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PPE > 8.2 Anaesthetics > Flashcards

8.2 Anaesthetics Flashcards

1
Q

What are the types of anaesthetics?

A

General
Local
Regional
Dissociative

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2
Q

What are the types of general anaethetics?

A

Volatile

IV

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3
Q

Examples of volatiles?

A

NO
Xenon
Fluranes

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4
Q

How do volatiles work?

A

A gas is passed over a filament where the volatile is turned into its gaseous form and breathed in via a ventilator

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5
Q

Advantages to Volatiles?

A

Easily turned on/off

Add a MAC sparing gas to reduce side effects

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6
Q

How do you measure the potency of volatiles?

A

MAC
Minimum Alveolar Concentration required for 50% of patients to be anaesthatised at that concentration (no response to surgical stimuli)

At equilibrium, it is equal to the spinal cord concentration, therefore CNS

Predicted by lipid solubility –> how well they can cross a membrane

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7
Q

What are the stages of anaesthetising a patient?

A

1) Give them a relaxing agent - premedicate
2) Induce
3) Maintain state - muscle relaxant, analgesia (opioid)
4) Recovery - undo state, give analgesia

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8
Q

Stages of Falling Under Anaesthesia… (4)

A

1) Analgesia
2) Excitation
3) Surgical Anaethesia
4) Respiratory Paralysis

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9
Q

How do anaesthetics act on the CNS?

Where does it act?

A 
Analgesia - dorsal horn
Muscle Relaxant - SC
Depress Reflexes - SC
Hypnosis - thalamus and the RAS
Resp/CVS Depression - Brainstem
(Amnesia - Hippocampus)
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10
Q

What increases MAC?

A 
Hyperthermia
Young People
Pregnancy
Alcoholics
CNS Stimulants
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11
Q

What decreases MAC?

A

Opioids
Elderly
Hypothermic

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12
Q

What affects Volatiles’ Pharmacokinetics?

A

A: MAC and Blood:Gas Coefficient
D: Organ perfusion, Tissue Uptake Capacity
E: Blood:Gas Coefficient, Oil:Gas Coefficient

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13
Q

What are some IV general anaesthetics?

A

Ketamine
Rapid Acting:
Propofol
Barbituates

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14
Q

When do you use IV general anaesthetics?

A

For induction or can do for whole operation (TIVA)

Bypasses the excitation stage of falling under

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15
Q

Pharmacokinetics ADME of IV General Anaesthetics?

A

A: Rapidly to CNS

D: Rapidly redistributed to tissues with higher capacity for Lipophilic drugs,

D/M: Protein Bound

E: Hepatic and Renal Conjugation

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16
Q

How do you measure potency of IV?

A

The plasma concentration to get to a certain endpoint, e.g. no eyelash reflex
Normally you switch to volatiles at this point

17
Q

How do anaethetics work? Targets…

A

Inhibit excitatory neurones: Glutamate

Excite Inhibitory neurones: GABA and Glycine

18
Q

How does it affect GABA and Glycine Receptors?
What do they normally do?
What effect do they have of pharmacodynamics?

A

Positive Allosteric Regulation

Bind externally to Cl- pore
Increases sensitivity to GABA, so increases Cl intracellularly to hyperpolarise, sends fewer signals

They increase efficacy and potency

19
Q

Which anaesthetics act on GABA?

A

All of them except Ketamine, N2O, Xenon

20
Q

Which excitatory neurones are effected?
How?
By which anaesthetics?

A

NMDA and nACh receptors
Non competitive allosteric antagonist (decrease efficacy but not potency/affinity)

NMDA- Inhibit them to glutamate, decrease the Ca2+ current
nACh - decrease Na+ currents
nACh- contributes to analgesia/amnesia but not sedation

Ketamine and N20

21
Q

When do we use local anaesthetics?

A

Dentistry
Child Birth
Post-Operative
Chronic Pain Management

22
Q

What is the difference between local and regional anaesthetics?

A

Local - used against specific peripheral nerves to give a specific loss of sensation
Regional - “block” used to prevent pain signals to a specific organ/limb, uses a local anaethetic and an opioid

23
Q

What are some local anaesthetics?

A

Lidocaine

Procaine

24
Q

How do local anasthetics work?

A

Reduce Na+ channels to prevent nerve transmission
so prefers small myelinated nerves
Use-dependent, block the active pain signalling molecules

25
Q

Properties of Local anaesthetics?

A

Lipid Soluble
Ring and amine structure
Bound by amide or ester bond (ester shorter t1/2)
Short half-life

26
Q

What can you use to prolong local anaethesia?

A

Adrenaline

27
Q

General ADRs of Anaesthetics?

A 
Depression of Resp/CVS
Arrythmias 
Hypotension
Post-Op Cognitive dysfunction
CHeck infections
Nausea (Opioids)

Allergies!

28
Q

An ADR of N20?

A

Can expand the airways and cavities which causes diffusion hypoxia

29
Q

ADRs of Local Anaesthetics?

A

Due to systemic spread

30
Q

How do we monitor people pre and peri-op?

A

Pre - assess general health, the airway, age, take history

Peri - monitor O2, CO2 and N2O sats, ECG, BP, Temp and EEG

PPE (25 decks)

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