4. anaesthetic agents

Question 1

Propofol use

Answer 1

anaesthetic induction and maintenance
sedation
anti-emetic

Question 2

propofol MoA

Answer 2

• enhance GABA, inhibit NMDA glutamate receptors

- fast acting

Question 3

propofol side effects

Answer 3

• decrease respiratory: apnoea, RR
• decrease cardiac activity: CO, TV, BP
• decrease ICP, suppress seizures

Question 4

what are barbiturates used for?

Answer 4

anxiolytic, anaesthetic, suppress seizures, sleeping air

Question 5

examples of barbituates

Answer 5

thiopental
methohexital
phenobarbital
anxiolytics

Question 6

main use of thiopental (barbiturate)

Answer 6

• fast acting induction agent
• cerebral protection in surgery (Reduces pain demand) - prevents status epileptics
  e. g. in surgery when heart stopped and heart-lung machine can’t be used

Question 7

methohexital uses (barbiturate)

Answer 7

induction for ECT (electroconvulsive therapy) due to rapid onset&recovery.
reduces seizure threshold

Question 8

phenobarbital use (barbiturate)

Answer 8

seizure suppressant

Question 9

adverse effects of barbituates

Answer 9

-bronchoconstriction in asthmatics

Question 10

side effects of barbituates

Answer 10

• apnoea - needs ventilation
• increases HR, lower BP
• decreases cerebral O2 demand
• suppress seizures

Question 11

main uses of ketamine

Answer 11

acute analgesia
pads sedation
bronchodilation
‘dissociative anaesthesia’

Question 12

side effects of ketamine

Answer 12

maintains RR, maintains BP
bronchodilation - relaxes muscle
*good in haemodynamically unstable patients
hallucinations

Question 13

contraindications for ketamine

Answer 13

• can trigger phychotic reaction in schizophrenia

- elderly can react badly

Question 14

what happens to the metabolism of ketamine

Answer 14

metabolised in liver to norketamine which has less activity than ketamine

Question 15

etomidate uses

Answer 15

IV induction agent

Question 16

etomidate’s adverse effect

Answer 16

adrenal suppression: dampens stress response which isn’t ideal for surgery

Question 17

etomidate side effects

Answer 17

decreased ventilatory response to CO2
-haemodynamically stable
acts like propofol for neuro (decreases ICP and O2 demand)

Question 18

what can etomidate be used to treat

Answer 18

hypercorticolaemia

Question 19

benzodiazepine use

Answer 19

*sedative (can't anaesthetise so safer than thiopental)
anti-convulsant 
sleeping aid
*anxiolytic
*amnesic

Question 20

Benzos side effect

Answer 20

amnesia
decreased respiratory: response to CO2, hypoxic response, muscular tone
stable CV
neuro:

Question 21

adverse effects of benzos

Answer 21

lorazepam and diazepam can cause venous irritation and thrombophlebitis (basically superficial DVT)
-post-operative delirium

Question 22

what is flumazenil

Answer 22

competitive agonist against benzodiazepines at GABA receptor

-used. in benzos overdose