Anesthetics are drugs that are used to cause complete or partial loss of sensation. The anesthetics can be subdivided into general and local anesthetics, depending on their site of action. General anesthetics are central nervous system (CNS) depressants used to produce loss of pain sensation and consciousness. Local anesthetics are drugs used to cause loss of pain sensation and feeling in a designated area of the body without the systemic effects associated with severe CNS depression.
Children are at greater risk for complications after anesthesia—laryngospasm, bronchospasm, aspiration, and even death. They require very careful monitoring and support, and the anesthetist needs to be very skilled at calculating dosage and balance during the procedure. Propofol is widely used for diagnostic tests and short procedures in children older than 3 years of age because of its rapid onset and metabolism and generally smooth recovery. Sevoflurane has a minimal impact on intracranial pressure and allows a very rapid induction and recovery with minimal sympathetic reaction. It is still quite expensive, however, which may limit its use. The dosage of anesthetics may need to be higher in children, and that factor will be considered by the anesthetist.
Nursing care after general anesthesia should include support and reassurance; assessment of the child for any skin breakdown related to immobility; and safety precautions until full recovery has occurred.
Local anesthetics are used in children in much the same way that they are used in adults.
儿童局部麻醉药使用与成份大致相同。
Bupivacaine and tetracaine do not have established doses for children younger than 12 years of age. Benzocaine should not be used in children younger than 1 year of age.
布比卡因和丁卡因尚无12岁以下儿童的确定剂量。苯佐卡因不应用于1岁以下儿童。
When topically applying a local anesthetic, it is important to remember that there is greater risk of systemic absorption and toxicity with infants.
当局部使用局部麻醉药，必须记住婴儿所存在的较大的系统吸收和毒性危险。
Tight diapers can act like occlusive dressings and increase systemic absorption.
紧身的尿布就象是封闭敷料，增加系统性吸收。
Children need to be cautioned not to bite themselves when receiving dental anesthesia.
必须提醒儿童在进行牙科麻醉时不要咬自己
Adults 成人
Adults require a considerable amount of teaching and support when receiving anesthetics, including what will happen, what they will feel, how it will feel when they recover, and the approximate time to recovery.
成人使用麻醉药时必须提供充分的宣教和支持，包括会发生什么、会有什么感觉、恢复时会有什么感觉及大致的恢复时间。
Adults should be monitored closely until fully recovered from general anesthetics and should be cautioned to prevent injury when receiving local anesthetics. It is important to remember to reassure and talk to adults who may be aware of their surroundings yet unable to speak.
应密切监护成人，直到全身麻醉完全恢复。应提醒成人，进行局部麻醉时应防止损伤。必须记住安慰并与告诉这些成人，他们可以意识到周围环境但会说不出话来。
Most of the general anesthetics are not recommended for use during pregnancy because of the potential risk to the fetus. Short-onset and local anesthetics are frequently used at delivery. Use of a regional or other local anesthetic is usually preferred if surgery is needed during pregnancy. During lactation, it is recommended that the mother wait 4 to 6 hours to feed the baby after the anesthetic is used.
鉴于胎儿风险，多数全麻都不推荐在妊娠期间做。分娩时也常常采用短效、局部麻醉。妊娠期间必须手术时，通常偏向于采取部位性或局部性麻醉。哺乳期间，建议母亲在施行麻醉4 – 6小时后哺乳。
Older Adults 老人
Older patients are more likely to experience the adverse effects associated with these drugs, including CNS, CV, and dermatological effects. Thinner skin and the possibility of decreased perfusion to the skin make them especially susceptible to skin breakdown during immobility. Because older patients often also have renal or hepatic impairment, they are also more likely to have toxic levels of the drug related to changes in metabolism and excretion. The older patient should have safety measures in effect, such as side rails, a call light, and assistance to ambulate; special efforts to provide skin care to prevent skin breakdown are especially important with older skin.
The older patient may require longer monitoring and regular orienting and reassuring. After general anesthesia, it is very important to promote vigorous pulmonary toilet to decrease the risk of pneumonia.
老年病人可能需要延长监护，定期进行安慰与定向指导。全麻后，采取有力的肺部清理，减少肺炎危险，这一点很重要。
★Vocabulary ★
anesthetic – n. a. 麻醉剂，麻药；麻醉的
general anesthetics – 全身麻醉药
local anesthetics – 局部麻醉药
designate – v. 把定名为，指定
anesthesia – n. 麻醉
laryngospasm – n. 喉痉挛
bronchospasm – n. 支气管痉挛
aspiration – n. 误吸
propofol – n. 丙泊酚，二异丙酚
sevoflurane – n. 七氟烷，七氟醚
induction – n. 诱导，吸气
anesthetist – n. 麻醉医师
bupivacaine – n. 布比卡因
tetracaine – n. 丁卡因
benzocaine – n. 苯佐卡因
occlusive – a. 闭合的，闭塞的
occlusive dressings – 封闭敷料
susceptible – a. 易受影响的，易感的
orient – v. 使适应，定向
reassure – v. 使放心，使消除疑虑
vigorous – a. 强力的，精力充沛的
pulmonary toilet – 肺卫生，肺清理
尽快地从茫然中理清复习思路，准确地抓住复习重点，这一愿望，“ISPN考试复习要点提示”帮您实现！
★Video ★
Aesthetic Therapy Across the Lifespan
★Test ★
1. General anesthetics potentiate the effects of which of the following drugs?
A. Depolarizing agents
B. Skeletal muscle relaxants
C. Volatile liquids
D. Inhalation anesthetics 2. The most dangerous metabolic side effect of general anesthesia that can occur during surgery is:
A. Hyperglycemia
B. Hyperthermia
C. Hypoglycemia
D. Hypothermia
奥医教育NCLEX-RN/ISPN “在线自测”题库正式上线，复习练习、效果检验一站完成。
答案 Answers
1. B. Skeletal muscle relaxants
Rationale: The effects of skeletal muscle relaxants are potentiated with the use of the general anesthetics. Depolarizing agents do not interact with general anesthetics. C and D are general anesthetics.
2. B. Hyperthermia
Rationale: Malignant hyperthermia is the most dangerous metabolic side effect of general anesthesia.
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