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Specialities > Anaesthesia > Flashcards

Anaesthesia Flashcards

1
Q

What is the effect of opiates

A

Analgesia and a little sedation

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2
Q

Effect of general anaesthetic agents

A

Sedation

Skeletal muscle relaxation (to a lesser degree)

Analgesia (small degree)

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3
Q

Effect of local anaesthetic

A

Analgesia and skeletal muscle relaxation

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4
Q

Effect of muscle relaxants

A

Relax skeletal muscle

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5
Q

How do general anaesthetic agents work

A

Interfere with neuronal ion channels

Hyperpolarise neurones

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6
Q

Which processes are interrupted first using general anaesthetic

A

Cerebral function lost from top down

  • more complex processes
  • LOC early and lose hearing later
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7
Q

How do IV anaesthetics differ from inhaled (general) with regards to induction

A

Faster induction for IV - 1 arm to brain circulation ~30 seconds

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8
Q

How do IV anaesthetics differ from inhaled (general) with regards to awakening

A

Rapid recovery in IV due to disappearance of drug from circulation

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9
Q

Sequence of general anaesthesia

A

Inhalational induction and maintainance

IV induction and inhalational maintenance

IV induction and IV maintenance (propofol or remifentanil)

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10
Q

How do GA affect the respiratory system

A

Respiratory depressants - reduce hypoxic and hypercarbic drive

Paralyse cilia

Decrease lung volumes and V/Q mismatch

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11
Q

Effect of GA on CVS

A

Venodilation and negatively inotropic effect so lower cardiac output

Arterial vasodilatation so reduced vascular resistance

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12
Q

Indications for muscle relaxants

A

Ventilation and intubation
When immobility is essential
Body cavity surgery

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13
Q

Problems with muscle relaxants

A

Awareness - being awake and unable to move

Incomplete reversal - airway obstruction and ventilatory insufficiency in immediate post op

Apnoea - dependence on airway and ventilatory support

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14
Q

How do you reverse a neuromuscular blocker (non-depolarising)

A

Increasing acetylcholine

- using anticholinesterases

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15
Q

What is the limiting factor in use of local anaesthetics

A

Toxicity - high plasma levels

Absorption > rate of metabolism so high plasma levels

Therefore vasoconstrictors reduce blood flow and absorption

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16
Q

Signs and symptoms of local anaesthetic toxicity

A

Circumoral and lingual numbess and tingling

Light-headedness

Tinnitus, visual disturb

Muscular twitching

Drowsiness

Cardiovascular depression

Convulsions

Coma

Cardiorespiratory arrest

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17
Q

Lignocaine, bupivacaine and prilocaine are all examples of

A

Local anaesthetics

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18
Q

How to local anaesthetics act

A

Sodium channel blockers that prevent propagation of action potential

  • they must pass into axon to block sodium channels from within and be un-ionised to cross membranes
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19
Q

What kinds of fibres are best blocked by local anaesthetics and why

A

Pain fibres are blocked easily because they have less myelinated fibres so more difficult to penetrate

Motor fibres are relatively spared

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20
Q

Affect of local anaesthetics

A

Venodilation - decreased CO

Arteriolar vasodilation - decreased SVR

So decreased MAP

Effects due to sympathectomy

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21
Q

Affect of regional block on respiratory

A

Inspiratory function mostly spared but expiratory function relatively impaired (cough dependent on abdo muscle function)

Increased V/Q mismatch

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22
Q

Contra-indications for spinal and epidural anaesthesia

A

Patient refusal
Fixed cardiac output - aortic/mitral stenosis

Infection

Bleeding diathesis/anticoagulation

Spinal problems/neurology

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23
Q

Indications for epidural and spinal anaesthesia

A

Avoidance of general anaesthesia

Severe resp disease

Avoid airway problems - difficult intubation or obstruction

Allergies/reactions to GA

24
Q

How do spinal and epidural anaesthetics differ in location

A

Spinal injection is subarachnoid

Epidural is extradural

25
Q

Duration of spinal compared to epidural

A

Spinal 2-3 hours

Epidural 3-4 hours and is extendable

26
Q

IV induction agents

A

Propofol

Thiopentone

27
Q

Gas induction agents

A

Sevoflurane (halothane)

28
Q

Airway complications

A

Obstruction by loss of airway tone or laryngospasm - forced reflex adduction of the vocal cords

Stimulation in light planes of anaesthesia and caused by stimulation so need to remove stimulus

Aspiration of gastric content or food or surgical debris - endotracheal tube protects from this

29
Q

The first step of the WHO pain ladder

A

Paracetamol and NSAIDS

30
Q

The second step of the WHO pain ladder

A

Paracetamol and NSAIDS

CODEINE

31
Q

The 3rd step of the WHO ladder of pain

A

NSAIDS and paracetamol

MORPHINE

32
Q

Chronic pain is described as

A

Pain lasting > 3 months

Lasting after normal healing

33
Q

Description of nociceptive pain

A

Obvious tissue injury or illness

Pain has protective function

Sharp and or dull

Well localised

34
Q

Neuropathic pain

A

Nervous system damage or abnormality that does not have a protective function

Burning, shooting +/- numbness, pins and needles

Not well localised

35
Q

A burning shooting pain with pins and needles which cannot be localised is likely

A

Neuropathic in nature

36
Q

A localised sharp pain is likely

A

Nociceptive in nature

37
Q

The ascending pain pathway is also called the

A

Spinothalamic tract

38
Q

Which chemicals are released in the periphery in response to injury

A

Prostaglandins and substance P

39
Q

What is the first relay station

A

Dorsal horn

40
Q

Where is the second relay station

A

Thalamus

41
Q

Where does pain perception occur

A

The cortex

42
Q

How does modulation of pain occur

A

Descending pathway from brain to dorsal horn

43
Q

Nerve trauma, diabetic pain, fibromyalgia and chronic tension headache are examples of ______ pain

A

Neuropathic

Nervous system damage or dysfunction

44
Q

Pathological mechanisms of neuropathic pain

A

Increased receptor numbers

Abnormal sensitisation of nerves (peripheral and central)

Chemical changes in the dorsal horn

Loss of inhibitory modulation

45
Q

Mild opioids

A

Codeine

46
Q

Strong opioids

A

Morphine
Oxycodone
Fentanyl

47
Q

Drugs for neuropathic pain

A

Tramadol

Anti-depressants - amitriptyline, duloxetine

Anticonvulsants - gabapentin

48
Q

Disadvantages of morphine

A

Constipation

Respiratory depression in high dose

Misunderstandings about addiction

Controlled drug

Oral dose is 2-3 times higher IV/IM/SC

49
Q

Advantages an disadvantages of tramadol

A

Less respiratory depression than other opioids

Not a controlled drug like morphine

Causes nausea and vomiting

Causes withdrawal affect - anxiety, tremors, diarrhoea

50
Q

Disadvantages for amitryptiline

A

Anti-cholinergic side effects e.g. Glaucoma, urinary retention

51
Q

Is the WHO pain ladder applicable to neuropathic pain

A

Often not

Use amitriptylline, gabapentin and duloxetine early

52
Q

The 3 pillars of anaesthesia

A

Relaxation (skeletal muscle)

Hypnosis (sleep)

Analgesia (pain relief)

53
Q

What is the best test to assess severity of a patients lung disease with regards to fitness for anaesthesia

A

Exercise tolerance - questionnaire asking about the ability to do activities without getting breathless

54
Q

Drugs which increase risk of paracetamol toxicity

A

Carbamazepine

…

55
Q

Treatment of paracetamol overdose

A

N-acetyl cysteine

56
Q

Suxamethonium is a

A

Muscular relaxant

It has a very fast onset

57
Q

What is the reported frequency of serious adverse events (that did result in serious harm, disability or death) among hospitalised patients in the UK

A

1-5%

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