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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
Q

Suxamethonium mechanism of action

A

Partial agonist of ACh receptor
Causes initial depolarisation (fasciculation) of the post synaptic membrane
Inhibition of restoration normal membrane polarity

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26
Q

Sedation definition

A

Range of depressed conscious levels from relief of anxiety to general anaesthesia

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27
Q

Induction medication

A

IV: propofol
Gaseous: sevoflurane or nitrous oxide

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28
Q

Indications for gaseous induction

A

Patient’s request
Difficult IV access
Children’s
Partial airway obstruction

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29
Q

What is the risk of intubation of patient is not adequately anaesthetised ?

A

Laryngoscopy or tracheal intubation can induce harmful adrenergic stress response
-> increases pulse and BP

30
Q

Indications of intubation

A

Risk of vomiting or aspiration
Difficult airways (consider fibre optic)
Inaccessible/ shared airway (H&N surgery)
Paralysis required for surgery (abdo surgery)

31
Q

Muscle relaxation medication

A

Suxamethonium (depolarising)

Rocuronium/ vecoronium

32
Q

Rapid sequence induction: when is it used?

A

High risk of aspiration

33
Q

Rapid sequence induction: procedure

A 
Pre oxygenate 
Sellick manoeuvre 
Induction agent: propofol
Muscle relaxant: suxamethonium 
Intubation 
Longer acting muscle relaxant (non depolarising): rocuronium/ vencuronium
34
Q

Maintenance procedure (3 ways)

A
  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
Q

List signs of inappropriate anaesthesia levels

A 
HR  and BP increase 
Movement 
Lacrimation 
Dilated pupils 
Laryngospasm 
Bispectral index (BSI) ECG monitoring
36
Q

End of anaesthesia procedure

A 
Withdraw all gaseous and IV meds
Neostigmine 
Anticholinergic (atropine or glycopyrronium) 
ET tube removal 
Transfer to recovery
37
Q

Name 2 anticholinergics

A

Atropine

Glycopyrronium

38
Q

Suxamethonium is inactivated by

A

Plasma cholinesterases

39
Q

Suxamethonium: features of IV use

A 
Paralytic agent (used in RIS) 
Fast onset (0.5-1s) 
-> reduces risk of aspiration 
Short duration (3-5 min)
40
Q

Suxamethonium: problems and side effects

A 
Increases K+ 
Increases intra ocular pressure 
Muscle pains (30% post op) 
Repeated diss can cause bradycardia (Rx atropine) 
Suxamethonium apnea 
Malignant hyperthermia
41
Q

Non depolarising agents: name 2 examples

A

Rocuronium

Vecuronium

42
Q

Non depolarising agent reversal agent

A

Neostigmine

Sugammadex for rocuronium and vecuronium

43
Q

Neostigmine: class and mechanism of action

A

Reversal drug for non depolarising neuromuscular blockers
Anticholinesterase
-> prevents ACh breakdown in the synaptic cleft
-> increased ACh efficiency

44
Q

Non depolarising agents (rocuronium and vecuronium) mechanism of action

A

Competitive antagonists of ACh

45
Q

ADRs of inhalational agents (4)

A

Respiratory irritation
CV depression
Hepatitis
Malignant hyperthermia

46
Q

Name 4 IV anaesthetic agents used for induction

A

Propofol
Thiopental sodium
Ethamidate
Ketamine

47
Q

Propofol onset time

A

40 seconds

One arm-brain circulation

48
Q

Propofol mechanism of action

A

Positive modulation of GABA neurotransmitter

49
Q

Propofol: what causes it’s offset?

A

Drug redistribution not metabolism

50
Q

Propofol contraindications

A

Extremes of age
Egg or soy allergy
Compromised airway

51
Q

Propofol: when should we reduce the dose? (3)

A

Elderly
Debilitated
Shocked

52
Q

Propofol dose and midazolam as premed

A

Required dose reduced if on midazolam

53
Q

Propofol: common ASR

A

Pain at injection

use lidocaine

54
Q

Thiopental sodium: what type of medication is it?

A

IV Anaesthetic agent
Barbiturate
Normally mixed with water (2.5% solution)

55
Q

Features of Thiopental sodium use

A

Rapid onset

Offset within 3-8 mins due t redistribution

56
Q

Thiopental sodium ADRS

A

Anaphylaxis
Negative inotrope -> CO reduced by 20%
Bronchoconstriction

Intra arterial injection is painful

  • > ischaemia and gangrene
  • > indwelling cannula required for administration
57
Q

Thiopental sodium contraindications

A 
Airway obstruction / compromised airway 
Barbiturate allergy 
Fixed cardiac output states (AS) 
Hypovolaemia  or low BP 
Porphyria
58
Q

Etomidate: what type of medication is it

A

IV Anaesthetic agent for induction
Carboxylate imidazole
Used in emergencies

59
Q

Etomidate when is it used and why ?

A

History of trauma/ head injury
Cases where avoidance of hypovolaemia is important

  • no histamine release
  • cardiovascular stability
  • rapid recovery
60
Q

Ethomidate: ADRs

A

involuntary muscle movements
nausea
adrenal supression

61
Q

Ketamine: what type of medication is it?

A

IV/IM anaesthetic agent for pediatric anesthesia or procedural sedation
potent bronchodilator

62
Q

Ketamine: when is it used?

A

Paeds
Procedural sedation
Staticus asthmaticus (potent bronchodilator)

63
Q

Ketamine: ADRs

A

hypertonus
salivation
slow troublesome recovery
delirium/hallucinations/nightmares

64
Q

Curare : what is it and reversal

A

reversible nicotinic ACh receptor blocker

-> reversal: cholinesterase inhibitor (pyridostigmine)

65
Q

alpha- neurotoxins: what is it

A

irreversible nicotinic ACh receptor blocker in snake venom

66
Q

Botulin toxin: MOA and reversal

A

blocks exocytosis of ACh

-> reversal: cholinesterase inhibitor (pyridostigmine)

67
Q

Organophosphates: MOA and reversal

A

irreversible AChEsterase inhibitoion (similar to nerve gas)

  • > prolonged ACh binding
  • > reversal: pralidoxime
68
Q

Myasthenia gravis: define

A

autoimmune depletion of nicotinic ACh receptor on the post-synaptic membrane

69
Q

Eaton-Lambert syndrome: define

A

paraneoplastic or immune syndrome -> antibodies against voltage gated Ca2+ channels
defective ACh release at the post synaptic membrane

70
Q

Lidocaine: MOA

A

voltage gated Na+ channel blockade (responsible for signal propagation)

Peri-op (5 decks)

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