What is the role of the RN, LPN in the administration of Anesthetics?
It is the expectation of the New Hampshire Board of Nursing that administration of medications classified as anesthetics for the purpose of sedation, and analgesia requires special attention. Utilizing appropriate descriptive terminology is complicated by the properties of some medications and their effects. Propofol, for example, is classified by the Food and Drug Administration as a sedate/hypnotic at lower doses and as an anesthetic agent when given at sufficiently high doses. While the phrase “medications classified as anesthetics” is used in this document, it should be understood that classification of medications may change and new medications may be developed. The accountability statement applies to other medications with anesthesia inducing properties, even if not classified as anesthetics. It should also be understood that the medications might be used for other purposes, including procedural sedation and analgesia.
The licensed nurse must decline to administer medications classified as anesthetics or other medications if the nurse perceives the administration would be unsafe under the circumstances or if the medication is restricted by manufacturer guidelines, including black box warning (such as is seen with propofol) or outside the scope of practice of the licensed nurse. The nurse should be cognizant of drugs that have the potential for rapid, profound changes in sedative/anesthetic depth and the lack of antagonist medications and drugs that contain manufacturer's warnings (black box) limiting administration to persons trained in general anesthesia, should receive care consistent with that required for deep sedation.
(Source: American Society of Anesthesiologists and Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia )
As noted in the literature, sedation combined with analgesia may easily become deep sedation or loss of consciousness because of the agents used as well as the physical status and drug sensitivities of the patient. The administration of sedation requires continuous monitoring of the patient and the ability to respond immediately and appropriately to any adverse reaction or complication.
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New Hampshire Board of Nursing
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