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Specialties > Anaesthesia > Flashcards

Anaesthesia Flashcards

1
Q

what is anaesthesia

A

the state of insensibility either in the whole body or an area/region

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2
Q

What is the triad of anaesthesia

A

Hypnosis, Analgesia, Relaxation

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3
Q

How do IV and Inhalation work differently in terms of the diffusion of drugs

A

IV works by allosteric binding (to receptors) whereas inhaled drugs dissolve into membranes

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4
Q

what is the minimum alveolar concentration

A

minimum amount of drug required to produce anaesthesia

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5
Q

is IV or inhalation quicker for induction of anaesthesia and why

A

IV quicker due to them being highly fat soluble but they also redistribute very quickly too

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6
Q

side effects of anaesthesia

A 
depress the CV system
reduce sympathetic outflow
negative ionotropic effect on the heart 
vasodilation of arteries and veins 
leads to a decrease in MAP

also resp depressors- reduce hypoxic and hpercarbic drive so decreased tidal volume and increased rate
muscle relaxants can cause reduced lung volumes

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7
Q

how do we combat the decrease in MAP that the anaesthesia causes

A

use fluids, vasopressors and ionotropes

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8
Q

how do muscle relaxants work

A

interfere with the NMJ and therefore affect skeletal muscle

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9
Q

Examples of drugs we use for anaesthesia

A

thiopentone, propofol

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10
Q

when do we require muscle relaxants

A

if needing to use ventilation or intubation
when immobility is essential
body cavity surgery

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11
Q

Issues with muscle relaxants

A

awareness
incomplete reversal
need to maintain the airway and provide ventilatory support

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12
Q

Why does analgesia help with anaesthesia

A

pain is arousing, supresses reflex responses in unconscious patients, contributes to the hypnotic effect of general anaesthesia

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13
Q

what are the main form of analgesia we use

A

Opiods- fentanyl- short acting and potent

morphine

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14
Q

Describe briefly what an anaesthesia assessment involves

A 
Assess
identify risks 
optimise 
minimise risk 
inform and support patients decision 
consent
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15
Q

what is the time scale for urgent surgery

A

2-3 weeks

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16
Q

What is involved in an assessment plan

A 
look at co morbidities and how well controlled they are, unknown co morbidities,
ability to withstand stress
drugs and allergies 
previous surgeries 
potential anaesthetic issues
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17
Q

What is the ASA grade

A 
1- Healthy patient 
2- mild to moderate systemic disturbance 
3-severe systemic disturbance 
4- life threatening disease
5-moribound patient 
6- organ retrieval
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18
Q

what is on the cardiac risk index and why is it significant

A 
more than 2 things= high risk 
high risk surgery 
ischaemic heart disease 
congestive heart failure 
cerebrovascular disease 
Diabetes 
renal failure
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19
Q

Describe the METS scale for exercise tolerance

A 
2- walk around the house
3- light housework
4-walk 100-200m 
5- climb stairs or hill
6- walk briskly on the flat
7- play golf/ hike/ any exercise 
8-run an short distance 
9- do strenuous exercise or physical work
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20
Q

what is the gold standard for assessing fitness for surgery

A

cardiopulmonary exercise testing

21
Q

why do we carry out a prop assessment

A

to see if there are any conditions that we are able to optimise before surgery through lifestyle changes

22
Q

What medications are stopped before pre op most of the time

A

anti- diabetic meds, anti- coags

23
Q

what are the 5 minimum standards of monitoring

A

ECG, O2 sats, non invasive blood pressure, end tidal CO2, airway pressure monitoring

24
Q

why do we give preoxygenation before surgery and what is it

A

when we give supplemental 100% O2 for a couple mins before anaesthesia due to decrease in lung volume and muscle relaxants can cause you to stop breathing briefly
means you have more time to desaturate

25
Q

What happens in induction

A

Patient is given GA, analgesia and potentially muscle relaxant often in IV but can be inhaled

26
Q

What are the 4 planes of anaesthesia

A

analgesia and amnesia
delirium to unconsciouness
surgical anaesthesia
apnoea and death

27
Q

What occurs in maintanance

A

Airways are managed - often a mask but may need more oropharyngeal tube or intubation

28
Q

Why would we need to intubate in surgery

A 
protection from aspiration (those who are unfasted) 
need for muscle relaxants 
shared airway 
need for tight CO2 control 
minimal access to patient
29
Q

What are the 3 options for controlling breathing

A

spontaneous ventilation
controlled ventilation
supported ventilation

30
Q

how often is bp measure during surgery

A

every 5 mins

31
Q

why is there a risk of hypothermia in surgery

A

drugs used cause dilation and therefore more heat loss, also exposed

32
Q

how do we minimise risk of hypothermia

A

only expose areas needed to
measure temperature every 30 mins- in some people all the time
warming blankets or forced warm air if needed

33
Q

What drugs do we use for maintanance

A

IV- TIVA or vapour (gas) for Inhaled

34
Q

what charts and values are documented throughout surgeries

A

prescription record
obs chart
ventilation chart
fluid balance

35
Q

what occurs in emergence

A

theatre sign out
neuromuscular blocker reversal if one used
general anaesthetic stopped
therefore you should see:
return of spontaneous breathing
return of airway reflexes
suctioning and removal of airway device and transfer to recovery room

36
Q

what is acute pain

A

pain of recent onset and limited duration

37
Q

what is chronic pain

A

pain lasting more than 3 month and that lasts after normal healing

38
Q

what is nociceptive pain

A

physiological/inflammatory - there is obvious tissue injury or illness. Can often be described as sharp/dull and well localised

39
Q

What is neuropathic pain

A

tissue damage isn’t obvious - nervous system abnormality

Burning, shooting, numbness, pins and needles, not well localised

40
Q

what are simple analgesics

A

Paracetemole, NSAIDS

41
Q

advantages and disadvantages of paracetamol

A

cheap, safe, orally or IV, good for mild pain or moderate if used with other drugs
Liver damage in overdose

42
Q

Advantages and disadvantages of NSAIDS

A

cheap and safe and good for nociceptive pain when given with paracetamol
can get GI and renal side effects and sometimes bronchospasm in asthma patients

43
Q

Examples of weak opiods

A

Codeine, tramadol

44
Q

pros and cons of codeine

A

cheap and safe and good for mild to moderate nociceptive pain
constipation and not good for neuropathic

45
Q

pros and cons for tramadol

A

less resp depression than other opioids
can be used with other analgesic drugs
less constipation
causes nausea and vomiting and is a control drug

46
Q

What type of pain is morphine good for

A

cancer pain, nociceptive

47
Q

what do we use TCA’s for when treating pain and give me an example of one

A

good for neuropathic pain

48
Q

other than TCA’s what can we use for treating neuropathic pain

A

anticonvulsants- carbamazepine, sodium valproate

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