anaesthesia

Question 1

what does anaesthesia mean?

Answer 1

loss of sensation

Question 2

what does regional anaesthesia block?

Answer 2

a specific nerve plexus

Question 3

what is conscious sedation?

Answer 3

depression of the central nervous system whilst maintaining verbal contact with the patient during the sedation

Question 4

what is malignant hyperthermia?

Answer 4

Inherited disorder of skeletal muscle only triggered by certain anaesthetic drugs

Abnormal accumilation of calcium in muscle cells leading to hypermetabolism, muscle rigidity and muscle breakdown releasing toxic metabolites into the bloodstream (potassium - cardiac arrhythmias)

Question 5

clinical presentation of malignant hyperthermia 5

Answer 5

Unexplained increase in expired Co2 concentration - hypermetabolism

Unexplained tachycardia - as cells are hypermetabolising so have increased oxygen requirement

Unexplained increase in O2 requirement

Temperature increase - hypermetabolic state

Profound muscle rigidity

Question 6

what is the treatment for malignant hyperthermia? 2

Answer 6

Dantrolene - only drug effective in limiting the MH process

Active cooling of the pt is commenced

Question 7

what is Suxamethonium apnoea?

Answer 7

pt remains paralysed for 6hrs

Question 8

what premedications are given before GA?

Answer 8

benzodiazepine to reduce the amounts of other agents required for anaesthesia

Question 9

what 3 drugs can be given to induce anaesthesia?

Answer 9

propofol
thiopental
etomidate

Question 10

what are the 4 stages of anaesthesia?

Answer 10

Stage I -> loss of consciousness

Stage II -> excitement or delirium and coughing vomiting and struggling may occur

Stage III -> stage of surgical paraesthesia (respiratory paralysis), laryngeal reflex lost and pupils dilate

Stage IV -> cessation of respiration to death

Question 11

what short acting muscle relaxant is given to ensure the airways remain open

Answer 11

suxamethonium

Question 12

what long acting muscle relaxant is given to ensure the airways remain open?

Answer 12

atracurium/rocuronium

Question 13

when and what meant that dental surgeons no longer able to anaesthetise and operate simultaneously

Answer 13

1991 - Poswillo report

Question 14

what did the royal college of anaesthetists say in 1999?

Answer 14

to give GA chairside had to have same equipment as hospital. As this is not viable this lead to the end of non-hospital GA

Question 15

remember if GA can be avoided it should be -> LA and conscious sedation