Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Med School Yr 2 > 10 - Anaesthesia > Flashcards

10 - Anaesthesia Flashcards

1
Q

what system is involved in the sleep/wake cycle and is a target of anaesthesia/

A

reticular activating system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 5 stages of anaesthesia?

A
  • preparation
  • induction
  • maintenance
  • early recovery
  • delayed recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the biggest concern when anaesthetising diabetic pts?

A

hypoglacaemic episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the 3 types of anaesthesia?

A
  • local
  • general
  • combined
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

in what type of anaesthesia is consciousness not impaired?

A

local

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the 3 types of local anaesthesia?

A
  • topical
  • field
  • regional - spinal/epidural
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the triad of general anaesthesia?

A
  • hyponosis - IV agents
  • analgesia - opiates and non opiates
  • muscle relaxation - depolarising and non- depolarising
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

when is propofol typically used in anaesthesia?

A

induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

the potency of anaesthetic agents is related to what?

A

their lipid solubility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

order these anaesthetics from most to least potent:
* isoflurane
* halothane
* N2O
* sevoflurane
* deslurane

A
  • halothane
  • isoflurane
  • sevoflurane
  • desflurane
  • N2O
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what pain pathways is the area targeted by anaesthetic drugs?

A

descending pain pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what receptors do opiates act on?

A

mu receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

list 3 natural opiates

A

morphine
dihydro-morphine
codeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

give an example of an opiate analogue

A

tramadol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

give 4 examples of synthetic/semisynthetic opiates

A
  • pethidine
  • fentanyk
  • alfentanyl
  • remifentanyl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

mu 1 receptors are primarily involved in what?

A

analegesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

mu 2 receptors are primarily involved in what?

A

respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

mu3 receptors are primarily involved in what?

A

vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what can be given in cases of opiate over dose?

A

naloxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how should naloxone be administered and why?

A
  • via infusion
  • very short half life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

why should naloxone not be given as a bolus?

A

can result in pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

at what stage of anaesthesia are neostigmine and glycopyrolate used?

A

recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is role of glycopyrolate in the recovery stage of anaesthesia?

A

offsets bradycardia caused by neostigmine

24
Q

why should pts fast before elective surgeries/

A

empty stomach reduces the risk of stomach contents refluxing into oropharynx and then being aspirated into the traceha

25
Q

before being put under general anesthesia the pt will breath 100% O2 for a few minutes - why is this?

A

gives them a reserve of O2 for the perikod between losing consciousness and being successfully intubated and ventilated - in case there are issues establishing an airway

26
Q

what premedications can be given before a pt is put under general anaesthesia?

A
  • benzos - relaxes muscles and reduces anxiety
  • opiates - reduces pain and hypertensive response to laryngoscope
  • alpha2-adrenergic agonists - sedation + pain
  • antacids - reflux, pregnancy, hiatus hernia
  • antibiotics - surgical implant, endocarditis
  • anticholinergics
27
Q

what is the theory of general anaesthetic action?

A

enhance inhibitory signals or blocking excitatory signals

28
Q

how are anaesthetic agents administered in the induction phase?

A

IV or inhalation

29
Q

list 4 IV options for general anaesthetic

A
  • propofol
  • ketamine
  • sodium thiopentone
  • etomidate
30
Q

what are 4 inhaled options for general anaesthetics?

A
  • sevoflurane
  • desflurane
  • isoflurane
  • nitrous oxide
31
Q

what is the mechanism of inhaled anaesthetics?

A
  • diffuse across lung tissue
  • enter blood
  • enter brain
  • recovery via exhalation
32
Q

what is the mechanism for IV anaesthetics?

A
  • bolus of drug injected directly into blood
  • travels to brain
  • ultimate recovery by elimination
33
Q

what drug is commonly used for TIVA?

A

propofol

34
Q

why may inhalation induction be chosen over IV?

A
  • IV access is difficult to obtain
  • difficulty maintaining airway
  • pt preference, eg,. children
35
Q

what is the duration of action of IV anaesthetics? what is used to prolong this?

A
  • duration = 5-10 minutes
  • prolonged using mixture of inhaled anaesthetics
36
Q

maintenance of anaesthesia is achieved through what?

A

inhalation of a carefully controlled mixture of:
* oxygen
* nitrous oxide
* volatile anaesthetic agent

or through continuous infusion of propofol through an IV catheter

37
Q

how do muscle relaxants work?

A

preventing ACh from binding to receptor

38
Q

what are the two categories of muscle relaxants?

A

depolarising - suxamethonium
non-depolarising - rocuronium
atracurium

39
Q

what is used to reverse the effects of muscle relaxants at the end of surgery?

A

cholinesterase inhibitors - neostigmine or sugammadex (non-depolarising muscle relaxants)

40
Q

antimetics are often given at the end of the procedure to prevent post-operative nausea and vomiting - give 3 examples

A

ondansetron - avoid in pts with prolonged QT interval
dexamethasone - caution in diabetics and immunocompromised
cyclizine - caution in heart failure and elderly

41
Q

what are some significant risks of anaesthesia?

A
  • accidental awareness
  • aspiration
  • dental injury
  • anaphylaxis
  • cardiovasc events
  • malignant hyperthermia
  • death
42
Q

what is malignant hyperthermia?

A

potentially fatal hypermetabolic response to anaesthesia that causes:
* hyperthermia
* increased CO2 production
* tachycardia
* muscle rigidity
* acidosis
* hyperkalaemia

43
Q

what increases the risk of malignant hyperthermjia?

A
  • volatile anaesthetics - isoflurane, sevoflurane, desflurane
  • suxamethonium
  • genetic mutations - autosomal dominant
44
Q

how is malignant hyperthermia treated?

A

dantrolene - interrupts muscle rigidity and hypermetabolism by interferring with Ca2+ movement in skeletal muscle

45
Q

a pt is having surgery. identify why the following anaesthetic agents are used in combination:
* propofol
* isoflurane
* fentanyk
* atracurium
* suxamethonium
* atropine/glycopyrrolate
* neostigmine

A
  • propofol - IV rapid induction
  • isoflurane - inhalaed for maintenance
  • fentanyl - opiod analgesic
  • atracurium - muscle relaxant
  • suxamethonium - muscle relaxant
  • atropine/glycopyrrolate - muscarinic antagonist to prevent/treat bradycardia and reduce salivary secretions
  • neostigmine - reverse NMJ blockade
46
Q

what is the mechanism of action of propofol?

A

GABA agonist - increases inhibitory effect

47
Q

what is the volume of distribution of propofol?

A
  • 60L/kg
48
Q

what is the MOA of isoflurane?

A
  • reduces gap junction channel opening times
  • alters tissue excitability
  • induces muscle relaxation
49
Q

what is the MOA of fentanyl?

A
  • agonist of mu opioid receptor
  • inhibits adenylate cyclase
  • = downregulation
  • hyperpolarises cell and inhibits nerve activity
50
Q

what is a typical dose of fentanyl?

A

0.05mg/mL IV

51
Q

what is the MOA of suxamethonium?

A
  • depolarising neuromuscular blocker
  • mimics ACh but not rapidly hydrolysed
52
Q

wh

what is the MOA of atracurium?

A
  • non-depolarising neuromuscular blocker
  • antagonist of ACh sp. at nicotinic receptors
53
Q

what is the MOA of neostigmine?

A
  • inhibits AChE
  • prolongs action of ACh
  • increases muscular contraction and reverses muscle relaxants
54
Q

what is hte MOA of atropine/glycopyrrate

A
  • antagonise muscarinic receptors
  • inhibit cholinergic transmission
  • decreases bradycardia risk from neostigmine
55
Q

what is the MOA of mannitol?

A
  • increases blood plasma osmolarity
  • increases flow of water from tissues
  • decreases ICP
56
Q
A

Med School Yr 2 (96 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions