*(topical)relieves burns or pain

*(IV)blocks nerves

*lidocaine (Xylocaine)

"Amide" type of drug

[other drugs: procaine (Novocain) and benzocaine (Americaine)]

"Ester" type of drug

*CNS ↑: restless, irritable, tremors, confusion, convulsions

*CNS ↓: resp. depression

*hypotension

*IV lidocaine: life-threatening conduction disorders of the heart can occur w/ extremely high doses

*Monitor: VS and CNS effects during & after procedure

*if hypotension occurs, lower HOB

*if hypotension worsens, admin. ephedrine or phenylphrine

*Monitor: respiratory status

*avoid eyes, broken skin

*addition of epi can ↑ length of anesthesia

*previous allergy, sepsis or severe trauma

*Bradycardia or heart block

*myasthenia gravis, resp. depression, hx of malignant hyperthermia

*older adults

*B blockers, cimetidine(Tagamet), quinidine: ↑ lidocaine levels

*Phenytoin: ↑ risk of cardiac effects

*Procainamide: ↑ risk for CNS & cardiac effects

*rapid induction of anesthesia/hypnosis for short procedures

*adjunct anesthesia w/ other drugs for procedures > 15minutes

sodium thiopental (Pentothal)

Other: methohexital sodium (Brevital)

*↓ CNS significantly

*↑ inhibitory effects of GABA

* ↓ HR and BP

*cardiovascular toxicity (hypotension, tachycardia to compensate for ↓BP)

*resp. depression and apnea

Monitor:

*VS pre, intra, and postprocedure

*resp. status

*IV only

*intra-arterial or vein extravasation not allowed (causes tissue, artery damage)

*allergy to barbs

*hepatic porphyria

*hx of paradoxical excitation

*asthma

*hepatic/renal disease

*myasthenia gravis

*chronic resp disease

*severe anemia

*cardiac disease

*use w/ other CNS depressants may ↑ resp depression

*use w/ probenecid may ↑ duration of anesthesia

*kava kava and valerian ↑ sedative properties

*multiple incompatibilities occur w/ other drugs

*sedation before general anesthesia

*moderate sedation w/ induction of amnesia (ie. edoscopy)

*supplement to inhalation anesthesia for surgery

General Anesthesia/Benzodiazepines: Prototype drug

midazolam (Versed)

Other drug: diazepam (Valium)

*CNS ↓

*↑ inhibition of GABA

*hypnotic/causes sedation

*amnesia

*cardiac/resp arrest

*expect amnesia (somone to accompan at d/c)

*monitor vs intra and post

*inject iv bolus slowly; wait 2 min before 2nd dose

*potential for cardiac/resp arrest

*IM into large muscle

*IV bolus/infusion

*can be in combination w/ opioid

*DO NOT give bolus to neonate

*pregnancy (delivery and lactation)

*sensitivity to benzos

*glaucoma

*parkinson's

*other neuromuscular disorders

*cardiac, pulmonary, or renal disorders

*anticonvulsants

*CNS depressants

*cimetidine can cause toxicity

*smoking ↓ sedation

*herbals can ↑or↓ effects

*supplements general anesthesia

*provides "neurolept anesthesia"

*provides anesthesia w/ skeletal muscle relaxant for high risk situations

*Narcotic agonist

-analgesia

-sedation

*sedation

*nausea

*resp depression

*circulatory depression

Monitor: VS, LOC, for nausea (admin antiemetic drug)

*resuscitation equipment

*opioid antagonist naloxone (Narcan)

*stick lozenges: between cheek and gum, pt should suck for approx. 15min

*IV

*expect drowsiness

*report nausea

*frequent monitor pre, intra, post

*controlled substance

*substance abuse

*myasthenia gravis

*pregnancy/delivery

* ↑ ICP

*older/younger children

*debilitated pts

*cardiac/resp disorders

*liver/kidney disorders

*other CNS depressants

- ↑ sedation, resp depression

*within 2wks of MAOIs