The patient has an extensive history of alcoholism. He is having coronary bypass surgery. While administering anesthesia, the certified nurse anesthetist notes that the patient requires higher-than-usual amounts of the drug. The nurse correctly evaluates this response as what phenomenon?
1. The nurse anesthetist most likely did not calculate the correct amount of anesthesia for this patient.
2. The patient has developed a paradoxical reaction to the anesthesia and will require a different drug.
3. The patient has developed a resistance to the anesthesia, so it will not work very well.
4. The patient has developed cross-tolerance to the anesthesia and will require higher amounts.
4
Rationale 1: There is no evidence to support that the nurse anesthetist incorrectly calculated the anesthesia dose.
Rationale 2: Paradoxical refers to the opposite response; in this case, the patient would have become very excitable; there is no evidence of this.
Rationale 3: Resistance refers to the immune system and infections and should not be used interchangeably with tolerance.
Rationale 4: With chronic alcohol use, the liver adapts and metabolizes alcohol at a faster rate. More of the substance is required to achieve the same effect. This is a phenomenon known as cross-tolerance. This patient has a tolerance to alcohol, so he will require additional anesthesia for surgery since both drugs are CNS depressants.
Global Rationale: With chronic alcohol use, the liver adapts and metabolizes alcohol at a faster rate. More of the substance is required to achieve the same effect. This is a phenomenon known as cross-tolerance. This patient has a tolerance to alcohol, so he will require additional anesthesia for surgery since both drugs are CNS depressants. There is no evidence to support that the nurse anesthetist incorrectly calculated the anesthesia dose. Resistance refers to the immune system and infections and should not be used interchangeably with tolerance. Paradoxical refers to the opposite response; in this case, the patient would have become very excitable, and there is no evidence of this.
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