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Surgery > Anaesthesia And Pain Relief > Flashcards

Anaesthesia And Pain Relief Flashcards

1
Q

IV anaesthetic agents

A

1- propofol
2- thiopentone
3- etomidate
4- ketamine

“PTEK”

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2
Q

Propofol

A

Can be used as a continuous infusion

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3
Q

Thiopentone

A

Rapid induction.
But can cause myocardial depression and lowering of BP.
Lowering of intracranial pressure makes it useful for neurosurgery.

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4
Q

Etomidate

A

Brief duration of action.

But can cause adrenocortical depression(it is a steroid)

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5
Q

Ketamine

A

Ideal choice for field anesthesia.

Can cause Emergence Delirium.

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6
Q

Enhanced Recovery Programmes

A

Adequate preoperative care. Multidisciplinary approach. Good choice of anesthesia.

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7
Q

Triad of General Anesthesia

A

1- amnesia (loss of awareness)
2- muscle relaxation
3- analgesia : pain relief

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8
Q

Induction is frequently done by

A

IV propofol

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9
Q

Maintenance is done by

A

IV propofol or inhalational agents such as sevoflurane. Isoflurane. Desflurane.

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10
Q

Induction in children, needle phobic adults, and those in which difficult airway is anticipated

A

Inhalational induction by sevoflurane

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11
Q

Rapid Sequence Induction(RSI)

A

Predetermined dose of IV propofol and rapidly acting muscle relaxant such as suxamethonium.
Used in those in which there is high risk of regurgitation.
In emergency surgery.
Non- emergency surgery of those who have delayed stomach emptying.

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12
Q

Total Intravenous Induction(TIVA)

A

IV propofol and ultra short acting opioid remifentanil.

Used in neurosurgery. Airway laser surgery. Cardiopulmonary bypass. Day case surgery.

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13
Q

Why nitrous oxides has been discontinued

A

Post operative nausea and vomiting.
Increases size of air bubble in eye. Ear and abdominal surgery.
Mutagenic and powerful greenhouse gas.

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14
Q

Things to manage in General Anesthesia

A

Airway
And
Ventilation

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15
Q

Airway management in general anesthesia

A

During induction airway is managed by oropharyngeal airway.

After induction, endotracheal tube or laryngeal mask airway.

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16
Q

Pros of laryngeal mask airway

A

Less irritable to patient and less traumatic

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17
Q

Difficult intubation by endotracheal tube can be managed by

A

Fibrooptic Intubating bronchoscope

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18
Q

Pros of endotracheal tube

A

Provision of cuff causes positive pressure and protects the lungs from aspiration

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19
Q

Ventilation used during intubation

A

Bag mask ventilation

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20
Q

Ventilation used after induction

A

Spontaneous or ventilator assisted.

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21
Q

Ventilator assisted ventilation can either be

A

1- volume controlled
2- pressure controlled
3- positive end expiratory pressure(PEEP)

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22
Q

Volume controlled ventilation

A

Allows adequate air entry but risks high pressure damage especially in laparoscopic surgery, morbidly obese patients and lung disease patients who can’t withstand Barotrauma

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23
Q

Pressure controlled ventilation

A

Prevents high pressure damage but at the risk of inadequate airway entry.

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24
Q

PEEP

A

Allows alveoli to remain open and prevents vascular shunting

It maintains the functional residual capacity (FRC)

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25
Q

Double lumen tubes and endobronchial tubes

A

Allow collapse of one lung while ventilating the other lung

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26
Q

Guedal airway

A

Tongue remains out but risk of aspiration is still there.

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27
Q

Complications during intubation

A 
Failed intubation 
Accidental bronchial intubation 
Trauma 
Aspiration during intubation 
Disconnection and blockage 
Delayed tracheal stenosis
28
Q

Muscle relaxants can either be

A

1- depolarising like suxamethonium

2- non depolarising like vecuronium. Atracurium. Rocuronium.

29
Q

Pros of Suxamethonium

A

Rapid and lasts for short duration.

Spontaneous recovery.

30
Q

Cons of suxamethonium

A

Hyperkalemia
Muscle pain
Anaphylaxis
Malignant hyperthermia(fatal)

31
Q

Non depolarising agents require reversal by

A

Neostigmine

Sugammadex

32
Q

Vecuronium

A

Long acting.

Dependent on hepatic and renal function

33
Q

Atracurium

A

Intermediate acting.
Good for patients who have hepatic and renal dysfunction.
Can cause allergic reactions though.

34
Q

Rocuronium

A

Intermediate acting.

Can cause allergic reactions

35
Q

Monitoring during general anesthesia

A 
1- ecg 
2- blood pressure 
3- oxygen saturation 
4- oxygen concentration 
5- carbon dioxide concentration
36
Q

Types of local anesthesia by mode of administration

A

1- topical anesthesia(EMLA. Cocaine. Lignocaine 4%)
2- local infiltration
3- regional nerve blocks (interscalene, axillary brachial plexus, femoral and sciatic nerve blocks)
4- central neuraxial blocks (spinal and epidural)

37
Q

Complications of local anesthesia

A

1- infection
2- hematoma such as epidural hematoma
3- overdose
4- accidental vascular injection leading to cardiac arrythmias and cardiac rest. Depressed consciousness and coma.

38
Q

S/E of prilocaine

A

Methhaemoglobinemia

39
Q

S/E of bupivacaine

A

Ventricular arrythmias and cardiac arrest. It should never be used IV

40
Q

Ropivacaine

A

Least cardiotoxic.

Greater sensory motor separation.

41
Q

Levobupivacaine

A

Isomer of bupivacaine. Less cardiotoxic properties

42
Q

Adrenaline with local anesthetic

A

Hastens onset. Prolongs duration of action.

43
Q

Adrenaline is contraindicated in

A

Cardiovascular disease patients.
Patients taking TCAs and MAO inhibitors.
In end-arterial locations

44
Q

Where is regional anesthesia beneficial

A

Patients of cardiorespiratory compromise.

Obstetric cases.

45
Q

Guided nerve blocks by

A

1- nerve stimulators

2- ultrasound guided

46
Q

EMLA (eutectic mixture of local anesthetics)

A

Topical. Used in children for vene puncture

47
Q

Cocaine

A

In nasal surgery. Also called

Mofatts solution.

48
Q

Lignocaine 4%

A

Spray. During awake fibrooptic intubation

49
Q

Complications of interscalene block

A

1- Phrenic nerve block
2- horners syndrome
3- accidental spinal injection

50
Q

Transversus abdominus plane block (TAP block)

A

Triangle of petit.
Medial to anterior axillary line.
Blocks T6-L1 nerves.
Injected in plane bw transversus abdominus and internal oblique muscles.

51
Q

Intravenous regional anesthesia (biers block)

A

Prilocaine used.
Tourniquet applied.
Left in place for 20 mins post surgery.
Used in short surgery esp of upper limb like carpal tunnel release.

52
Q

Spinal anesthesia

A

More rapid than epidural.
Can cause sympathetic blockage and hypotension if injected above T10.
Can lead to dural puncture headache. So limit the number of punctures and use fine bore needles designed to split rather than cut the dura.

53
Q

Epidural anesthesia

A

Slower in onset than spinal.
Continuous infusion is possible by a catheter left in place in the epidural space.
Technically more difficult.
Local anesthetic is combined with an opioid like fentanyl

54
Q

Types of chronic pain

A

1- nociceptive pain
2- neuropathic pain
3- psychogenic pain

55
Q

Neuropathic pain management

A

TCAs
Anticonvulsants
Pregabalin and gabapentin

56
Q

Nociceptive pain includes

A

1- musculoskeletal pain

2- cancer pain

57
Q

Chronic pain control in benign disease

A

1- local anesthetics and steroids
2- nerve stimulation procedures like acupuncture. Transcutaneous nerve stimulation. Spinal cord stimulation. Releases endorphins

58
Q

Treatment of trigeminal neuralgia

A

Nerve decompression craniotomy

59
Q

Severe chronic pain

A

Slow releasing oral formulations of morphine and oxycodone

Transcutaneous patches of fentanyl and buprenorphine

60
Q

Treatment of pain dependent on sympathetic nervous system activity

A

IV phentolamine

Percutaneous chemical lumber sympathectomy in advanced ischemic disease of the legs.

61
Q

Pain control in malignancy

A

Pain step ladder
1- simple analgesics
2- intermediate strength opioids like codeine. Tramadol. Dextropropoxyphene
3- strong opioids like morphine

62
Q

MST morphine

A

Enteric Coated slow release tablets of morphine

63
Q

Main s/e of opioids

A

Constipation. Regular use of laxatives required.

64
Q

Subcutaneous opioid

A

Diamorphine

65
Q

IV morphine used in

A

Acute crises like pathological fractures

66
Q

Neurolytic techniques in cancer pain

A

Percutaneous anterolateral cordotomy in patients with limited life expectancy

Surgery (10 decks)

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