10.11 Anesthetics
As a nurse, you may care for clients prior to surgery (preoperative), during surgery (perioperative), or after surgery (postoperative). One of your roles is to monitor the effects of anesthetics on your client’s vital signs, paying close attention to respiratory status (respiratory rate, depth, quality, and SpO2), as well as their level of consciousness and pain level.
There are three categories of anesthetics:
- Local: Local anesthetic is when a medication (e.g., lidocaine) is injected into the skin at the site of the procedure to achieve numbness for procedures like suturing. EMLA cream is a combination of lidocaine and prilocaine used before procedures such as starting intravenous (IV) access, especially for children. Read more information about lidocaine and EMLA cream in Table 10.11.
- Conscious Sedation: Conscious sedation is a combination of medications that allow the client to be relaxed (midazolam) and free of pain (e.g., fentanyl) during a medical procedure (e.g., colonoscopy). This allows the client to remain awake and aware, without feeling discomfort. The client may or may not be able to speak or respond in this state.
- General Anesthesia: General anesthesia is a medication-induced reversible unconsciousness with loss of protective reflexes. Arousal, even to painful stimuli, cannot occur. General anesthesia requires the establishment and maintenance of airway control.[1] Propofol is an example of an intravenous general anesthetic. The intravenous (IV) injection of propofol induces anesthesia within 40 seconds from the start of injection.[2]
Table 10.11 Local Anesthetics
| Class/Subclass | Prototype/Generic | Nursing Considerations | Therapeutic Effects | Side/Adverse Effects |
|---|---|---|---|---|
| Anesthetics | lidocaine | Note that lidocaine is indicated for anesthesia, as well as other indications such as analgesia and cardiac dysrhythmias
The appropriate dosage of lidocaine varies depending on the indication being treated, client age, weight, and other factors Can be administered topically, or via transdermal patch, injection, or other routes, depending on the specific indication |
Used to numb a specific area of the body before a medical procedure or provide analgesia | Dizziness, nausea, and numbness |
| lidocaine and prilocaine (EMLA cream)[3] | Dosage is based on age, medical condition, and weight
Use only on normal skin Wear gloves and apply directly onto the skin but do not rub in. Cover with airtight dressing if directed. Remove the dressing and cream prior to the procedure |
Used to numb a specific area of the body before a medical procedure
Considered a standard of care for nonemergent, invasive pediatric treatments such as IV starts and lab draws |
Protect area from injury because it may be numb for several hours
Do not expose area to heat or cold until feeling returns |
- Frandsen, G., & Pennington, S. (2018). Abrams’ clinical drug: Rationales for nursing practice (11th ed.). pp. 305, 310, 952-953, 959-960. Wolters Kluwer. ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- WebMD. (n.d.). EMLA 2.5% topical cream. https://www.webmd.com/drugs/2/drug-2358-8170/emla-topical/lidocaine-prilocaine-cream-topical/details ↵