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Leeds MBCHB Year 4 ACC > Anaesthesia > Flashcards

Anaesthesia Flashcards

1
Q

3 key components to GA

A

Amnesia - lack of response and recall
Analgesia
Akinesis - paralysis

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2
Q

3 key monitoring requirements for BEFORE GA

4 during

A

ECG
SPO2
NIBP

Gases (O2 CO2 and vapour)
Pressure
Nerve stimulator
Temperature

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3
Q

4 main induction agents

A

Propofol
Thiopentone
Ketamine
Etomidate

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4
Q

Why is propofol most used

A

Excellent suppression of air way reflexes

Reduced PONV

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5
Q

3 key propofol side effects

A

Drop in HR and BP
Pain on injection
Involuntary movements

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6
Q

Thiopentone advantages (2)

A

Faster than propofol (used for RSI)

Anti-epileptic properties

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7
Q

Thiopentone disadvantages

A

Drop in BP (RISE IN HR)
Rash
If intra arterial gangrene and thrombosis
Contraindicated in porphyria

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8
Q

Ketamine advantages

A 
Rise in HR/ BP (does not drop like most)
Good analgesia (can be used as sole anaesthetic)
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9
Q

Ketamine disadvantages

A

Slow onset (90 seconds)
N and V
Emergence phenomenon

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10
Q

Etomidate advantages

A

Haemodynamically stable
Lowest incidence of hypersensitivity reactions
Rapid onset

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11
Q

Etomidate disadvantages

A

Pain on injection
Spontaneous movement
Adrenal suppression
PONV

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12
Q

Best induction agent for HF patients

A

Etomidate

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13
Q

Which induction agent cannot be used in patients with porphyria

A

Thiopentone

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14
Q

Which induction agent causes a rise in HR and BP

A

Ketamine

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15
Q

Which induction agents cause PONV

A

Ketamine and etomidate

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16
Q

Which induction agent does not affect HR or BP

A

Etomidate

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17
Q

What is 1 MAC

A

The minimum alveolar concentration that causes 50% of patients analgesia and 100% of patients amnesia

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18
Q

Which induction agent is used when IVA cannot be obtained

A

Sevoflurane (kids)

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19
Q

Which inhalation agent is sweet smelling

A

Sevoflurane

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20
Q

Which inhalation agent is fastest acting

A

Desflurane

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21
Q

Which inhalation agent has least effect on organ blood flow

A

Isoflurane

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22
Q

Best inhalation agent for long operations

A

Desflurane (but high CO2 output)

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23
Q

Why are analgesic drugs required for intubation

A

Suppress response to laryngoscopy and airway insertion (as well as surgical pain)

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24
Q

Why would remifentinil be given before propofol

A

Takes longer to act (1-5 mins instead of 15 seconds)

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25
Q

Which NSAID can be given IV

A

Parecoxib and ketorolac

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26
Q

What must be done before giving muscle relaxants

A

Ensure ability to ventilate

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27
Q

What are the two types of akinesis agents

A

Depolarising (sux) and non depolarising

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28
Q

Advantages and disadvantages of sux

A

RSI as rapid onset and rapid offset

Muscle pains, fasciculations, hyperkalemia, malignant hyperthermia, rise in ICP

29
Q

Reversal agent for non depolarising muscle relaxants (rocuronium)

A

Nesostigmine (and glycopyrrolate)

30
Q

Longest acting non depolarising akinesis agent

A

Pancuronium

31
Q

Shortest acting non depolarising akinesis agent

A

Mivacurium

32
Q

3 most commonly used vaso active drugs (not adrenaline)

A

Ephedrine
Phenylephrine
Metaraminol

33
Q

Other than adrenaline, drug which can be used in severe hypotension

A

Dobutamine

34
Q

Vasoactive drugs which causes rise in BP by vasoconstriction

A

Phenylepherine (drop in HR)

Metaraminol

35
Q

Vaso active drug that causes rise in BP and HR

A

Ephedrine

36
Q

Vasoactive drug that causes drop in HR

A

Phenylepherine

37
Q

Key difference between ephedrine and phenylephrine

A

Phenylepherine causes drop in HR

Ephedrine cause increase in HR

38
Q

What is Sugammadex and why would it be used

A

Does not inhibit ACHase so anti-musc agent not needed like when using neostigmine

Associated with less side effects

39
Q

Why can neostigmine not be given alone

A

Inhibits acetylcholinesterase so need to give an anti-musc like glycopyrrolate

40
Q

In pain reception, where is the first 2 relay stations

A

Dorsal horn and then thalamus (then brain for perception)

41
Q

What are the 2 chemical key parts of a LA

A

Lipidsoluable hydrophobic aromatic
Charged hydrophilic amide

Joined by either ester or amide

42
Q

Max dose of lignocaine

A

3mg/kg

43
Q

Max dose of bupivacaine

A

2mg/kg

44
Q

Max does of prilocaine

A

6mg/kg

45
Q

How man mg/ml in 1ml of 1% of x

A

times by 10 so that 10mg/ml

46
Q

How to tell which LAs are amides

A

Have X…I…X… caine

Basically have an I in them

47
Q

Which protein do most GAs inhibit and how

A

GABA by allowing CL- ions in

48
Q

Score used to determine likely ease of intubation

A

Mallampati score

49
Q

What is the difference between dead space and a shunt

A

Dead space has good ventilation but no blood

Shunt has good blood but poor ventilation

50
Q

In patients with multiple allergies, which type of LA should be used

A

Amide (not esters)

51
Q

Is Bupivacaine long acting and what is its max dose

A

Yes

2mg/kg

52
Q

How to LA work

A

Block NA channels

53
Q

Safe dose of lignocaine without adrenaline

A

3mg/kg

54
Q

Safe dose of Lignocaine with adrenaline:

A

7mg/kg

55
Q

Safe dose of Bupivacaine / levobupivacaine ( with or without adrenaline):

A

2mg/kg

56
Q

Safe dose of Prilocaine

A

6mg/kg

57
Q

What electrolyte abnormality can sux cause

A

Hyperkalemia

58
Q

What ASA grade is pregnancy

A

2

59
Q

What BMI is ASA 2

A

30-40

60
Q

What ASA grade would a patient with well controlled diabetes be

A

2

61
Q

What is ASA 6

A

Organ retrieval

62
Q

What ASA grade would mean patient is not expected to survive without operation

A

5

63
Q

Quickest acting anaesthetic agent

A

Sodium thiopentone

64
Q

LA safe doses pneumonic

A

3726

3: L
7: L with adrenaline
2: Bupivacaine
6: priolocaine

65
Q

Drug used to treat malignant hyperthermia

A

dantrolene

66
Q

Is sux depolarising or non depolarising

A

Depolarising

67
Q

Side effects of non depolarising muscle relaxants

A

Hypotension (apparently )

68
Q

How long before an operation can a patient have milk tea

A

6 hours

Leeds MBCHB Year 4 ACC (5 decks)

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