Chapter 11: General and Local Anesthetics

General anesthetics depress central nervous system activity to produce multiple effects including analgesia, amnesia, skeletal muscle relaxation, and abolition of protective reflexes, and can be administered through inhalation or intravenous routes depending on clinical context and patient factors. The concept of balanced anesthesia is central to modern surgical practice, involving the simultaneous use of multiple drug classes such as propofol, volatile agents like sevoflurane and desflurane, nitrous oxide, benzodiazepines, and neuromuscular blocking agents to achieve optimal anesthetic depth while minimizing adverse effects and overall drug exposure. The chapter addresses the stages of anesthesia progression and introduces minimum alveolar concentration as a key pharmacodynamic measure of anesthetic potency and individual variability. Local anesthetics including lidocaine, bupivacaine, and procaine operate through sodium channel blockade in peripheral nerves, preventing action potential generation and enabling targeted anesthesia for minor procedures, regional techniques such as epidural administration, and pain management during recovery. Critical safety content emphasizes serious adverse reactions including malignant hyperthermia, a life-threatening pharmacogenetic complication triggered by susceptible individuals exposed to volatile anesthetics and succinylcholine, along with dantrolene as the specific antidote. Additional complications such as respiratory depression, hypotension, and hepatotoxicity require vigilant monitoring and appropriate intervention. The chapter integrates comprehensive nursing responsibilities spanning preoperative assessment and patient preparation, intraoperative monitoring and documentation, postoperative management of nausea and vomiting, and safe recovery protocols that promote patient safety and comfort throughout the perioperative period.