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46 Cards in this Set
- Front
- Back
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What terms best describe the effect of breathing NO2?
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NO2 produces light conscious sedation and analgesia
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what is the best way to handle mild patient anxiety?
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Explain,question, and reassure them. it is your relationship that is the key.
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How is NO2 provided for use?
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- it is stored in blue tanks 90-95% liquid form under pressure with 5-10% in gaseous phase.pressure on the tank is 700-800 lb/square inch.
- tanks are identified size wise: E-mobile, G/H tanks are for storage. |
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What level of conscious sedation is achieved by breathing NO2 and oxygen?
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Light to mild conscious sedation
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What does MAC mean?
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It stands for minimum alveolar concentration-it is the amount of inhaled gas that immobilizes half of the patients who breath it.
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What is the MAC of NO2?
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105% which is only obtained under pressure and in the presence of hypoxia
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what effects does altering the alveolar concentration of a gaseous agent in the alveolus have?
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the higher the alveolar concentration of NO2 the more rapidly the arterial concentration rises. so at higher percentages it crosses the alveolar membrane faster. this is known as the concentration effect
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why do we breathe pure oxygen at the end of nitrous administration?
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To prevent diffusion hypoxia which occurs because for each part of NO2 leaving the alveolus 35 parts of N are entering it. thus the amount of oxygen in the alveolus to breathed is less than 20%, it is diluted by N2.
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what effect does breathing NO2 with a halogenated hydrocarbon have?
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when breathed with a second gas it will make the second gas diffuse more rapidly and lowers the MAC of the second gas increasing its potentcy. the second gas is the halogenated hydrocarbon.
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what is the relative speed of drug reversal with agents delivered by different routes?
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- inhaled revered most quickly
- IV - IM - Oral most slowly reversed |
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what makes the nitrous tank pressure gauge drop?
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- when the amount of liquid drops below a certain concentration, meaning the liquid inside is almost used up.
- full tank pressure 700-900 lbs/square inch. |
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what stimulates respiration in a normal healthy person?
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CO2
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what stimulates respiration in a patient with severe COPD?
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hypoxia (lack of oxygen)
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what is the most common problem with the use of NO2 analgesia?
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poor patient selection leading to poor behavioral reaction
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what is the most severe complication with the use of NO2 analgesia?
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vomiting with potential aspiration leading to chemical pneumonia.
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what can happen with an injection into an artery?
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irritation to the vessel lining causing spasm compromising the circulation to the area of distribution causing necrosis.
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how do we treat a convulsion caused by local anesthesia?
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benzodiazipines and oxygen
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what are the relative contraindications to the administration of NO2?
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- ASA IV (MI within last 6 months)
- recent retinal bubble repair - hypoxia driven COPD - management problems |
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what are the safety devices on a gas machine?
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- tank pin index
- colored tanks, tubing, and flow meters - oxygen/nitrous tubing color coded - can't deliver NO2 w/o oxygen - can't deliver less than basal oxygen requirement (3L/min) - oxygen flush button - can use to assist respiration - automatic emergency room air inlet |
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when can vomiting occur with nitrous?
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- when patient has not been NPO 34- hours prior
- opioids especially in women - high NO2 concentration - choppy delivery of NO2 - hypoxia - swallowing gas or blood - anxiety |
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what is the best monitoring device during nitrous sedation?
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verbal and visual contact
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what disease states influence successful administration of NO2?
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- Post MI (less than 6 months)
- COPD and any basic respiratory problem |
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how do we treat vomiting in an unconscious patient?
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position the patient with right side down permitting direct flow from right main stem bronchus and preventing material from being trapped in the left main stem bronchus
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what are the characteristics of a modern inhalation sedation machine?
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fail safe devices
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why is scavengering necessary?
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- reduced prolonged exposure, you need ventilation that prevent recirculation
- trace long term exposure can lead to: a. decreased hematopoiesis b. decreased fertility and spontaneous abortions c. sensory neuropathy with abuse |
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what is titration and routes of drug administration that permit it?
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titration is the balancing of the administration of an agent against the patients response knowing what the ideal response would be
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Routes of administration that allow titration?
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- IV
- inhalation - oral doses - given over a series of appointments |
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what instructions do you give patients who are going to receive NO2 analgesia?
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- bring a driver
- NPO 3-4 hours prior |
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which items on a medical history influence anesthetic choice?
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- allergies
- cardiac and respiratory history |
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what are 2 techniques for NO2 analgesia administration?
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- constant oxygen flow
- constant volume flow |
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Constant oxygen flow
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- here you increase NO2 1/2-1 liter per minute until it equals 20-30%
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Constant volume flow
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- as you increase the nitrous you decrease the oxygen the same amount to keep the volume constant.
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what does it mean when the patient starts to laugh with "laughing gas"?
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you have over sedated the patient other symptoms include:
- persistently closing their mouth - spontaneous mouth closing - nausea - sluggish response - sleepy - incoherent speech - uncooperative - cries or giggles - uncoordinated movements |
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what is verrill's sign and when is it seen?
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- it is ptosis (drooping of the eyelids) and it is seen in moderate or deep conscious sedation
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what are the main benzos and how do they differ?
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- valium (diazepam)
- versed (midazolam) - minimal vein irritation - better anterograde amnesia - shorter half-life 4-6 hours with no hang over - syrup available for oral administration |
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when giving IV valium what are the best veins to use?
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- you just want to avoid small veins, and small needles
- Don't use the back of the hand |
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when should IV doses be lowered in geriatric patients?
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I would say all the time because:
- less biotransformation by the liver - less protein binding - slower onset |
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know what barbiturates are used for sedation?
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- pentobarbital- (nembutal)- short acting 2-4 hours
- secobarbital (seconal) |
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what is propofol?
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also known as diprivan, it is a popular drug used for the induction of general anesthesia. it can be used carefully and titrated for conscious sedation
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what are the clinical effects of narcotics?
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- blood pressure depression due to peripheral vasodilatation
- respiratory depression - potentiate other depressants - bronchoconstrictors |
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Demerol side effects:
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- release histamine causing vein tracking
- N and V - dry mouth |
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fentanyl side effects:
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muscular rigidity
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commonly used narcotics include:
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- demerol
- fentanyl |
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absolute contraindications for drugs used for sedation or general anesthesia:
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- Benzos- acute narrow angle glaucoma
- Barbiturates- acute intermittent porphyria |
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Drug antagonists and the principle concern when using antagoists:
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- Narcan- opioid antagonist which counteracts BP/respiratory depression.
- Romazicon- antagonist for benzos - atropine- used for dry mouths, and to counteract bradycardias seen with benzos, barbiturates, and opioids. - there is no antagonist for barbiturates, you must support BP/respirations |
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what protective reflexes minimize foreign body aspiration?
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Laryngospasm will close the vocal chords when material is in the pharynx due to cough reflex being depressed.
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