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FBN > Anaesthesia > Flashcards

Anaesthesia Flashcards

1
Q

Give an example of a lipid soluble and an uncharged local anaesthetic. How do they work?

A

Uncharged: benzocaine
Lipid soluble: tetracaine
Dissolve in membrane and block channel from within.

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2
Q

How do local anaesthetics work?

A

Na+ channel blockade - prevent propagation of APs

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3
Q

What is anaesthesia?

A

Insensitivity to pain following the suppression of - afferent sensory reflex (local/regional) and/or central neural processing (general anaesthesia).

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4
Q

Give an example of a local, regional and General method of anaesthesia.

A

Gel/local injection, inject into CSF, inhalation/I.V.

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5
Q

How can some anaesthetics duration be enhanced?

A

By using vasoconstrictors.

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6
Q

Where are regional anaesthetics inserted?

A

L4

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7
Q

Why must you make sure the patient is hydrated before a regional anaesthetic?

A

May lead to hypotension.

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8
Q

How long does a RA last?

A

2-3 hours

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9
Q

What are the two ways of giving a GA? Give examples of both.

A

Inhalation - inorganic gases such as NOS or a volatile liquid such as halothane. I.V - barbiturates eg: thiopental GABAa receptor. Non-barbiturates, ketamine acting on the NDMA receptor.

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10
Q

What are the modes of action of a GA?

A

Includes altered synaptic transmission in thalamic/cortical structures.

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11
Q

What are the uses of a GA? (4)

A

Anaesthetic - loss of consciousness, amnesia, inhibition of sensory reflex, skeletal muscle relaxation and analgesia.
Hypnotic - induces sleep, can be roused by external stimuli.
Tranquilliser - quieten without impairing consciousness, ease anxiety without causing sleep.
Medically induced coma

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12
Q

What can an induced coma be induced by?

A

Dose of barbiturate or propofol.

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13
Q

When is induced coma used?

A

Protect brain during/following major neurosurgery, reduces energy requirements of the brain and therefore time for healing and swelling.

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14
Q

What happens in stage 1 of anaesthesia?

A

Induction - transition from alert to unconscious. Autonomic reflexes progressively depressed in dose dependant manner - airway and resp reflexes, ventilation rate, circulatory reflexes.
There is a decrease in higher cortical function, consciousness is not lost but thoughts blurred. Reflexes present, smell and pain lost at end of stage.

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15
Q

How is stage 2 avoided?

A

Rapid acting anaesthetic.

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16
Q

What happens in stage 2?

A

Cortical inhibitory centres depressed, muscle tone increases, vomiting, temperature control lost and alpha rhythm of EEG desynchronised - dangerous state.

17
Q

Describe stage 3

A

Slow synchronised EEG, regular slow breathing, medically centres depressed, reflexes lost and pupils dilated.

18
Q

What happens in stage 4?

A

Loss of respiration, EEG waves are lost and you die.

19
Q

What are the characteristics of a an ideal inhaling anaesthetic?

A

Analgesic, full muscle relaxation, no increase in capillary bleeding. Rapid induction and recovery, wide safety margin, free of unwanted side effects, non irritant and nice taste, non-explosive with air.

20
Q

What is the MAC?

A

Potency of inhalation anaesthetic agent defined by MAC required to produce surgical anaesthesia.

21
Q

What is the MAC altered by?

A

N20, increase in age, pregnancy, some therapeutic drugs.

22
Q

Why is chloroform bad?

A

Metabolised by liver and its products are toxic.

23
Q

How are inhalation agents metabolised?

A

They are inert and are not metabolised, eliminated via the lungs.

24
Q

Are bogus injection short or long acting? What does this mean in turns of maintenance?

A

Short acting, poorly maintained without continuous infusion due to redistribution.

25
Q

What are Nokia injections ideal for?

A

Induction, then maintain with inhalation GA

26
Q

What are the two types of I.V infusion? Give examples of both and their pros and cons.

A

Thiopental is a barbiturate - is high lipid solubility. They are indicted very quickly but no analgesia, respiratory depression, low therapeutic index, irritant.
Non-barbiturates are ketamine and propofol. Ket is a rapid glutamate receptor blocker, analgesic and amnesic, high B.P and H.R, nausea and confusion during recovery.
Propofol - not analgesic, low incidence of nausea and vomiting, no bronchospasm.

27
Q

Where are the sites of action for a GA?

A

Reticular activating system and hippocampus.

28
Q

What are problems with GA?

A

Drug interactions, respiratory depression, CV effects, renal failure, hepatotoxicity, malignant, hyperpyrexia.

29
Q

Give an example of a weak-base local anaesthetic.

A

Lidocaine

FBN (22 decks)

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