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Prepared by: Ryan Matira, RN
Common Medications in OR-DR
The extent of anxiety appears to be associated with the particular procedure being performed to the patient.
Primary goals for premedication :Anxiolytic effectsReduction in preoperative painAmnesiaReduction in secretionIncrease in gastric fluid pH with a decrease in
gastric fluid volumeReduction of autonomic nervous system reflex
responses
Overview
Reduction in required anesthetic amounts
Prophylaxis with respect to allergic reaction
Reduced cardiac activityReduction/avoidance of
postoperative nausea and vomitingPostoperative analgesia
Factors that influence the choice those drugs for premedications and associated dosages:
Whether the surgery is classified as "inpatient" or "outpatient"
Whether the surgery is being performed as an elective or emergency procedure
Concerns about the ability of the patient to tolerate the drug
Patient age & weight & physical status Anxiety level of the patient-Recall that an anxious patient
is likely to have elevation of circulating catecholamines which may cause a suboptimal cardiovascular preoperative state
Whether the patient has had an adverse response to the particular medication during a previous procedure
Most commonly used sedative/anxiolyticThese agents may also cause some degree of
retrograde amnesia as well like midazolam (Dormicum) and lorazepam (Ativan)
may also be used the night before schedule surgery in management of pre-surgical insomnia
Adverse Effects:Major adverse effectsRespiratory depression - cautious use
in view of possible respiratory depression leading to inadequate oxygenation.
Reduction in cognitive & motor function
Benzodiazepines
Nursing Considerations: Avoid alcohol & hazardous activities that
requires alertness Instruct patient to avoid standing after taking
the drug Check RR Monitor BP, PR, RR during IV – medical
equipment should be nearby
• Advantages for use in preoperative medication:
Absence of myocardial depressant effects Alleviate the preoperative pain Management of discomfort associated with
invasive monitor insertionManagement of pain which may be
associated with establishing regional anesthesia
Commonly used opioids:MorphineMeperidine (Demerol)
Opioids
Adverse Effects: Respiratory depression Orthostatic hypotension Nausea & vomiting Delayed gastric emptying may also cause smooth muscle constriction pinpoint pupils
Nursing Considerations: Check BP at least not less than 90/60 mmhg Check RR not > 12 CPM Check Urine output >30 cc/hr – Monitor I&O Monitor LOC Increase bulk & fluids in diet May be given by PCA pump in terminal illness Place Naloxone (Narcan) at Bedside
Purpose of premedication: prevention of intraoperative allergic reactions
Example: Diphenhydramine (Benadryl)Common S/E:
Dizziness; drowsiness; dry mouth, throat, nose, thickening of mucus in nose or throat, photosensitivity, excessive perspiration, thickening of bronchial secretions, tightness of chest and wheezing
Nursing Considerations: Assess respiratory status, rate and rhythm, increase in
bronchial secretions, chest tightness & wheezing caution when driving, operating machinery, or
performing other hazardous activities. caution in patients with a history of lower
respiratory disease including asthma
Antihistamines
reduction of gastric acid secretionpremedication for patients with aspiration
pneumonia riskSpecific medications:
1. Cimetidine (Tagamet)2. Ranitidine (Zantac)3. Famotidine (Pepcid)4. Nizatidine (Axid)
Nursing Considerations: Assess abdominal pain, acute presence of blood in
emesis, stool or gastric aspirate Take at bedtime for best effect May be taken with or without meals Avoid smoking
H2 Receptors Antagonists
Purposes: use to dry up secretion in preparation for
awake intubationfor operative procedure that requires upper
airway topical anesthesia or for bronchoscopiesto reduce/prevent reflex bradycardia secondary
to: laryngospasm laryngeal stimulation hypoxia
Examples: Atropine, Glycopyrolate, Scopolamine
Anticholinergics
Nursing considerations:Watch for tachycardia – may lead to ventricular
fibrillationUse sunglasses – potential sensitivity to the sunThe drug will make the patient sweat less (Sweat
glands are normally innervated by sympathetic cholinergic fibers), causing the body temperature to increase. not to become overheated during exercise or hot weather
may cause some people to have blurred vision instruct patient to avoid driving or operating a machine if he or she is not able to see well
may cause some people to become dizzy or drowsyFor temporary relief of mouth dryness, use
sugarless candy or gum, melt bits of ice in your mouth
Antiemetic agents are included in anesthetic premedication with the objective decreasing postoperative nausea and vomiting incidence.
Drug used for prophylaxis against postoperative nausea and vomiting:Gastrointestinal prokinetic agents:
metoclopramide (Reglan) not be given to patients who are taking
dopamine antagonists, tricyclic antidepressants, sympathomimetic agents, or monoamine oxidase inhibitors (metoclopramide (Reglan) may cause hypertensive crises in patients with pheochromocytoma).
Antiemetic drugs
Nursing Considerattions:Assess GI complaints: N/V, anorexia,
constipation, abdominal distension before & after administration
Assess involuntary movements and inform physician
Avoid driving/ operating hazardous machines or alcohol intake because the drug has a sedating effect
Administer very slow IV
Antibiotics are considered for administration immediately before surgery for "contaminated, potentially contaminated, or dirty surgical wounds.“
The reason that the anesthesia provider is involved in antibiotic administration is that the antibiotics will be administered immediately preceding the surgical procedure-just before potential contamination could occur
Examples: Cefazolin, Penicillin Na, Vancomycin
Antibiotics
Side effects and complications may occur with antibiotic administration. Allergic reaction Hypotension Bronchospasm Nephrotoxicity
Nursing Considerations: Do ANST prior to administer the drug Always administer at the right time and right
length of time Assess any allergic reaction if ANST is not
prescribed by the Physician
Types of anesthesia1. Local anesthesia
An anesthetic drug (which can be given as a shot, spray, or ointment) numbs only a small, specific area of the body (for example, a foot, hand, or patch of skin).
a person is awake or sedated, depending on what is needed
It lasts for a short period of time and is often used for minor outpatient procedures (when patients come in for surgery and can go home that same day)
Anesthesia:
1. Regional anesthesiaAn anesthetic drug is injected near a
cluster of nerves, numbing a larger area of the body (such as below the waist, like epidurals given to women in labor).
It is generally used to make a person more comfortable during and after the surgical procedure. Regional and general anesthesia are often combined.
Two common types of regional anesthesia include:1. Epidural anesthesia - The anesthesiologist
injects the medicine into the lower back in the area surrounding the spine.
2. Spinal anesthesia - goes directly into the spinal canal and it also causes you to lose feeling in the lower part of your body.
3. General anesthesia The goal is to make and keep a person completely
unconscious (or "asleep") during the operation, with no awareness or memory of the surgery.
General anesthesia can be given through an IV (which requires sticking a needle into a vein, usually in the arm) or by inhaling gases or vapors by breathing into a mask or tube.
• Example: Lidocaine, Procaine, Tetracaine
Risks from any type of anesthesia include:Allergic reaction to the medicines used Breathing problems
Risks from local and regional anesthesia include:Bleeding and infection (rare) Long-term nerve damage (very rare) Temporary weakness or paralysis in the area that
received the anesthesia Risks from general anesthesia may include:
Irregular heartbeat Heart attack (rare) Nausea and vomiting Stroke (rare) Temporary mental confusion (delirium)
Nursing Considerations: Monitor VS q 15 mins after induction of the
anesthesia Administer prescribed anticholinergic drug
preoperatively Medical equipment should be placed nearby Provide quite environment for recovery to
decrease psychotic symptoms Place in flat position at least 8 hrs
postoperatively Minimize sudden movement Place basin for emesis at bedside
Metoclopramide (Reglan/Plasil):
Used most commonly to treat asthma, terbutaline is thought to relax the muscles of the uterus
Nursing precautions:A racing heartbeat or palpitations. These
medications should not be used for women with known heart condition because it can cause increase in heartbeat and palpitation
Aspiration precaution can cause nausea & vomitingNot given to pt with poorly controlled DM can
cause increase Blood glucoseCan decrease potassium level: caution to pt w/
heart problem & muscle spasm may occur
Terbutaline (Brecanyl)/ Ritrodine (yutopar):
NSAIDGiven as a suppository in the short term. Delays premature labor by reducing uterine
contractions through inhibition of prostaglandins.
Nursing Precautions: Avoid operating machine/vehicle may cause
drowsiness Do not stand or sit up quickly, especially if you
are an older patient. This reduces the risk of dizzy or fainting spells.
Indomethacin (Indocin):
• Usually given for eclamptic pt.
• Magnesium prevents or controls convulsions by blocking neuromuscular transmission and decreasing the amount of acetylcholine liberated at the end plate by the motor nerve impulse
• Antidote: Ca Gluconate - injectable calcium salt should be immediately available to counteract the potential hazards of Magnesium intoxication in eclampsia
• Nursing checks:Knee jerk reflexBP≥ 90/60mmHGRR≥ 16CPMTake ECGSerum K determination
Magnesium sulfate:
Administered, often in two doses, to stimulate growth in the lungs of the fetus.
Example: DecadronNursing precaution:
Avoid contact with people who have colds or infections.
Take adequate calcium and vitamin D supplements.
Check blood sugar levels closely.
Glucocorticoids:
Both are administered as vaginal suppositories to ripen the cervix prior to delivery.
This is the first step in preparing the cervix to respond to contractions.
Cytotec, while very effective, has been implicated in some uterine ruptures and should not be used under certain circumstances.
Misoprostol has been shown to produce uterine contractions that may endanger pregnancy
Mesoprostol (Cervidil and Cytotec):
Nursing Considerations:Assess dilatation and effacement of the cervix
& fetal heart tonesMonitor for N/V & Diarrhea Misoprostol can cause abortion
(sometimes incomplete which could lead to dangerous bleeding and require hospitalization and surgery), premature birth, or birth defects
Remain in supine 2 hrs after administration
The synthetic form of oxytocin, which is a natural hormone produced by a woman's body, Pitocin is used to start or improve contractions and control postpartum bleeding.
Pitocin, when given for induction of labor or augmentation of uterine activity, should be administered only by the intravenous route and with adequate medical supervision in a hospital.
Overstimulation of the uterus by improper administration can be hazardous to both mother and fetus.
Pitocin:
Nursing considerationAssess labor and contraction, FHTTurn pt to left side to increase oxygen to the
fetusAssess for water retentionWatch for fetal distressMonitor VS & I&O
