CITY OF MANILA UNIVERSIDAD DE MANILA (Formerly City College of Man of Manil ila a) Mehan Gardens, Manila College of Nurs of Nursiing
A Compilation of Anesthetic Drugs: A Drug Study In Partial Fulfillment Fulfillment for the Requirements Requirements on the Medical and Surgical Nursing(NCM106)- Related Learning Experience (OPERATING ROOM) Submitted by: Atawneh, Sarah Younes Y ounes 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 Ane Anesthetic
ila Ope Drug Drugs used used at Ospit Ospita al ng May Maynila Operati ratin ng room:
Spinal: Nubain
GEN MASKO
Midazolam
GEN IV + Isoflurane or Sevoflurane
Bupivacaine Tetracaine Meperidine HCL (Demerol) - optional Epinephrine PNB
GETA Nubain
Bupivacaine Isobaric
Midazolam
Lidocaine twist top
Tracrium
Epinephrine
Propofolel Thipental Na Anectine (Succinylcholine chloride ) Fentanyl
Clea / CTEA
Atropine Sulfate (Optional Nubain GEN IV
Midazolam Nubain Midazolam Profolol Fentanyl Demerol
Bupivacaine Isobaric Lidocaine Ampule Epinephrine Demerol (optional )
degree of amnesia but allows for prompt reversal of its effects and a rapid return to normal
Medication mistakenly injected into a vein; symptoms include dizziness, rapid heartbeat, and funny taste or numbness around the mouth
activities of daily living. Procedures such as endoscopies, incision and drainage of abcesses, and even balloon angioplastymay be performed under conscious sedation.
Horners syndrome (change of pupil size on one side)
Risk Factors for Complications During the Procedure :
Ptosis (drooping of the eyelid)
Current or past health problems
Pneumothorax (air trapped between the lung and rib cage )
Taking medications, supplements, or herbal remedies, blood thinners
Call Your Doctor If Any of the Following Occurs:
Allergies (eg, food allergies, medication allergies, latex allergies )
Signs of infection, including fever and chills
Smoking
Redness, swelling, increasing pain, or discharge from the injection site
Drinking alcohol
Tingling, numbness, or trouble moving around the affected area
Taking recreational drugs
Headache
Personal or family history of adverse reactions to anesthesia
Persistent coughing
Possible Complications:
Chest pain
Pain and tenderness around the injection site
Trouble breathing or shortness of breath
Bruising, infection, or bleeding of the injection site
Dizziness
Hematoma (a mass of clotted blood that forms in a tissue, organ, or body space as a
Heartbeat abnormalities
result of a broken blood vessel )
Funny taste or numbness of the mouth
Spinal headache (a severe headache that may occur after spinal or epidural anesthesia )
Other worrisome symptoms
Decrease in blood pressure
Nerve damage
Nubain
Generic Name (Brand Name)
Drug Classification & Indication
Dosage, Route, Frequency
Mechanism of Action
Generic
Drug
Name:
Classification:
Nalbuphine
synthetic opioid
-Adult: 0.150.20mg/kg
-Binds with opiate receptors in the CNS: ascending pain pathways in limbic system, thalamus, midbrain, hypothalamus, altering perception of and emotional response to pain .
agonistantagonist analgesic Brand Name:
Nubain Indication:
-Relief of moderate to severe pain; for pre-operatively analgesia, supplement to balanced anesthesia, surgical anesthesia.
-SC/IM/IV
Adverse Reaction
-Sedation, drowsiness,
Contraindication
Hypersensitivity
sweating,
to
nausea, dry
sulfites; lactation.
mouth and dizziness, headache, and vomiting
-Use with
nalbuphine,
cautiously 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.
Nursing Responsibility
Assess patients underlying condition before therapy obtain drug history. Monitor vital signs after parenteral route Monitor allergic reactions: rash, pruritus and Urticaria
Patient Teaching
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)
Drug Classification & Indication
Generic Name: Midazolan Hydrochloride
Drug Classification:
Brand Name:
Indication:
ApoMid azalon (C AN)
Benzodiazepine (short acting), CNS depressant
. 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
Adverse Reaction
Contraindicati on
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.
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.
. 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);
CV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension, palpitation,
Nursing Responsibility Assessment: y
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. Physical: Weight skin color, lesions, orientation, affect, reflexes, and sensory
Patient Teaching
y
y
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. Avoid using alcohol or sleep inducing or over-thecounter drugs before receiving this drug. 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.
neonates.
Dependence: drug dependence with withdrawal syndrome when drug is discontinued (more common with abrupt discontinuation of higher dosage used for longer than 4 mo.)
Use cautiously in elderly or debilitated patients; with impaired liver or renal function, lactation.
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,
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
Generic Name (Brand Name)
Heavy
Drug Classification & Indication
Generi c
Drug
Name:
Classification:
Bupivacaine HCl
Dosage, Route, Frequency
Dosage: Local injection:
Local anesthetic
y
Br and Name:
Bupi Heavy
Indication: peripheral nerve block, infiltration, sympathetic blockade, caudal, epidural, pudendal block analgesia via the epidural route spinal anaesthesia route
y
y
y
Individualized, varying with the anesthetic procedure, the degree of anesthesia required and the patient's response. Maximum single dose - 175 mg without epinephrine; 225 mg with epinephrine dose may be repeated at intervals of not less than 3 hours Maximum daily dose - 400 mg
PICRA y
20mL of 0.25%
Mechanism of Action
Adverse Reaction
Blocks both
Reactions to
the
Bupivacaine
initiation
are
and
characteristic
conduction
of those
of nerve
associated
impulses by
with other
decreasing
amide-type
the
local
neuronal
anaesthetics.
membrane'
The most
s
commonly
permeabilit
encountered
y to sodium
acute adverse
ions, which
experiences
results in
which demand
inhibition
immediate
of
countermeasur
depolarizati
es following
on with
the
resultant
administration
blockade of
of spinal
conduction.
anaesthesia are hypotension
Contraindication
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
y
Severe hemorrhage severe hypotension or shock and arrhythmias, such as complete heart block, which severely restrict cardiac output
Nursing Responsibility
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
Patient Teaching
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
y
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) continue for 72 hours or longer as necessary
due to loss of tone and respiratory paralysis or under ventilation due to cephalic extension of the motor level of anaesthesia. These may lead to cardiac
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
arrest if untreated. In addition, doserelated convulsions and cardiovascular collapse may result from diminished tolerance, rapid absorption from the injection site or from
Dosage: adjustments should be considered in
y
sympathetic
unintentional intravascular
y
Local infection at the site of proposed lumbar puncture 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
y
injection of a local anaesthetic solution. Factors
local injection -
influencing
for regional and
plasma protein
block anesthesia
binding, such
post-operative
as acidosis,
infusion of
systemic
continuous
diseases which
regional analgesia
alter protein
(PICRA) -
production, or
continuous
competition of
infusion
other drugs for protein binding
Frequency:
sites, may diminish
Depends on patients response
individual tolerance.
Tetracaine
Generic Name (Brand Name)
HCl
Drug Classification & Indication
Dosage, Route, Frequenc y
Mechanism of Action
Generi c
Drug
Anestheti
After topical
Name:
Classification:
c, local
application to the eye, local
Tetracaine
HCl
Anesthetic, local (ophthalmic)
Topical, to the lower
Br and Name:
Pontocaine Ak-T-Caine Ak-Taine Alcaine Diocaine Minims
Indication:
Ocu-Caine Ophthaine
Anesthesia, local
ately 1.3
Proparacaine
to 2.5 cm
and tetracaine
(approxim
are indicated
ately 1/2
to produce
to 1 inch)
local
of a 0.5%
anesthesia of
ointment.
short duration procedures including measurement of intraocular pressure
Ophthetic
al fornix, approxim
for ophthalmic Tetracaine
conjunctiv
(tonometry),
anesthetics penetrate to sensory nerve endings in the corneal tissue.
Adverse Reaction
Localized
Erythema, blanching, edema, or abnormal sensation at the site
These medications block both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's
Topical, to
permeability to
the
sodium ions. This
conjunctiv
reversibly
a, 1 or 2
stabilizes the
drops of a
membrane and
0.5% or
inhibits
1%
depolarization,
Allergic
Urticaria, angioedema, bronchospasm, and possible shock Systemic Reacti ons
CNS excitation and/or depression (lightheadedness,
Contraindicati on
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-
Nursing Responsibility
Monitor ECG, blood pressure and respiratory status frequently.
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.
Patient Teaching
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
resulting in the
nervousness,
foreign bodies
solution.
failure of a
apprehension,
and sutures,
propagated
euphoria,
and
action potential
confusion,
conjunctival
and subsequent
dizziness,
and corneal
conduction
drowsiness,
scraping in
blockade.
tinnitus,
diagnosis and
blurred or
gonioscopy.
double vision, vomiting,
Proparacaine
sensations of
and tetracaine
heat, cold or
are also
numbness,
indicated to
twitching,
produce local
tremors,
anesthesia
convulsions,
prior to
unconsciousne
surgical
ss, respiratory
procedures
depression and
such as
arrest).
cataract extraction and
Cardi o
pterygium
Bradycardia,
excision,
hypotension
usually as an
and
adjunct to
cardiovascular
locally injected
collapse
anesthetics.
leading to arrest
Ophthalmic solutions used
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)
Drug Classification & Indication
Dosage, Route, Frequency
Generi c
Drug
Adult:
Name:
Classification:
Meperidine hydrochloride
Opioid agonist analgesic
CNS:
specific opioid
dizziness,
receptors in the
Lightheaded
CNS to produce
ness,
analgesia,
sedation,
euphoria.
euphoria,
Sedation; the
dysphoria,
receptors
delirium,
mediating these
insomnia,
effects are
agitation,
thought to be the
anxiety, fear,
Preoperativ
same as those
hallucination
e
mediating the
s,
medication
effects of
disorientatio
:50-100 mg
endogenous
n
IM or SQ
opioids
Relief of pain: individualiz 50-150mg
Demerol
Indication:
Im, SQ, or
Oral,
PO every 3-
parenteral:
4 hours as
relief of
needed
moderate to severe pain Parenteral: Preoperative medication, support of
Adverse Reaction
Acts as agonist at
e dosage;
Br and Name:
Mechanism of Action
(enkephalins,
flushing,
Obstetric
and obstetric
anesthesia:
peripheral
analgesia.
when
circulatory
contraction
collapse,
s become
tachycardia,
regular, 50-
bradycardia,
100mg IM
palpitations,
or SQ ;
chest wall
Nursing Responsibility
Patient Teaching
Contraindica ted with hypersensiti vity to opioids, diarrhea caused by poisoning, BA, COPD, respiratory distress, anoxia, seizure.
Administer to
Take drug
lactating women 4-6
exactly as
hrs before next
prescribed
feeding to minimize
Avoid
the amount of milk
alcohol,
Keep opioid
antihistami
antagonist and
nes,
facilities for assisted
sedatives,
or controlled
tranquilizier
respiration readily
s and OTC
available during
drugs
parenteral
Do not take
Contraindica ted to premature infants
administration.
leftover
Use caution when
medication
injecting SQ into
for other
chilled areas of the
disorders,
body or in patients
and do not
with hypotension or
let anyone
in shock; impaired
else take
perfusion may delay
this
absorption; with
prescription
repeated doses, an
Report
excessive when the
severe
circulation is
nausea and
restored.
vomiting,
CV: facial
anesthesia
endorphins).
Contraindic ation
Use cautiously with acute abdominal conditions, CV disease, myxedema, delirium tremens, ulcerative
every 13hrs.
rigidity
Reduce dose of
constipatio
meperidine by 25% -
n,
50% in patients
shortness
receiving
of breath,
phenothiazines or
or difficulty
other tranquilizers
of
Give each dose of the
breathing
GI: Nausea,
oral syrup in half glass
Side effects
vomiting, dry
of water. If taken
such as loss
mouth,
undiluted, it amy
of appetite,
anorexia,
exert a slight local
constipatio
constipation
anesthetics effect on
n, dizziness,
Derma: pruritus, urticaria, laryngospas m, edema
colitis.
mucous membranes.
sedation,
Major
Reassure patient that
drowsiness,
Hazards:
addiction is unlikely ;
impaired
Respiratory
most patients who
visual
depression,
receive opiates for
acuity may
apnea,
medical reasons do
experience.
circulatory
not develop
depression,
dependence
respiratory
syndromes
arrest, shock,
Use meperidine with
cardiac
extreme caution in
arrest
patients with renal impairment or those requiring repeated dosing due to accumulation of normeperidine, a toxic metabolite that may cause seizures
Epinephrine
Generic Name (Brand Name)
Drug Classification & Indication
Dosage, Route, Frequency
Mechanism of Action
Adverse Reaction
Contraindicati on
Generic
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
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
-Binds with opiate receptors in the CNS: ascending pain pathways in limbic system, thalamus, midbrain, hypothalamus, altering perception of and emotional response to pain .
-Sedation, drowsiness, sweating, nausea, dry mouth and dizziness, headache, and vomiting
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
Name:
Epinephrine
Brand Name:
epinephrine b itartrate
Indication:
- In ventricular standstill after other measures have failed to restore circulation, given by trained personnel
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
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, 35 min. Use topical nasal solutions only for acute states; do not use for longer than 35 days, and do not exceed recommended dosage. Rebound nasal congestion can occur after vasoconstriction subsides.
Atracurium Besylate
Generic Name (Brand Name)
Drug Classification & Indication
Generic Name: Atracurium Besylate
Drug Classification: Analgesics, anesthesia anti psychotic, anti ulcer.
Brand Name:
Tr acri um
Indication:
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.
Dosage, Route, Frequency Inj ect ion:
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)
Musculoskelet al:
Inadequate block, prolonged block
Cardiovascular :
Hypotension, vasodilatation (flushing),
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
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.
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
Generi c
Drug
Dosage:
Produces
Name:
Classification:
Anesthesia
sedation/hyp
Adults younger than
nosis rapidly
55 yr of age
(within 40
Propofol General anesthetic
Indication: Br and Name:
Diprivan
Induction and maintenanc e of anesthesia
sec) and 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).
in adults; induction anesthesia in children at least 3 yr
For maintenance intermittent bolus, use 25 to 50 mg increments, as needed.
of age; maintenanc e anesthesia in children at least 2 mo of age; initiation
smoothly with minimal excitation; decreases IOP and systemic vascular resistance;
Contraindicatio n
Cardiovascula r
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.
Myocardial ischemia; hypotension; bradycardia; decreased cardiac output ; hypertension (especially in children). CNS
rarely is associated with malignant hyperthermia and
Elderly, Debilitated, or ASA III/IV (American Society of Anesthesiologists classification of heart disease, cardiac function, angina, and
Adverse Reaction
histamine
Amorous behavior; movement hypotonia; hallucinations ; neuropathy; opisthotonos.
release; suppresses
Dermatologic
cardiac output and respiratory
Rash.
Because patients who are in shock, under severe
Nursing Responsibility
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.
Patient Teaching
Advise patient that mental alertness, coordination , and physical dexterity may be impaired for some time after administrati on.
and maintenanc e of monitored anesthesia
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.
care sedation in adults; sedation in intubated or respiratorycontrolled adult ICU patients.
drive.
EENT Conjunctival hyperemia; nystagmus. Metabolic
For maintenance infusion, titrate to 50 to 100 mcg/kg/min (3 to 6 mg/kg/h). Neurosurgical patients
Hyperlipidem ia. Respiratory
IV Induction 20 mg every 10 sec until onset. Usual dose is 1 to 2 mg/kg.
Apnea; cough; respiratory acidosis during weaning.
For maintenance infusion, use 100 to 200 mcg/kg/min (6 to 12 mg/kg/h).
Miscellaneou s
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
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
Generic Name (Brand Name) Generi c
Name:
Sodium
Drug Classification & Indication
Dosage, Route, Frequency
Mechanism of Action
Adverse Reaction
Contraindicati on
Drug
Adults: IV 25 to 75 mg; observe for 60sec.
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
Cardiovascular: Myocardial depression; arrhythmias.
Absolute Contraindicati ons:
Classification:
Thiopental
sodium
Anesthesia
Barbiturate Br and Name:
Pentothal
- Powder for injection 2% (20mg/mL) - Powder for injection 2.5% (25mg/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,
Anesthesia Adults: IV 50 to 75 mg slowly every 20 to 40sec 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
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.
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.
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
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 90kg).
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)
Drug Classification & Indication
Dosage, Route, Frequency
Mechanism of Action
Adverse Reaction
Generi c
Drug
The dosage of
The
General
Name:
Classification:
succinylcholin
mechanism of
Malignant
e should be
action of
hyperthermia
individualized
Anectine
and should
involves what
always be
appears to be a
prolonged
determined
"persistent"
respiratory
by the
depolarization
Succinylcholi
depression or
clinician after
of the
apnea
ne chloride is
careful
neuromuscular
indicated as
assessment
junction. This
Cardi o
an adjunct to
of the patient
depolarization
Cardiac arrest,
succinylcholin e chloride
Anesthetic, local (ophthalmic)
Indication: Br and Name:
Anectine Quelicin
Respirat ory
Quelicin
general
is caused by
arrhythmias,
Preservative
anesthesia,
Anectine
bradycardia,
Free
to facilitate
mimicking the
tachycardia,
Sucostrin
tracheal
For Short Surgical Procedures
effect of
hypertension,
acetylcholine
hypotension,
Average dose required to produce neuromuscul ar blockade and to facilitate tracheal intubation is
but without
hyperkalemia,
intubation, and to provide skeletal muscle relaxation during surgery or mechanical
being rapidly hydrolysed by acetylcholinest
Others
Increased
erase. This
intraocular
depolarization
pressure,
leads to
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 (12 min); spontaneous respiration
Patient Teaching
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.
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
Dosage, Route, Frequency
Mechanism of Action
Adverse Reaction
Contraindic ation
Nursing Responsibility
Patient Teaching
Drug Classification: Narcotic agonist analgesic
Premedica tion: 0.05 0.1 mg IM 3060 min prior to surgery.
Acts at specific opioid receptors, causing analgesia, respiratory depression, physical depression, euphoria.
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
Contraindic ated with hypersensiti vity to narcotics, diarrhea caused by poisoning, acute bronchial asthma, upper airway obstruction, pregnancy.
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
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.
Indication: 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
IM /Transder ma
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 ( Act iq)
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, vomi ti n g, 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 Act iq 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
Generic Name (Brand Name)
Generic Name: Atropine Sulfate
Brand Name:
At roPen, SalTro pi ne
Drug Classification & Indication
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
Dosage, Route, Frequency
Mechanism of Action
Adverse Reaction
Contraindicatio n
Nursing Responsibility
T ablets-0.4 m, i nj ect ion: 0.05, 0.1, 0.3, o.4, 0.5, 0.8 mg/ml;
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.
Contraindicat ed with hypersensitivit y to anticholinergic drugs.
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.
IM,IV, SubQ, Topical
Systemic administration :
CV: Palpitations, bradycardia, ( low doses) tachycardia ( high doses)
Contraindicat ed with glaucoma, adhesions between iris and lens; stenosing peptic ulcer, pyloroduodena l obstruction; paralytic ileus.
GI: Dry mouth, altered taste perception, N/V, dysphagia, heartburn,
Use cautiously with Down syndrome, brain damage, spasticity,
Patient Teaching
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
Generic Name (Brand Name)
Drug Classification & Indication
Dosage, Route, Frequency
Generi c
Drug
Inhalation
Name:
Classification:
induction:
Isoflurane
Br and Name: F orane
Aerrane
Anesthetic
Indication: Forane USP) may be used for induction
Ethane Forane Forene
Forane induces a reduction in junctional
(isoflurane, Terrell
Mechanism of Action
and
conductance by initial 0.5 %
decreasing gap
v/v with
junction channel
oxygen or
opening times
oxygen and
and increasing
anesthesia. Adequate
General
Malignant hyperthermia and shivering
Hepatic
nitrous
gap junction
Rare reports of
oxide,
channel closing
mild,
increase to
times. Forane
moderate, and
1.5- 3 % v/v
also activates
severe
calcium
(sometimes
dependent
fatal)
ATPase in the
postoperative
sarcoplasmic
hepatic
reticulum by
dysfunction
maintenance of general
Adverse Reaction
Maintenan ce:
data have
1-2.5% v/v
increasing the
and hepatitis,
not been
with
fluidity of the
hepatic failure
developed to
oxygen
lipid membrane.
and hepatic
establish its
only
Also appears to
necrosis
application in
bind the D
obstetrical
subunit of ATP
Gastr ointestin
anesthesia.
synthase and
al Nausea,
NADH
Contraindication
Nursing Responsibility
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
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
Patient Teaching
Advise patient to stop herbal medication 23 weeks prior to surgery
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.
vomiting,
Forane also binds to the GABA
Respirat ory
receptor, the
Isoflurane can react with
large 2+
conductance Ca
desiccated
activated
carbon dioxide
potassium
(CO2)
channel, the
absorbents to
glutamate
produce
receptor and the
carbon
glycine receptor
monoxide,
Monitor respiratory function (dosage may need to be reduced)
Prepare to provide ventilator support
which may result in elevated levels of carboxyhemogl obin in some patients. M etabolic
Hyperkalemia Other
Transient elevations in white blood count
Document the use of these agents in the medical record
chest pain, trouble breathing or shortness of breath, dizziness, heartbeat abnormalities, funny taste or numbness of the mouth or other worrisome symptoms
Lidocaine hydrochloride
Generic Name (Brand Name)
Drug Classification & Indication
Dosage, Route, Frequency
Generi c
Drug
Local
Name:
Classification:
Lidocaine HCl
Local Anesthetic Antiarrhythmic
Br and Name:
Lidocaine anesthetic prep:
Indication: As anesthetic: infiltration anesthesia,
Xylocaine HCl
peripheral and
(inj.)
symphatetic
Octocaine
nerve blocks, central nerve
Mechanism of Action
Adverse Reaction
Contraindicatio n
Nursing Responsibility
Local anesthetic:
Injectable local
Check drug
Dosage is
anesthesi
blocks the
anesthesia;
concentration
changed
a: dosage
generation and
Contraindicate d with allergy to lidocaine or amide-type local anesthetics, HF, cardiogenic shock, strokesAdam syndrome
carefully;
frequently in
many
response to
concentration
cardiac rhythm
s are
on monitor.
available.
Oral lidocaine
Reduces
can cause
dosage with
numbness of
hepatic or
the tongue,
renal failure.
cheeks, and
Continuously
throat. Do not
monitor
eat or drink for
response
1 hour to
when used as
prevent biting
antiarrhythmi
the inside of
c or injected
your mouth
as local
and tongue
urticaria,
anesthesia.
and choking
edema
Keep life-
Side effects
support
such as
equipment
drowsiness,
and
numbness,
vasopressors
dizziness,
readily
burning, local
CNS: dizziness,
varies
conduction
with the
potentials in
area to be
sensory nerves by
anesthesiz
reducing sodium
ed and te
permeability.
reason for
Reducing height
the
and rate of rise of
anesthesi
the action
a; use the
potential,
Hypotension
lowest
increasing
due to
dose
excitation
sympathetic
possible.
threshold, and
blocks. Spinal
Direct
and caudal
inj
anesthesia,
10,20mg/
retrobulbar
mL
HA, backache, septic meningitis, sometimes incomplete recovery CV:
block
slowing conduction
Derma:
velocity.
pruritus,
Type 1
and
antiarrhythmic:
transtracheal
decreases
GU: urinary
injection;
diastolic
retention,
topical
depolarization,
urinary or fecal
anesthesia for
decreasing
incontinence
skin disorders
automaticity of
Use cautiously with hepatic or renal disease, inflammation or sepsis in the region of injection, labor and delivery and lactation.
Patient Teaching
and accessible
ventricular cells:
Topical Local
available in
irritation may
mucous
increases
Anesthesia:
case severe
experience.
membranes
ventricular
adverse
Report
reaction
difficulty
occurs
speaking, thick
Monitor for
tongue, DOB,
malignant
pain at the IV
hyperthermia;
site
As local
fibrillation
anesthesia
threshold.
before venipuncture or peripheral
Derma: contact dermatitis, urticaria, cutaneous lesions
IV cannulation
Hypersentitivit
have-life
when applied
y:
support
to intact skin
anaphylactoid
equipment
in children 3-
reactions
and IV
18 years old.
dantrolene
As
Local: Burning,
readily
antiarrhythmic
stinging,
available
: Mngt of
tenderness,
Reduce dose
ventricular
swelling, tissue
when treating
arrhythmias
irritation,
arrhythmias
during cardiac
necrosis
in HF, digoxin
surgery and
toxicity with
MI (IV use).
AV block, and
Use IM when
geriatric
IV
patients
administration
Monitor fluid
is not possible
load carefully;
or when ECG
more
monitoring is
concentrated
not available
solutions can
and the
be used to
danger of
treat
ventricular
arrhythmias
arrhythmias is
in patients on
great.
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