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Clinical Specialities > Anaesthesia > Flashcards

Anaesthesia Flashcards

1
Q

what problems can occur in general anaesthesia?

A

> polypharmacy so higher chance of reaction
muscle relaxation
- requires artificial ventilation
- airway management
separation of relaxation and hypnosis can lead to awarness

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2
Q

what do genera anaesthetics act on?

A

the neuronal ion channels opening up cl channels hyper polarising them

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3
Q

what tissues do IV anaesthetic agents pass though?

A

first the blood the into the viscera then into the muscle then into the fat

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4
Q

what is the MAC?

A

the maximum alveolar concentration, a measure of potency (low number high potency)

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5
Q

what is the affect of general anaesthesia on the central cardiovascular system?

A

depresses it
> decreased sympathetic outflow
> negative inotropic effect on the heart
> vasodialtion

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6
Q

what is the direct effect of general anaesthesia on the cardiovascular system?

A

> negatively inotropic
vasodilation decreasing the peripheral vascular resistance
vasodilation decreasing the venous return and cardiac output

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7
Q

what is the effect of general anaesthesia on the respiratory system?

A

> paralyses cilia
decreases the FRc (lower lung volumes, VQ mismatch)
resp. depressants (decreased hypoxic and hypercarbic drive, decreased tidal volume, increased uptake)

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8
Q

when are muscle relaxants indicated?

A

> ventilation and intubation
immobility is essential (microscopic and neurosurgery)
body cavity surgery

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9
Q

what problems occur with muscle relaxants?

A

> awareness
incomplete reversal causing airway obstruction
apnoea- dependence on ventilation and support

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10
Q

why is intra-operative analgesia often needed?

A

> prevents arousal
opiate contribute to hypnotic effects of GA
suppression of the reflex response to painful stimuli (tachycardia, hypertension)

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11
Q

what does toxicity of local or regional anaesthesia depend on?

A

> dose
rate of absorption
patient weight
drug

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12
Q

how might local anaesthetic toxicity present?

A 
> coma
> drowsiness
> numbness and tingling
> light headedness
> tinnitus
> visual disturbance
> muscle twitching
> CVS depression
> cardiopulmonary arrest
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13
Q

what is differential blockade?

A

there is different penetration to different nerve types (myelinated thick fibres are spared and pain fibres are blocked easily)

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14
Q

what is the physiological affect of a neuroaxial block?

A

> inspiratory function spared
expiratory function relatively impaired
decreased FRC
increased V/Q match

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15
Q

what agents can be used in induction of general anaesthesia?

A

> Propofol

> thiopentone

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16
Q

how are conscious levels monitored?

A

> movement
resp. pattern
processed EEG

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17
Q

is the airway is open and unobstructed it is……….?

A

maintained

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18
Q

what airway complications can occur in general anaesthesia?

A

> obstruction

  • ineffective triple airway manoeuvre
  • airway device malposition
  • laryngospasm (forced reflex adduction of the vocal cords)

> aspiration

  • gastric contents
  • blood
  • surgical debriment
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19
Q

what triple airway manoeuvre is used to maintain the airway?

A

> head-tilt
chin lift
jaw thrust

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20
Q

why might you intubate?

A

> protect airway from gastric contents
need for muscle relaxation
need for tight control of blood gases
restricted access to airway (maxfax)

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21
Q

what risks are there for the unconscious patient?

A 
> airway
> temperature
> loss of protective reflexes
> consent and identification
> pressure areas
> venous thromboembolism risk
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22
Q

how is the unconscious patient monitored?

A 
> FiO2
> ECG
> ETO2
> SPO2
> resp. parameters
> agent monitoring
> temperature
> venous and arterial monitoring
> processed ECG
> urine output
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23
Q

what is the process of emergence?

A

> muscle relaxant is reversed
resumption of spontaneous respiration
return of airway reflexes/control
extubation

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24
Q

what is the role of anaesthetists preop assessment?

A 
> identify risk
> optimise
> minimise risk
> inform and support he patient
> consent 
(reducing complications, delays, anxiety, mortality and length of stay)
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25
Q

what would you want to illicit from a preop history?

A 
> known comorbidities and their severity
> unknown comorbidities
> drugs and allergies
> previous surgery and anaesthesia
> family history and rarities (malignant hyperpyrexia and cholinesterase deficiency)
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26
Q

describe an ASAS grade 1

A

healthy

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27
Q

describe an ASAS grade 2

A

mild to moderate systemic disturbance

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28
Q

describe an ASAS grade 3

A

severe systemic disturbance

29
Q

describe an ASAS grade 4

A

life threatening disease

30
Q

describe an ASAS grade 5

A

moribund patient

31
Q

describe an ASAS grade 6

A

organ retrieval

32
Q

what does the cardiac risk index involve?

A 
> high risk surgery
> ischaemic heart disease
> congestive heart failure
> cerebrovascular disease
> diabetes
> renal failure
33
Q

what medication would not carry on as normal throughout a GA?

A

> antidiabetic medication

> anticoagulants

34
Q

describe an endotracheal tube?

A

> balloon at one end stopping it going down into the lungs
cuff so high pressure air enters the lungs
triggers gag reflex so sedation and anaesthesia is needed

35
Q

what is the effect of beta blockers on the heart rate?

A

decrease in rate

36
Q

what is the affect of chronotropes on the heart rate?

A

increases the rate

37
Q

what do inotropes drive?

A

contractility

38
Q

what do vasopressors drive?

A

afterload

39
Q

define chronic pain

A

pain lasting more than 3 months
lasting beyond normal healing
no identifiable cause

40
Q

describe cancer pain

A

progressive and a mixture of acute and chronic

41
Q

what is nociceptive pain?

A

> obvious tissue pain or illness
physiological/inflammatory pain
protective pain
well localised

42
Q

describe neuropathic pain

A

> nervous system damage/abnormality
tissue injury may not be obvious
serves no protective function
not well localised

43
Q

describe the physiology of pain in the periphery

A

there is tissue injury leading to a release of chemicals (prostaglandins) which stimulate the nociceptors.
the signal travels up the a-omega and c fibres.

44
Q

what analgesia can be given for peripheral pain?

A

> RICE

> NSAIDS

45
Q

describe the pathway of a pain signal when it reaches the spinal cord

A

the first relay station is the dorsal horn where a omega and c fibres synapse with a second nerve and travel up the contralateral side of the spinal cord

46
Q

what analgesics can intervene at the spinal cord?

A

> TENS
opioids
ketamine

47
Q

where is the second pain relay station?

A

the thalamus

48
Q

what analgesics work on the modulation pathways?

A 
> psychological
> paracetamol
> opioids
> amitriptyline
> clonidine
49
Q

what pathological mechanisms are there in neuropathic pain?

A

> increased receptor number
chemical changes in the dorsal horn
abnormal sensitisation of the nerves
loss of normal inhibitory modulation

50
Q

what is a disadvantage of paracetamol?

A

liver damage in overdose

51
Q

what are the advantages of paracetamol?

A

> cheap
many routes
safe

52
Q

what are the advantages of NSAIDS?

A

> cheap

> good for nociceptive pain with paracetamol

53
Q

what are the disadvantages of NSAIDS?

A

> GI side effects
renal
sensitive asthmatics

54
Q

what are the advantages of codeine?

A

> cheap

> good for mild/moderate acute nociceptive pain with paracetamol

55
Q

what are the disadvantages of codeine?

A

> constipation

> not good for chronic pain

56
Q

name some anticonvulsants

A

> gabapentin
sodium valproate
carmabezopeine

57
Q

what are anticonvulsants good for?

A

neuropathic pain

58
Q

what is the action of anticonvulsants?

A

reduce abnormal firing of nerves

59
Q

what is the action of amitriptyline?

A

decrease in inhibitory signals

60
Q

what are the advantages of amitriptyline?

A

> cheap
treats depression
neuropathic pain

61
Q

what are the disadvantages of amitriptyline?

A

anticholinergic side effects

62
Q

what are the advantages of morphine?

A

> cheap
effective if given regularly
good for chronic cancer pain or moderately severe nociceptive pain

63
Q

what are the disadvantages of morphine?

A

> controlled drug

> resp. depression at high doses

64
Q

what is the action tramadol?

A

it has a weak opioid effect plus inhibitor of serotonin and noradrenaline reuptake

65
Q

what are the advantages of tramadol?

A

> less respiratory depression
not a controlled drug
can be used with opioids and simple analgesics

66
Q

what are the disadvantages?

A

> nausea

> vomiting

67
Q

how would you assess pain?

A 
> verbal rating score
>  numerical rating score
> visual analogue scale
> smiley faces
> abbey pain score
68
Q

what non-pharmacological treatment is there for pain?

A 
Physical
> RICE
> surgery
> acupuncture
> massage

Psychological
> explanation
> reassurance
> counselling

69
Q

describe the WHO analgesic ladder

A

> mild/moderate pain: non-opioids
moderate/severe pain: mild opioids +/- non-opioids
severe pain: strong opioids +/- non-opioids

Clinical Specialities (6 decks)

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