DRUG NAME Generic Name: Isoflurane Brand Name: Suprane Classificatio n: Inhalant general anesthetic agent

MECHANISM OF ACTION Isoflurane reduces pain sensitivity (analgesia) and relaxes muscles. Isoflurane binds to GABA receptors, glutamate receptors and glycine receptors, and also inhibits conduction in activated potassium channels. Glycine inhibition helps to inhibit motor function, while bonding to glutamate receptors mimics the effects of NMDA.

INDICATIO NS Used for inductio n and mainten ance of general anesthe sia Use in surgery and dentistr y for its analgesi c and anesthe tic effects.

CONTRAINDI-CATION Isoflurane is contraindicated in patients with a history or predilection towards malignant hyperthermia. It should be used with caution (benefits vs. risks) in patients with increased CSF or head injury, or myasthenia gravis. Some animal studies have indicated that isoflurane may be fetotoxic. Use during pregnancy with caution.

ADVERSE EFFECTS Arrythmias; elevation of CBC count; hypotension, respiratory depression, GI upset, shivering, nausea and vomiting during postoperative period.

NURSING RESPONSIBILITIE S Assess patient for previous sensitivity reaction. Monitor vital signs. Monitor liver and renal function. Assess for carbohaemoglo binemia Assess for malignant hyperthermia.

DRUG NAME Generic Name: Halothane Brand Name: Halotan Classificatio n: Anesthetics; Inhalation; General Anesthetics

MECHANISM OF ACTION It depresses the central nervous system by blocking the effects of the excitatory neurotransmitter , glutamic acid at the NMDA receptors. It is a cardiovascular stimulant, causing an increase in B.P, heart rate and cardic output due to sympathetic stimulation. It increases cerebral blood flow.

INDICATION S Halothane remains a useful general anesthetic in veterinary medicine due to its relative safety, potency, controllability, nonflammability, and comparative low cost. For the induction and maintenance of general anesthesia

CONTRAINDI -CATION

ADVERSE EFFECTS

NURSING RESPONSIBILITIES Assess patient for previous sensitivity reaction. Assess patients condition before starting therapy and regularly therafter to monitor drugs effectiveness. Monitor vital signs. Monitor liver and renal function. Instruct patient not to use alcohol during therapy.

Common effects: Patients Emergence with hypertensi phenomena during on, recovery from ischaemic ketamine are heart common vivid, often disease, unpleasant dreams, aneurysms confusion, and hallucinations, hyperthyroi delirium, and dism (due involuntary to CVS movement. stimulation Diazepam 0.2-0.3 ). mg/kg intravenously before giving ketamine reduces the Patients incidence of these with effects. increased intracranial Rare Effects: Increase in skeletal tension and muscle tone and psychotic fasciculations. disorders.

Generic Name: Midazolam hydrochloride Product Name: Midazolam Injection

Trade Names
Midazolam - Syrup 2 mg/mL - Injection 1 mg (as hydrochloride)/mL - Injection 5 mg (as hydrochloride)/mL Midazolam Injection (Canada)

Indications and Usage

Preoperative sedative; conscious sedation prior to diagnostic, therapeutic or endoscopic procedures; induction of general anesthesia; supplement to nitrous oxide and oxygen for short surgical procedures; infusion for sedation of intubated and mechanically ventilated patients as a component of anesthesia or during treatment in critical care setting.

Action of Midazolam Injection:

Benzodiazepines potentiate the inhibitory effects of gamma aminobutyric acid (GABA) throughout the CNS, resulting in anxiolytic, sedative hypnotic, muscle relaxant and antiepileptic effects

Dosage and Administration

Preoperative Sedative Adults IM 0.07 to 0.08 mg/kg approximately 1 h before surgery. Conscious Sedation Adults IV 1 to 2.5 mg as 1 mg/mL dilution over 2 min. Increase by small increments to total dose of no more than 5 mg in at least 2 min intervals; use less if patient is premedicated with other CNS depressants. Children

IM 0.1 to 0.15mg/kg. Doses up to 0.5 mg/kg have been used for more anxious patients. Total dose usually does not exceed 10 mg. Children (younger than 6 mo of age) IV Titrate in small increments to clinical effect and monitor carefully. Children (6 mo to 5 yr of age) IV 0.05 to 0.1 mg/kg. Total dose up to 0.6 mg/kg may be necessary. Do not exceed 6 mg. Children (6 to 12 yr of age) IV 0.025 to 0.05 mg/kg. Total dose up to 0.4 mg/kg. Do not exceed 10 mg. Children (12 to 16 yr of age) IV Dose as adults. Induction of General Anesthesia Unpremedicated Adults IV 0.3 to 0.35mg/kg as 1 mg/mL dilution over 20 to 30 sec, allowing 2 min for effect; may use increments of approximately 25% of initial dose. Premedicated Adults IV 0.15 to 0.35mg/kg over 20 to 30 sec. Continuous Infusion Adults Loading dose 0.01 to 0.05 mg/kg given slowly over several minutes. May be repeated at 10- to 15-min intervals until adequate sedation is achieved. Maintenance

0.02 to 0.1 mg/kg/h (1 to 7 mg/h). Children (non-neonatal) IV 0.05 to 0.2 mg/kg over at least 2 to 3 min in patients whose trachea is intubated. Loading dose may be followed by continuous IV infusion at 0.06 to 0.12 mg/kg/h (1 to 2 mcg/kg/min). Increase or decrease approximately 25% of the initial infusion rate or subsequent infusion rate. Intubated preterm and term newborns (younger than 32 wk of age) 0.03 mg/kg/h (0.5mcg/kg/min). Intubated preterm and term newborns (younger than 32 wk of age) 0.06 mg/kg/h (1mcg/kg/min). Maintenance Of Anesthesia IV Increments of approximately 25% of induction dose in response to signs of lightening of anesthesia and repeat as necessary.

Adverse Reactions
Cardiovascular
Bigeminy; hypotension; PVCs; tachycardia; cardiac arrest; vasovagal episode; bradycardia; nodal rhythm.

CNS
Headache; oversedation; retrograde amnesia; euphoria or dysphoria; confusion; argumentativeness; anxiety; emergence delirium and dreaming; nightmares; tonic/clonic movements; tremor; athetoid movements; ataxia; dizziness; slurred speech; paresthesia; weakness; loss of balance; drowsiness; nervousness; agitation; restlessness; prolonged emergence from anesthesia; insomnia; dysphonia.

Dermatologic
Hives; hive-like elevation at injection site; swelling or feeling of burning; warmth or coldness at injection site; rash; pruritus.

EENT
Vision disturbances; nystagmus; pinpoint pupils; cyclic eyelid movements; blocked ears; blurred vision; diplopia; difficulty focusing; loss of balance.

GI
Nausea; vomiting; acid taste; excessive salivation; retching.

Respiratory
Respiratory depression or arrest; decreased tidal volume, decreased respiratory rate; apnea, coughing; laryngospasm; bronchospasm; dyspnea; hyperventilation; wheezing; shallow respirations; airway obstruction; tachypnea.

Miscellaneous
Pain, tenderness and induration at injection site; yawning; chills; lethargy; weakness; toothache; faint feeling; hematoma; desaturation, apnea, hypotension, paradoxical reactions, hiccough, seizure-like activity, nystagmus (children).

Patient Information

Inform patient and family pre-operatively about possibility of temporary postoperative amnesia. Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness until drowsiness has subsided or until day after administration, whichever is longer. Advise patient to avoid alcohol and other CNS depressants for 24 h following administration. Patients receiving continuous infusion in critical care settings over an extended period of time may experience symptoms of withdrawal following abrupt discontinuation.

Bupivacaine HCl (Sensorcaine) Drug Study

Posted by: Matt Vera in Drug Study January 25, 2012 Last updated on March 13th, 2012 0 26 Views Local anesthetics such as bupivacaine block the generation and the conduction of nerve impulses, presumably by increasing the threshold for electrical excitation in the nerve, by slowing the propagation of the nerve impulse, and by reducing the rate of rise of the action potential. In general, the progression of anesthesia is related to the diameter, myelination and conduction velocity of affected nerve fibers. Clinically, the order of loss of nerve function is as follows: (1) pain, (2) temperature, (3) touch, (4) proprioception, and (5) skeletal muscle tone. GENERIC NAME: Bupivacaine HCL BRAND NAME: Sensorcaine, Marcaine GENERAL CLASSIFICATION: amide type local anaesthetic

Indications of Bupivacaine

For the production of local or regional anesthesia or analgesia for surgery, for oral surgery procedures, for diagnostic and therapeutic procedures, and for obstetrical procedures.

Contraindications of Bupivacaine

Sensorcaine (bupivacaine HCl) is contraindicated in obstetrical paracervical block anesthesia. Its use by this technique has resulted in fetal bradycardia and death. Sensorcaine is contraindicated in patients with a known hypersensitivity to it or to any local anesthetic agent of the amide type or to other components of bupivacaine solutions.

Side-Effects of Bupivacaine

Mild dizziness or drowsiness. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; changes in hearing; chest pain; excitement; irregular heartbeat; nausea; numbness that lasts for more than a few hours; restlessness; ringing in the ears; seizures; severe dizziness or drowsiness; tremors; vomiting.

Nursing Considerations of Bupivacaine

1. When appropriate, patients should be informed in advance that they may experience temporary loss of sensation and motor activity, usually in the lower half of the body following proper administration of caudal or lumbar epidural anesthesia. Also, when appropriate, the physician should discuss other information including adverse reactions in the Sensorcaine package insert. 2. Inform the patient before using this medication, to tell his/her doctor or pharmacist of all prescription and nonprescription/herbal products he/she may use. Do not start or stop any medicine without doctor or pharmacist approval.