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Anaesthesia > 1. Overview Of Anaesthesia > Flashcards

1. Overview Of Anaesthesia Flashcards

1
Q

Role of anaesthetists

A

Anaesthetists are responsible for the peri- operative care of a surgical patient m. This implies that they should be involved in the pre-, infra- and postoperative management of patients, in consultation with other clinicians e.g surgeon, physicians, intensivists, the primary care physician etc.

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2
Q

Define general anaesthesia

A

General anaesthesia can be defined as a reversible drug induced coma-like state that is characterised by loss of consciousness, loss of recall and variable loss of somatic and autonomic reflexes

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3
Q

What does “anaesthesia” in Greek mean

A

Without sensation

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4
Q

Division of anaesthetic into three distinct periods

A

Pre- operative
Anaesthetic
Post- operative

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5
Q

Pre- operative period

A

pre-operative visit or consultation where the anaesthetist meets the patient, examines them, and plans an anaesthetic appropriate for the specific procedure the patient is undergoing.

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6
Q

Sub-Division of the anaesthetic period

A

Induction phase
Maintenance phase
Emergence phase

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7
Q

Post- operative

A

postoperative or recovery period where the patient returns to full physiological functioning.

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8
Q

Anaesthetists as peri- operative physicians

A

They care for their patients during their operative journey

Anaesthetists are the patient’s guardian during this period and must endeavor to maintain normal physiological functioning whilst administering the anesthetic

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9
Q

things done in the pre- operative visit

A
  • relevant history
  • examination of the patient
  • special investigations
  • inform the patient about the attendant anaesthetic risks
  • give outline of the journey through the surgical period
  • premedication orders
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10
Q

division of the anesthetic period

A
  • pre induction
  • induction
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11
Q

pre induction

A
  • machine, monitoring and equipment check
  • identifying the presence of emergency equipment and drugs
  • drawing up the drugs to be used
  • patient is prepared for anaesthesia
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12
Q

how is the patient prepared for anaesthesia

A

by establishing venous access and administering pre- induction drugs

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13
Q

what does the administration of induction drugs depend on

A

on patient-, medical-, or surgical- factors ad well as the knowledge and technical skills of the anaesthetic team

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14
Q

risk of induction

the risks of induction come from:

A

it is a high risk period

the risks of induction come from:
*equipment and monitor malfunctions,
*failure to recognize airway problems
* untoward reactions to administered drugs

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15
Q

what does induction mean

A

the transition from an awake to an anaesthetized state

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16
Q

classification of anaesthesia

A

regional (local)
general

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17
Q

maintenance period

A

the anaesthesia must be administered adequately to the appropriate level and maintained until the surgery is complete

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18
Q

what must the anaesthetist monitor the patient on

A
  • clinical grounds
  • non invasive and invasive monitoring device
  • “point of care” blood test
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19
Q

problems that may arise during the maintenance period

A
  • peri operative fluid shifts
  • blood loss
    -aggravation of pre- existing medical or surgical conditions
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20
Q

how is the reversal period induced

A

removing maintenance drugs or administering antidotes

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21
Q

emergence or reversal

A

the patient is allowed to “lighten”, regain spontaneous ventilation and the ability to maintain their own airway and protective reflexes

22
Q

examples of post- operative placement of the patient

A
  • a recovery area or post anaesthesia care unit prior to returning to the ward (or home)
  • a high care unit for more intensive monitoring or pain/fluid management
  • the intensive care unit (ICU) for further invasive monitoring and organ support
23
Q

post operative period

A

no anaesthetic is complete until the patient is fully recovered from the effects of the anesthetic drugs
patients must be monitored until able to cope will all basic physiological functions

24
Q

pain management

A

it is crucial for relieving the patient from discomfort, both physical and psychological

25
Q

Three main objectives of general anaesthesia

A

hypnosis
analgesia
immobility/ muscle relaxation

26
Q

advantage of treat each angle of the triad of anaesthesia with specific drugs

A

allows a lower total dose of each drug due to synergism and therefore less chance of severe side effects

27
Q

aim of hypnosis

A

patients want to be awareness free

28
Q

aim of immobility/ muscle relaxation

A

surgeons want patients to be movement free

29
Q

aim of analgesia

A

Anaesthetists want the patient to be reflex free

30
Q

define synergism

A

an interaction between two or more drugs that causes the total effect of the drugs to be greater than the sum of the individuals effects of each drug

31
Q

define analgesia

A

medication that acts to relieve pain

32
Q

classification of hypnosis

A

psychological hypnosis
chemical hypnosis

33
Q

psychological hypnosis

A

-time consuming
-unreliable (only 10-30% of patients can tolerate surgery)
-expertise not available

34
Q

division of chemical hypnosis

A

general anaesthesia
sedation

35
Q

division of general anaesthesia

A

intravenous anaesthesia
inhalation anaesthesia

36
Q

intravenous anaesthesia: one dose

A

induction agent

37
Q

intravenous anaesthesia: continuous doses

A

total intravenous anaesthesia (TIVA)

38
Q

division of sedation

A

non- anaesthetic agents
neuroleptic anaesthesia

39
Q

non- anaesthetic agents

A
  • all general CNS depressants may causes unconsciousness depending on the dose
  • benzodiazepines, alcohol, phenothiazine, barbiturates have all been used
    -in low doses, some general anaesthetic agents (such as Propofol) can cause reliable sedation without suppressing reflexes or respiration
40
Q

neuroleptic anaesthesia

A

-partial sedation whereby consciousness is altered enough to lose comprehension or resistance to procedure
* ketamine
*butyrophenones (droperidol or haloperidol -rarely used nowadays)

41
Q

how can immobility of the patient be achieved

A

restraints
deep general anaesthesia
neuromuscular blocking drugs
local anaesthetic

42
Q

restraints

A

Some patients, once rendered unconscious, are physically restrained to assist the
surgeon’s view. Be aware of patients’ neurovascular bundles to prevent injury.

43
Q

deep general anaesthesia

A

This can be used alone to prevent movement, but this may result in high doses of
drugs causing side effects

44
Q

neuromuscular blocking drugs

A

These drugs work on the neuromuscular junction and are divided into two groups:
(a) Depolarising
(b) Non-depolarising

these agents also paralyze the muscles used for respiration, and this artificial ventilation (manual or automatic) is mandatory

45
Q

local anaesthetic

A

In the correct place and at the correct strength, local anaesthetics are sufficient to
cause motor nerve blockade with adequate muscle relaxation for surgery

46
Q

multimodal approach to analgesia

A

combining several methods of pain

47
Q

simple analgesics

A

. paracetamol per os, per rectum or intra-venous (Perfalgan®)

48
Q

NSAIDs

A

for surgical inflammatory pain, e.g.
diclofenac

49
Q

opiates

A

reduce pain inputs, i.e. inhibit the nociceptive pathway, e.g. morphine.

Many
routes of delivery, e.g. oral, intramuscular, subcutaneous, transcutaneous, epidural
or spinal

50
Q

local anesthetics

A

block pain pathways

51
Q

Serotonin and / or Noradrenaline agonists,

A

Tramadol

52
Q

Monitoring

A

ALL PATIENTS MUST BE MONITORED WHILE RECEIVING PERIOPERATIVE CARE, which
could be seen as adding a fourth corner to the triangle., making it a square or diamond.

Anaesthesia (14 decks)

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