Anaesthesia revision Flashcards
Give 3 examples of Benzodiazepines used for sedation
Midazolam
Lorazepam
Diazepam
Give 3 examples of opioids used for sedation
Fentanyl
Alfenatyl
Remifenatyl
What are the components of Entonox?
50:50 oxygen and nitrous oxide
Name 3 local aneasthetics
Lidocaine
Bupivacaine
Levobupivacaine
Name 2 inhaled general anaesthetics
Isoflurane
Sevoflurane
Name 3 general anaesthetics administered IV
Propofol
Midazolam
Thiopental
Name one depolarising neuromuscular blocker
Suxamethonium
Name two non-depolarising neuromuscular blockers
Atracurium
Vecuronium
What is the MoA of benzodiazepines?
Co-agonist at GABA gamma subunit receptor to increase activity
Reduces neuronal transmission by increasing inhibition
What is the MoA of opioids used for sedation?
Decrease neuronal transmission by decreasing opening of VG calcium channels (thus reducing calcium release and endocytosis of NT vesicles)
How do local anaesthetics work?
Block VG Sodium channels in their active state either across the membrane or directly through the channel
Reversible block of nerve conduction
What is the MoA of Suxamethonium?
Depolarising NMB
Stops further depolarisation once channel is opened by overloading system
What is the MoA of non-depolarising NMBs?
Completely bind to Ach receptors to stop depolarisation or presynaptically stop Ach release
What can be used to reverse Benzodiazepines?
Flumazenil
What can be used to reverse Opioids?
Naloxone
What can be used to reverse non-depolarising NMBs?
Acetylcholinesterase inhibitors (e.g. Neostigmine)
What are the pros and cons of using Benzodiazepines as sedation?
Pros = good sedative, muscle relaxant, reduced anxiety Cons = no analgesia, can give amnesia
What are the pros and cons of using opioids as sedation?
Pros = good sedative, analgesic, smooth muscle relaxant Cons = respiratory depression is SE
What are the pros and cons of using Entonox as sedation?
Pros = non-airway irritant, good analgesic Cons = can increase pressure in lungs and middle ear, prolonged use affects blood (NO)
What are the pros and cons of local anaesthetics?
Pros = no loss of consciousness at normal dose, good recovery with fewer side effects Cons = can't use in inflamed tissue (acidic pH)
What are the pros and cons of general anaesthetics?
Pros = good for invasive procedures, rapid, controllable Cons = longer recovery time, systemic effects, respiratory and cardiac depression
What are the pros and cons of depolarising NMBs?
Pros = rapid onset, short duration (2-6 mins) Cons = initial muscle twitch
What are the pros and cons of non-depolarising NMBs?
Pros = widely used, moderate onset Cons = active metabolite that can result in residual paralysis
What are the ideal scores for Richmond and Ramsey sedation scales?
Richmond = 0 Ramsey = 2
