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Peri-op > Anaesthesia > Flashcards

Anaesthesia Flashcards

1
Q

Pre- op assessment: ACE inhibitors

A

Check BP and U&E

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2
Q

Pre- op assessment: Antibiotics, which are important

A

aminoglycosides, colistin and tetracycline

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3
Q

Pre- op assessment: Antibiotics

A

aminoglycosides, colistin and tetracycline

prolong neuromuscular blockade (including depolarizing neuromuscular blockers)

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4
Q

Pre- op assessment: Anticoagulants

A

Check indication and INR
Aim INR <1.5
Swap warfarin -> heparin
avoid epidural/spinal

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5
Q

Pre- op assessment: Anticonvulsants

A

continue up to 1 h pre-op

post-op use IV or NGT

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6
Q

Pre- op assessment: Beta-blockers

A

continue up to morning of the surgery

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7
Q

Pre- op assessment: Bronchodilators

A

continue + supplement with nebs if required

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8
Q

Pre- op assessment: Contraceptive Pill

A

stop 4 weeks before major/leg surgery

restart 2 wks after

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9
Q

Pre- op assessment: Digoxin

A

continue up to morning of surgery
check for toxicity and K+ levels
suxamethonium -> increases K+ -> ventricular arrhythmias in those on digoxin

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10
Q

Pre- op assessment: Diuretics

A

beware hypokalaemia, check U&E

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11
Q

Pre- op assessment: HRT

A

stop before hip surgery

use heparin and stockings

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12
Q

Pre- op assessment: Insulin

A 
stop on the day of surgery 
start GKI (glucose, K+ and insulin) infusion
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13
Q

Pre- op assessment: Levadopa

A

possible arrhythmias under GA

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14
Q

Pre- op assessment: Lithium

A

check recent serum levels
may potentiate non-depolarising muscle relaxants
beware post-op toxicity & U&E imbalance

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15
Q

Pre- op assessment: Monoamine oxidase inhibitors

A

get expert help
interactions with narcotics/anaesthetics
-> hypo/hypertensive crisis

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16
Q

Pre- op assessment: Ophthalmic drugs: Anticholinesterases (glaucoma)

A

may cause sensitivity and prolong duration of drugs metabolised by cholinesterase (eg suxamethonium)

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17
Q

Pre- op assessment: Ophthalmic drugs: beta blockers eye drops

A

may cause systemic symptoms:

bronchospasm/ hypotension

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18
Q

Pre- op assessment: tricyclic antidepressants

A

enhance effects of adrenaline
exert anticholinergic effects
-> increased HR, arrthythmias and decreased BP

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19
Q

Premedication types (7)

A 
Anaelgesi 
Anxiolysis 
Amnesia 
Antacid 
Anti-emetics 
Antacid
Antibiotics 
Anti-autonomic
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20
Q

Inhalation agent: 1st choice

A

Sevoflurane

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21
Q

Sevoflurane

A 
Inhalation agent 
Maintains anaesthesia and reduces awareness 
Halogenated ether 
Well tolerated 
Fast onset and offset 
Low rates of irritation
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22
Q

Neuromuscular junction action potential transfer

A

AP reaches the nerve terminal
Presynaptic membrane releases vesicles of ACh by exocytosis
ACh diffuses across the synaptic cleft
ACh binds to post synaptic nicotine can ACh receptors
Na+ influx causing depolarisation

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23
Q

Neuromuscular blockers: depolarising agent example

A

Suxamethonium

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24
Q

Suxamethonium, what anaesthetic medication is it?

A

Depolarising neuromuscular blocker atrial agonist of ACh receptors

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25
Suxamethonium mechanism of action
Partial agonist of ACh receptor Causes initial depolarisation (fasciculation) of the post synaptic membrane Inhibition of restoration normal membrane polarity
26
Sedation definition
Range of depressed conscious levels from relief of anxiety to general anaesthesia
27
Induction medication
IV: propofol Gaseous: sevoflurane or nitrous oxide
28
Indications for gaseous induction
Patient's request Difficult IV access Children's Partial airway obstruction
29
What is the risk of intubation of patient is not adequately anaesthetised ?
Laryngoscopy or tracheal intubation can induce harmful adrenergic stress response -> increases pulse and BP
30
Indications of intubation
Risk of vomiting or aspiration Difficult airways (consider fibre optic) Inaccessible/ shared airway (H&N surgery) Paralysis required for surgery (abdo surgery)
31
Muscle relaxation medication
Suxamethonium (depolarising) | Rocuronium/ vecoronium
32
Rapid sequence induction: when is it used?
High risk of aspiration
33
Rapid sequence induction: procedure
``` Pre oxygenate Sellick manoeuvre Induction agent: propofol Muscle relaxant: suxamethonium Intubation Longer acting muscle relaxant (non depolarising): rocuronium/ vencuronium ```
34
Maintenance procedure (3 ways)
1. Volatile agent in N2O/O2 mixture +/- opiates 2. IV propofol +/- opiates 3. High doses of opiates if on mechanical ventilation (high risk of awareness)
35
List signs of inappropriate anaesthesia levels
``` HR and BP increase Movement Lacrimation Dilated pupils Laryngospasm Bispectral index (BSI) ECG monitoring ```
36
End of anaesthesia procedure
``` Withdraw all gaseous and IV meds Neostigmine Anticholinergic (atropine or glycopyrronium) ET tube removal Transfer to recovery ```
37
Name 2 anticholinergics
Atropine | Glycopyrronium
38
Suxamethonium is inactivated by
Plasma cholinesterases
39
Suxamethonium: features of IV use
``` Paralytic agent (used in RIS) Fast onset (0.5-1s) -> reduces risk of aspiration Short duration (3-5 min) ```
40
Suxamethonium: problems and side effects
``` Increases K+ Increases intra ocular pressure Muscle pains (30% post op) Repeated diss can cause bradycardia (Rx atropine) Suxamethonium apnea Malignant hyperthermia ```
41
Non depolarising agents: name 2 examples
Rocuronium | Vecuronium
42
Non depolarising agent reversal agent
Neostigmine | Sugammadex for rocuronium and vecuronium
43
Neostigmine: class and mechanism of action
Reversal drug for non depolarising neuromuscular blockers Anticholinesterase -> prevents ACh breakdown in the synaptic cleft -> increased ACh efficiency
44
Non depolarising agents (rocuronium and vecuronium) mechanism of action
Competitive antagonists of ACh
45
ADRs of inhalational agents (4)
Respiratory irritation CV depression Hepatitis Malignant hyperthermia
46
Name 4 IV anaesthetic agents used for induction
Propofol Thiopental sodium Ethamidate Ketamine
47
Propofol onset time
40 seconds | One arm-brain circulation
48
Propofol mechanism of action
Positive modulation of GABA neurotransmitter
49
Propofol: what causes it's offset?
Drug redistribution not metabolism
50
Propofol contraindications
Extremes of age Egg or soy allergy Compromised airway
51
Propofol: when should we reduce the dose? (3)
Elderly Debilitated Shocked
52
Propofol dose and midazolam as premed
Required dose reduced if on midazolam
53
Propofol: common ASR
Pain at injection | use lidocaine
54
Thiopental sodium: what type of medication is it?
IV Anaesthetic agent Barbiturate Normally mixed with water (2.5% solution)
55
Features of Thiopental sodium use
Rapid onset | Offset within 3-8 mins due t redistribution
56
Thiopental sodium ADRS
Anaphylaxis Negative inotrope -> CO reduced by 20% Bronchoconstriction Intra arterial injection is painful - > ischaemia and gangrene - > indwelling cannula required for administration
57
Thiopental sodium contraindications
``` Airway obstruction / compromised airway Barbiturate allergy Fixed cardiac output states (AS) Hypovolaemia or low BP Porphyria ```
58
Etomidate: what type of medication is it
IV Anaesthetic agent for induction Carboxylate imidazole Used in emergencies
59
Etomidate when is it used and why ?
History of trauma/ head injury Cases where avoidance of hypovolaemia is important - no histamine release - cardiovascular stability - rapid recovery
60
Ethomidate: ADRs
involuntary muscle movements nausea adrenal supression
61
Ketamine: what type of medication is it?
IV/IM anaesthetic agent for pediatric anesthesia or procedural sedation potent bronchodilator
62
Ketamine: when is it used?
Paeds Procedural sedation Staticus asthmaticus (potent bronchodilator)
63
Ketamine: ADRs
hypertonus salivation slow troublesome recovery delirium/hallucinations/nightmares
64
Curare : what is it and reversal
reversible nicotinic ACh receptor blocker | -> reversal: cholinesterase inhibitor (pyridostigmine)
65
alpha- neurotoxins: what is it
irreversible nicotinic ACh receptor blocker in snake venom
66
Botulin toxin: MOA and reversal
blocks exocytosis of ACh | -> reversal: cholinesterase inhibitor (pyridostigmine)
67
Organophosphates: MOA and reversal
irreversible AChEsterase inhibitoion (similar to nerve gas) - > prolonged ACh binding - > reversal: pralidoxime
68
Myasthenia gravis: define
autoimmune depletion of nicotinic ACh receptor on the post-synaptic membrane
69
Eaton-Lambert syndrome: define
paraneoplastic or immune syndrome -> antibodies against voltage gated Ca2+ channels defective ACh release at the post synaptic membrane
70
Lidocaine: MOA
voltage gated Na+ channel blockade (responsible for signal propagation)

Peri-op (5 decks)

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