections by decreasing

adrenergic blocker or facilities for intermittent positive pressure breathing on standby in case pulmonary edema occurs. Maintain a beta-adrenergic blocker (propranolol; a cardioselectiv ebeta-blocker, such as atenolol, should be used in patients with respiratory distress) on standby in case cardiac arrhythmias occur. Do not exceed recommended dosage of inhalation products; administer pressurized inhalation drug forms during second half of

congestion around eustachi anostia -Management of open-angle (chronic simple) glaucoma, often in combination with miotics or other drugs -Conjunctivitis, during eye surgery to control bleeding, to produce mydrias is

inspiration, because the airways are open wider and the aerosol distribution is more extensive. If a second inhalation is needed, administer at peak effect of previous dose, 3 5 min. Use topical nasal solutions only for acute states; do not use for longer than 3 5 days, and do not exceed recommended dosage. Rebound nasal congestion can occur after vasoconstriction subsides.

Atracurium Besylate

Generic Name (Brand Name) Generic Name: Atracurium Besylate

Drug Classification & Indication Drug Classification: Analgesics, anesthesia anti psychotic, anti ulcer. Indication:

Dosage, Route, Frequency Injection: 10mg/ml; 2.5ml ampoule

Mechanism of Action Atracurium Besylate Preservative Free binds to the nicotinic acetycholine (cholinergic) receptors in the motor endplate and blocks access to the receptors. In the process of binding, the receptor is actually activated - causing a process known as depolarization. Since it is not degraded in the neuromuscular junction, the depolarized membrane remains depolarized and unresponsive to any other impulse, causing

Adverse Reaction Allergic reactions (anaphylactic or anaphylactoid responses) which, in rare instances, were severe (e.g., cardiac arrest)

Contraindica tion Contraindica ted in patients known to have an allergic hypersensiti vity to NIMBEX or other bisbenzylisoqui nolinium agents. Use of NIMBEX from vials containing benzyl alcohol as a preservative is contraindicat ed in patients with a known hypersensiti vity to benzyl alcohol.

Nursing Responsibility Use in combination with agents that cause sedation/amnes ia and analgesia; atracurium has no effect on level of consciousness or pain threshold. Dilute with D^sub 5^W or 0.9% sodium chloride solution. Don't use with lactated Ringer's solution, which can cause atracurium to degrade quickly, or with alkaline solutions, especially barbiturates, which can inactivate

Patient Teaching

Brand Name: Tracrium For inpatients and outpatients as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation in the ICU.

Musculoskelet al: Inadequate block, prolonged block

Instruct patient to take a missed dose as soon as p[possible. Instruct patients to take the drug with meals. Emphasized importance of taking drugs as prescribed, even if patient is feeling better. Warn patients to avoid hazardous activities when dizziness occurs.

Cardiovascular : Hypotension, vasodilatation (flushing),

muscle paralysis.

tachycardia, bradycardia Respiratory: Dyspnea, bronchospasm, laryngospasm

Integumentary : Rash, urticaria, reaction at injection site

atracurium. Monitor the patient's response to blockade with peripheral nerve stimulation. To reverse neuromuscular blockade, administer an anticholinestera se agent such as neostigmine in combination with an anticholinergic agent such as glycopyrrolate. Don't administer by intramuscular injection; atracurium can cause tissue irritation.

Propofol

Generic Name (Brand Name)

Drug Classification & Indication

Dosage, Route, Frequency

Mechanism of Action

Adverse Reaction

Contraindicatio n

Nursing Responsibility

Patient Teaching

Generic Name: Propofol

Drug Classification: General anesthetic

Dosage: Anesthesia Adults younger than 55 yr of age IV Induction 40 mg every 10 sec until onset. Usual dose is 2 to 2.5 mg/kg total. For maintenance infusion, titrate to 100 to 200 mcg/kg/min (6 to 12 mg/kg/h). For maintenance intermittent bolus, use 25 to 50 mg increments, as needed. Elderly, Debilitated, or ASA III/IV (American Society of Anesthesiologists classification of heart disease, cardiac function, angina, and

Indication: Brand Name: Diprivan Induction and maintenanc e of anesthesia in adults; induction anesthesia in children at least 3 yr of age; maintenanc e anesthesia in children at least 2 mo of age; initiation

Produces sedation/hyp nosis rapidly (within 40 sec) and smoothly with minimal excitation; decreases IOP and systemic vascular resistance; rarely is associated with malignant hyperthermia and histamine release; suppresses cardiac output and respiratory

Cardiovascula r Myocardial ischemia; hypotension; bradycardia; decreased cardiac output; hypertension (especially in children). CNS Amorous behavior; movement hypotonia; hallucinations ; neuropathy; opisthotonos. Dermatologic Rash.

Propofol is contraindicate d in patients hypersensitive to it or any of components of the product. It should not be used in patients where general anesthesia or sedation are contraindicate d. Propofol should only be used in facilities where sufficient monitoring and patientsupport capabilities are available. Because patients who are in shock, under severe

Monitor hemodynami c status and assess for dose-related hypotension. Take seizure precautions. Tonic-clonic seizures have occurred following general anesthesia with propafol. Be alert to the potential for drug induced excitation (e.g., twitching, tremor, hyperclonus) and take appropriate safety measures.

Advise patient that mental alertness, coordination , and physical dexterity may be impaired for some time after administrati on.

and maintenanc e of monitored anesthesia care sedation in adults; sedation in intubated or respiratorycontrolled adult ICU patients.

physical status used to assign risk for anesthesia.) IV 20 mg every 10 sec until onset. Usual dose is 1 to 1.5 mg/kg. For maintenance infusion, titrate to 50 to 100 mcg/kg/min (3 to 6 mg/kg/h). Neurosurgical patients IV Induction 20 mg every 10 sec until onset. Usual dose is 1 to 2 mg/kg. For maintenance infusion, use 100 to 200 mcg/kg/min (6 to 12 mg/kg/h). IV Induction 2.5 to 3.5 mg/kg over 20 to 30 sec. For maintenance infusion (at least 2 mo), use 200 to 300 mcg/kg/min immediately following the induction dose, then, after the first 30 min of maintenance, use

drive.

EENT Conjunctival hyperemia; nystagmus. Metabolic Hyperlipidem ia. Respiratory Apnea; cough; respiratory acidosis during weaning. Miscellaneou s Asthenia; burning, stinging, or pain at injection site; fever.

stress or have undergone trauma may be overly sensitive to the cardiovascular and respiratory depressant effects of propofol, it should be used with caution in these patients. Patients with hypoprotein emia may be susceptible to untoward effects. Other general anesthetic agents may be a safer choice in these patients.

Provide comfort measures; pain at the injection site is quite common especially when small veins are used.

infusion rates of 125 to 150 mcg/kg/min titrated to achieve the desired clinical effect, are typically needed. Sedation Adults younger than 55 yr of age IV Initiation 100 to 150 mcg/kg/min (6 to 9 mg/kg/h) for 3 to 5 min (preferred method) or slow injection of 0.5 mg/kg over 3 to 5 min; follow by maintenance infusion. For maintenance, use 25 to 75 mcg/kg/min (1.5 to 4.5 mg/kg/h) (preferred method) or incremental bolus doses of 10 to 20 mg. Elderly, Debilitated, or ASA III/IV IV Initiation Same as adults; not as rapid bolus. For

maintenance, use 20% reduction of adult dose; avoid rapid bolus doses. ICU Sedation Adults IV Initiation 5 mcg/kg/min (0.3 mg/kg/h) for at least 5 min; increments of 5 to 10 mcg/kg/min (0.2 to 0.6 mg/kg/h) over 5 to 10 min may be used until desired level of sedation is achieved. For maintenance, use 5 to 50 mcg/kg/min (0.3 to 3 mg/kg/h) or higher may be required; use minimum dose required for sedation.

Thiopental Sodium

Generic Name (Brand Name) Generic Name: Thiopental sodium

Drug Classification & Indication Drug Classification: Anesthesia Barbiturate

Dosage, Route, Frequency Adults: IV 25 to 75 mg; observe for 60 sec. Anesthesia Adults: IV 50 to 75 mg slowly every 20 to 40 sec until anesthesia is established then 25 to 50 mg as needed or continuous infusion of 0.2% or 0.4%. Preanesthe tic Sedation: Adults: PR 1 g/34

Mechanism of Action Ultra short-acting barbiturate anesthetics depress the central nervous system (CNS) to produce hypnosis and anesthesia without analgesia. The exact mechanism by which barbiturate anesthetics produce general anesthesia is not completely understood. However, it has been proposed that they act by enhancing responses to gammaaminobutyric acid (GABA), diminishing glutamate (GLU) responses, and

Adverse Reaction Cardiovascular: Myocardial depression; arrhythmias. CNS: Delirium, headache; amnesia; seizures. Dermatologic Rash. GI: Abdominal pain; rectal irritation; diarrhea; cramping; rectal bleeding (rectal suspension). Respiratory: Apnea; laryngospasm; bronchospasm; hiccoughs; sneezing; coughing.

Contraindicati on Absolute Contraindicati ons:  Absence of suitable veins for intravenou s administra tion,  hypersensi tivity (allergy) to barbiturate s and (3) variegate porphyria (South African) or acute intermitten t porphyria. Relative Contraindicati ons:

Nursing Responsibility Avoid alcohol intake at least 24 hours without advice of the health care professional Inform patient that medication will decrease mental recall of the procedure mood-altering drugs, or any other CNS depressant medicines for at least 24 hours without advice of the health care professional Aseptic technique is essential. Solution is capable of

Patient Teaching

Brand Name: Pentothal - Powder for injection 2% (20 mg/mL) - Powder for injection 2.5% (25 mg/mL)

Indication: as anesthetic agent for brief (15 minute) procedures, for induction of anesthesia prior to administratio n of other anesthetic agents, to supplement regional anesthesia,

Instruct patient to notify health care provider of any signs of hypersensiti vitiy to barbiturate s. Inform patient to avoid alcohol or other CNS depressants for 24 h. Advise patient that drug can continue to impair abilities for 24 h following administrati on and caution patient to

to provide hypnosis during balanced anesthesia with other agents for analgesia or muscle relaxation, for the control of convulsive states during or following inhalation anesthesia, local anesthesia, or other causes, in neurosurgical patients with increased intracranial pressure, if adequate ventilation is provided for

kg (30 mg/kg). Basal Narcosis Adults PR 1 g/22.5 kg (44 mg/kg) (max, 3 to 4 g for adults weighing over 90 kg).

directly depressing excitability by increasing membrane conductance (an effect reversed by the GABA antagonist picrotoxin), thereby producing a net decrease in neuronal excitability to provide anesthetic action. The mechanism by which thiopental reduces intracranial pressure and protects the brain from cerebral ischemia and hypoxia is not completely understood. However, it is related to thiopental's anesthetic action and results in increased cerebral vascular

Miscellaneous: Thrombophlebi tis; pain at injection site; salivation; shivering.

 Severe cardiovasc ular disease  hypotensio n or shock,  conditions in which the hypnotic effect may be prolonged or potentiate d excessive premedicat ion, Addison's disease, hepatic or renal dysfunctio n, myxedema , increased blood urea, severe anemia, asthma, myastheni a gravis, and status asthmaticu

rapid growth of bacteria contaminants. Infections and subsequent dea6hs have been reported May cause drowsiness or dizziness. Advice patients to request assistance prior to ambulation and transfer to avoid driving or any kind of activities that requires alertness until response to medication is known

avoid driving or performing other tasks requiring mental alertness.

narcoanalysis and narcosynthes is in psychiatric disorders.

resistance with a decrease in cerebral blood flow and cerebral blood volume, and decreased cerebral metabolic rate for oxygen. Various mechanisms of action have been proposed, including a reduction of cerebral metabolic rate, a decrease in the functional activity of the brain, an inhibition of the brain stem neurogenic mechanism of vasoparalysis, a sealing effect on membranes, and a scavenging of free oxygen radicals

s.

Succinylcholine chloride

Generic Name (Brand Name) Generic Name: succinylcholin e chloride

Drug Classification & Indication Drug Classification: Anesthetic, local (ophthalmic)

Dosage, Route, Frequency The dosage of succinylcholin e should be individualized and should always be determined by the clinician after careful assessment of the patient

Mechanism of Action The mechanism of action of Anectine involves what appears to be a "persistent" depolarization of the neuromuscular junction. This depolarization is caused by Anectine mimicking the effect of acetylcholine but without being rapidly hydrolysed by acetylcholinest erase. This depolarization leads to

Adverse Reaction General Malignant hyperthermia Respiratory prolonged respiratory depression or apnea Cardio Cardiac arrest, arrhythmias, bradycardia, tachycardia, hypertension, hypotension, hyperkalemia, Others Increased intraocular pressure, muscle fasciculation,

Contraindicati on Succinylcholine is contraindicate d in persons with personal or familial history of malignant hyperthermia, skeletal muscle myopathies, and known hypersensitivit y to the drug. It is also contraindicate d in patients after the acute phase of injury following major burns, multiple trauma, extensive denervation of skeletal muscle, or upper motor neuron injury,

Nursing Responsibility Lab tests: Obtain baseline serum electrolytes. Electrolyte imbalance (particularly potassium, calcium, magnesium) can potentiate effects of neuromuscula r blocking agents. Be aware that transient apnea usually occurs at time of maximal drug effect (1 2 min); spontaneous respiration

Patient Teaching

Indication: Brand Name: Anectine Quelicin Quelicin Preservative Free Sucostrin Succinylcholi ne chloride is indicated as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical

Patient may experience postprocedura l muscle stiffness and pain (caused by initial fasciculations following injection) for as long as 24 30 h. Be aware that hoarseness and sore throat are common even when pharyngeal airway has not been used. Report residual muscle weakness to physician.

For Short Surgical Procedures Average dose required to produce neuromuscul ar blockade and to facilitate tracheal intubation is

ventilation.

0.6 mg/kg ANECTINE Injection given intravenously . The optimum dose will vary among individuals and may be from 0.3 to 1.1 mg/kg for adults. For Long Surgical Procedures The dose of succinylcholin e administered by infusion depends upon the duration of the surgical procedure and the need for muscle relaxation. The average rate for an adult ranges between 2.5

desensitization.

jaw rigidity, postoperative muscle pain, rhabdomyolysi s with possible myoglobinuric acute renal failure, excessive salivation, and rash.

because succinylcholine administered to such individuals may result in severe hyperkalemia which may result in cardiac arrest. The risk of hyperkalemia in these patients increases over time and usually peaks at 7 to 10 days after the injury. The risk is dependent on the extent and location of the injury. The precise time of onset and the duration of the risk period are not known.

should return in a few seconds or, at most, 3 or 4 min. Have immediately available: Facilities for emergency endotracheal intubation, artificial respiration, and assisted or controlled respiration with oxygen. Monitor vital signs and keep airway clear of secretions.

and 4.3 mg per minute. Intermittent IV Injection An IV injection of 0.3 to 1.1 mg/kg may be given initially, followed, at appropriate intervals, by further injections of 0.04 to 0.07 mg/kg to maintain the degree of relaxation required.

Fentanyl

Generic Name (Brand Name) Generic Name: Fentanyl

Drug Classification & Indication Drug Classification: Narcotic agonist analgesic Indication:

Dosage, Route, Frequency Premedica tion: 0.05 0.1 mg IM 30 60 min prior to surgery. IM /Transder ma

Mechanism of Action Acts at specific opioid receptors, causing analgesia, respiratory depression, physical depression, euphoria.

Adverse Reaction

Contraindic ation Contraindic ated with hypersensiti vity to narcotics, diarrhea caused by poisoning, acute bronchial asthma, upper airway obstruction, pregnancy.

Nursing Responsibility Administer to women who are nursing a baby 4 6 hr before the next scheduled feeding to minimize the amount in milk. Provide narcotic antagonist, facilities for assisted or controlled respiration on standby during parenteral administration. Prepare site for transdermal f orm by clipping (not shaving) hair at site; do not use soap, oils, lotions, alcohol; allow skin to dry completely before application. Apply

Patient Teaching These side effects may occur: dizziness, sedation, drowsiness, impaired visual acuity (ask for assistance if you need to move); nausea, loss of appetite (lie quietly, eat frequent small meals); constipatio n (a laxative may help). Do not drink grapefruit juice while on this drug.

Brand Name: Actiq, Fentora, Onsolis,Durag esic

- Analgesic action of short duration during anesthesia and immediateposto p period Analgesic supplement in general or regional anesthesia Administration with a neuroleptic as an anesthetic preme dication, for induction of anesthesia, and

Sedation, clamminess, sweating, headache, vertigo, floating feeling, dizziness, lethargy, confusion, lightheadedness, nerv ousness, unusual dreams, agitation, euphoria, hallucinations, delirium, insomnia, anxiety, fear, disorientation, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, convulsions Palpitation, increase or

as an adjunct in maintenance of general and regional anesthesia For use as an anesthetic agent with oxygen in selected high-risk patients Transdermal sys tem: management of chronic pain in patients requiring opioid analgesia Treatment of breakthrough pain in cancer patients being treated with narcotics (Actiq)

decrease in BP, circulatory depression, cardia c arrest, shock, tachycardi a, bradycardia, arrhythmia, palpitations Rash, hives, pruritus, flushing, warmth, sensitivity to cold Diplopia, blurred vision Nausea, vomiting, dry mouth, anorexia, constipation, bilia ry tract spasm Ureteral spasm, spasm of vesical sphincte rs, urinary retention or hesitancy,oliguria, antidiuretic effect , reduced libido or potency

immediately after removal from the sealed package; firmly press the transdermal s ystem in place with the palm of the hand for 10 20 sec, making sure the contact is complete. Must be worn continually for 72 hr. Use caution with Actiq form to keep this drug out of the reach of children (looks like a lollipop) and follow the distribution restrictions in place with this drug very carefully.

Report severe nausea, vomiting, palpitations , shortness of breath, or difficulty breathing.

Atropine sulphate

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Generic Name: Atropine Sulfate

Drug Classification: Anticholinergic, antidote, Antiparkinsonia n, Belladonna alkaline Indication: Antisialogogue for preanesthetic medication to prevent or reduce respiratory tract secretions. Treatment of parkinsonism; relieves tremors and rigidity Restoration of cardiac rate and arterial pressure during anesthesia when

Brand Name: AtroPen, SalTropine

Tablets-0.4 m, injection: 0.05, 0.1, 0.3, o.4, 0.5, 0.8 mg/ml; IM,IV, SubQ, Topical

Competitively blocks the effects of acetylcholine at muscarinic cholinergic receptors that mediate the effects of parasympathetic post ganglionic impulses, depressing salivary and bronchial secretions, dilating the bronchi, inhibiting vagal influences in the heart, relaxin the GI and GU tracts, inhibiting gastric acid secretion, ( high dose), relaxing the pupil of the eye, and preventing accommodation foe near vision,

CNS: Blurred vision, mydriasis, cycloplegia, photophobia, increased IOP, headache flushing, nervousness, weakness, dizziness, insomnia, mental confusion, or excitement. CV: Palpitations, bradycardia, ( low doses) tachycardia ( high doses) GI: Dry mouth, altered taste perception, N/V, dysphagia, heartburn,

Contraindicat ed with hypersensitivit y to anticholinergic drugs. Systemic administration : Contraindicat ed with glaucoma, adhesions between iris and lens; stenosing peptic ulcer, pyloroduodena l obstruction; paralytic ileus. Use cautiously with Down syndrome, brain damage, spasticity,

Assessment: History: Hypersensitivity to anticholinergic; glaucoma; adhesions between iris and lens; stenosing peptic ulcer, paralytic ileus. Physical: skin color, lesions, texture, T; orientation, reflexes, bilateral grip strength, affect, ophthalmic examination, P, BP, R adventitious sounds.

Take as prescribed, 30 minutes before meals, avoid excessive dosage. Avoid hot environments you will be heat intolerant, and dangerous reactions may occur. Report rash, flushing, eye pain difficulty breathing tremors, loss of coordination, irregular heartbeat, palpitations, headache, abdominal distention, hallucinations, sever or persistent dry mouth.

vagal stimulation produced by intra-abdominal traction causes a decrease in pulse rate, lessening the degree of AV block when increased vagal tone is a factor. Relief of bradycardia and syncope due to hyperactive carotid sinuses reflex. Relief of pylorospasm, hyper tonicity of the small intestine, and hypermotility of the clon Relaxation of the spasm of biliary and ureteral colic and bronchospasm. Relaxation of the tone of the

also blocks the effects of acetylcholine in the CNS.

constipation, bloated feeling, paralytic ileus, gastroesophag eal reflux. GU: Urinary hesitancy and retention, impotence. Other: decreased sweating and predispositions , suppression of lactation. Local: transient stinging Systemic: systemic adverse effects, depending on amount absorbed.

hypertension, hyperthyroidis m, lactation.

detrusor muscle of the urinary bladder in the treatment of the urinary tract disorder. Control of crying and laughing episodes in patients with brain lesions. Relaxation of uterine hyper tonicity. Management of peptic ulcer. Control of rhinorrhea of acute rhinitis or hay fever.

Isoflurane

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Patient Teaching

Generic Name: Isoflurane

Drug Classification: Anesthetic

Inhalation induction:

Brand Name: Forane Terrell Aerrane Ethane Forane Forene

Indication: Forane (isoflurane, USP) may be used for induction and maintenance of general anesthesia. Adequate data have not been developed to establish its application in obstetrical anesthesia.

initial 0.5 % v/v with oxygen or oxygen and nitrous oxide, increase to 1.5- 3 % v/v

Maintenan ce: 1-2.5% v/v with oxygen only

Forane induces a reduction in junctional conductance by decreasing gap junction channel opening times and increasing gap junction channel closing times. Forane also activates calcium dependent ATPase in the sarcoplasmic reticulum by increasing the fluidity of the lipid membrane. Also appears to bind the D subunit of ATP synthase and NADH

General Malignant hyperthermia and shivering

Hepatic Rare reports of mild, moderate, and severe (sometimes fatal) postoperative hepatic dysfunction and hepatitis, hepatic failure and hepatic necrosis Gastrointestin al Nausea,

Contraindicate d to patients with known sensitivity to Isoflurane, USP or to other halogenated agents and known or suspected genetic susceptibility to malignant hyperthermia.

Used with caution in patients with coronary artery disease

Advise patient to stop herbal medication 23 weeks prior to surgery

Monitor blood pressure and temperature to detect residual hypotension and the possibility of malignant hyperthermia

Must be given with a licensed anesthesiologi st

Emergency kit must be made available

Report for signs of infection, including fever and chills, redness, swelling, increasing pain, or discharge from the injection site, tingling, numbness, or trouble moving around the affected area, headache, persistent coughing,

dehydogenase. Forane also binds to the GABA receptor, the large conductance Ca2+ activated potassium channel, the glutamate receptor and the glycine receptor

vomiting, Respiratory Isoflurane can react with desiccated carbon dioxide (CO2) absorbents to produce carbon monoxide, which may result in elevated levels of carboxyhemogl obin in some patients. Metabolic Hyperkalemia Other Transient elevations in white blood count Monitor respiratory function (dosage may need to be reduced)

Prepare to provide ventilator support

chest pain, trouble breathing or shortness of breath, dizziness, heartbeat abnormalities, funny taste or numbness of the mouth or other worrisome symptoms

Document the use of these agents in the medical record

Lidocaine hydrochloride

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Generic Name: Lidocaine HCl

Drug Classification: Local Anesthetic Antiarrhythmic

Brand Name: Lidocaine anesthetic prep: Xylocaine HCl (inj.) Octocaine

Indication: As anesthetic: infiltration anesthesia, peripheral and symphatetic nerve blocks, central nerve blocks. Spinal and caudal anesthesia, retrobulbar and transtracheal injection; topical anesthesia for skin disorders

Local anesthesi a: dosage varies with the area to be anesthesiz ed and te reason for the anesthesi a; use the lowest dose possible. Direct inj 10,20mg/ mL

Local anesthetic: blocks the generation and conduction potentials in sensory nerves by reducing sodium permeability. Reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity. Type 1 antiarrhythmic: decreases diastolic depolarization, decreasing automaticity of

Injectable local anesthesia; CNS: dizziness, HA, backache, septic meningitis, sometimes incomplete recovery CV: Hypotension due to sympathetic block Derma: pruritus, urticaria, edema GU: urinary retention, urinary or fecal incontinence

Contraindicate d with allergy to lidocaine or amide-type local anesthetics, HF, cardiogenic shock, strokesAdam syndrome Use cautiously with hepatic or renal disease, inflammation or sepsis in the region of injection, labor and delivery and lactation.

Check drug concentration carefully; many concentration s are available. Reduces dosage with hepatic or renal failure. Continuously monitor response when used as antiarrhythmi c or injected as local anesthesia. Keep lifesupport equipment and vasopressors readily

Dosage is changed frequently in response to cardiac rhythm on monitor. Oral lidocaine can cause numbness of the tongue, cheeks, and throat. Do not eat or drink for 1 hour to prevent biting the inside of your mouth and tongue and choking Side effects such as drowsiness, numbness, dizziness, burning, local

and accessible mucous membranes As local anesthesia before venipuncture or peripheral IV cannulation when applied to intact skin in children 318 years old. As antiarrhythmic : Mngt of ventricular arrhythmias during cardiac surgery and MI (IV use). Use IM when IV administration is not possible or when ECG monitoring is not available and the danger of ventricular

ventricular cells: increases ventricular fibrillation threshold.

Topical Local Anesthesia: Derma: contact dermatitis, urticaria, cutaneous lesions Hypersentitivit y: anaphylactoid reactions Local: Burning, stinging, tenderness, swelling, tissue irritation, necrosis

available in case severe adverse reaction occurs Monitor for malignant hyperthermia; have-life support equipment and IV dantrolene readily available Reduce dose when treating arrhythmias in HF, digoxin toxicity with AV block, and geriatric patients Monitor fluid load carefully; more concentrated solutions can be used to treat arrhythmias

irritation may experience. Report difficulty speaking, thick tongue, DOB, pain at the IV site

arrhythmias is great.

in patients on fluid restrictions Large amount of anesthesia used during cosmetic procedures may result in severe, lifethreatening adverse effects. Check lidocaine preparation carefully; epinephrine is added to solutions of lidocaine to retard the absorption of the local anesthetic from the injection site. Make sure that solutions are use only to produce

local anesthesia Use caution to prepvent choking. Patient may have difficulty swallowing after using oral topical anesthetic. Do not give food or drink for 1 hour use of oral anesthetic Monitor for safe and effective serum drug concentration s (antiarrhythm ic use: 15mcg/mL). Doses more than 610mcg/mL are usually toxic

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