Anaesthesia revision

Question 1

Give 3 examples of Benzodiazepines used for sedation

Answer 1

Midazolam
Lorazepam
Diazepam

Question 2

Give 3 examples of opioids used for sedation

Answer 2

Fentanyl
Alfenatyl
Remifenatyl

Question 3

What are the components of Entonox?

Answer 3

50:50 oxygen and nitrous oxide

Question 4

Name 3 local aneasthetics

Answer 4

Lidocaine
Bupivacaine
Levobupivacaine

Question 5

Name 2 inhaled general anaesthetics

Answer 5

Isoflurane

Sevoflurane

Question 6

Name 3 general anaesthetics administered IV

Answer 6

Propofol
Midazolam
Thiopental

Question 7

Name one depolarising neuromuscular blocker

Answer 7

Suxamethonium

Question 8

Name two non-depolarising neuromuscular blockers

Answer 8

Atracurium

Vecuronium

Question 9

What is the MoA of benzodiazepines?

Answer 9

Co-agonist at GABA gamma subunit receptor to increase activity
Reduces neuronal transmission by increasing inhibition

Question 10

What is the MoA of opioids used for sedation?

Answer 10

Decrease neuronal transmission by decreasing opening of VG calcium channels (thus reducing calcium release and endocytosis of NT vesicles)

Question 11

How do local anaesthetics work?

Answer 11

Block VG Sodium channels in their active state either across the membrane or directly through the channel
Reversible block of nerve conduction

Question 12

What is the MoA of Suxamethonium?

Answer 12

Depolarising NMB

Stops further depolarisation once channel is opened by overloading system

Question 13

What is the MoA of non-depolarising NMBs?

Answer 13

Completely bind to Ach receptors to stop depolarisation or presynaptically stop Ach release

Question 14

What can be used to reverse Benzodiazepines?

Answer 14

Flumazenil

Question 15

What can be used to reverse Opioids?

Answer 15

Naloxone

Question 16

What can be used to reverse non-depolarising NMBs?

Answer 16

Acetylcholinesterase inhibitors (e.g. Neostigmine)

Question 17

What are the pros and cons of using Benzodiazepines as sedation?

Answer 17

Pros = good sedative, muscle relaxant, reduced anxiety
Cons = no analgesia, can give amnesia

Question 18

What are the pros and cons of using opioids as sedation?

Answer 18

Pros = good sedative, analgesic, smooth muscle relaxant 
Cons = respiratory depression is SE

Question 19

What are the pros and cons of using Entonox as sedation?

Answer 19

Pros = non-airway irritant, good analgesic 
Cons = can increase pressure in lungs and middle ear, prolonged use affects blood (NO)

Question 20

What are the pros and cons of local anaesthetics?

Answer 20

Pros = no loss of consciousness at normal dose, good recovery with fewer side effects
Cons = can't use in inflamed tissue (acidic pH)

Question 21

What are the pros and cons of general anaesthetics?

Answer 21

Pros = good for invasive procedures, rapid, controllable 
Cons = longer recovery time, systemic effects, respiratory and cardiac depression

Question 22

What are the pros and cons of depolarising NMBs?

Answer 22

Pros = rapid onset, short duration (2-6 mins) 
Cons = initial muscle twitch

Question 23

What are the pros and cons of non-depolarising NMBs?

Answer 23

Pros = widely used, moderate onset
Cons = active metabolite that can result in residual paralysis

Question 24

What are the ideal scores for Richmond and Ramsey sedation scales?

Answer 24

Richmond = 0 
Ramsey = 2