Anaesthesia

Question 1

What is usually given for general anaesthesia?

Answer 1

Several different types of drug, induced with a volatile inhalation or IV which is maitained during surgery. Analgesics eg opioids are also used.

Question 2

Discuss neuromuscular blocking drugs

Answer 2

Requires intermittent positive-pressure ventilation. Acetilcholinesterases are given following surgery to reverse the effects of these

Question 3

What is the most common drug used for iv anaesthesia?

Answer 3

Propofolol is the most common, but not used in neonates. Has less hangover effects than others.

Question 4

Which drug is used to induce but has no analgesic properties?

Answer 4

Thiopental, and can cause dose related cv and resp depression. Awakening is rapid as drug redistributes into other tissues especially fats. Effects can continue for 24 hrs

Question 5

Discuss etomidate

Answer 5

Rapid recovery with no hangover effect, causes least hypotension.

Question 6

What is the main disadvantage to the use of ketamine?

Answer 6

High incidence of hallucinations, nightmares and other transient psychotic effects

Question 7

What is nitrous oxide used for?

Answer 7

The maintenance of anaesthesia

Question 8

What is a lethal potentially fatal side effect of anaesthesia?

Answer 8

Malignant hyperthermia. Rapid rise in temp, increased muscle rigidity, tachycardia and acidosis. Treated with dantrolene sodium.

Question 9

What sedation is used for dental surgery?

Answer 9

Should be limited to conscious sedation. Diazepam and temazepam

Question 10

What is vital for the anaesthetist to know pre surgery?

Answer 10

All medications the patient has been taking. Eg high dose steroids

Question 11

Which drugs should not be stopped pre surgery?

Answer 11

antiepileptics, antiparkinsonism, antipsychotics, anxiolytics, bronchodilators, cv drugs, glaucoma, immunosuppressants, dependance, thyroid drugs

Question 12

What should happen with patients taking antiplatelets or oral anticoags?

Answer 12

Decide if stopped or switched to heparin. Stable angina - aspirin should only be continued if high thrombotic risk.

Question 13

Which drugs should be stopped before surgery?

Answer 13

Combined oral contraceptives, MAOIS, Lithium 24 hours before major surgery but can be continued for minor. Potassium sparing witheled on morning as hyperkalaemia risk, ACE and ARB can cause hypotension so withold 24 hours pre