Anaesthestics Flashcards
where is epidural placed before C sections
L3/4 or L4/5
low pressure headache is a common complication of…
obstetric epidural
general anaesthesia has two main drugs:
anaesthetic + neuromuscular blocker
2 common inhaled general anaesthetics and side effects
sevoflourane = malignant hyperthermia
desflourane = respiratory irritation
inhaled anaesthetic, rigid muscles especially masseter, core body temp increasing, co2 trace increasing
what is happening and why and management??
malignant hyperthermia
caused by autosomal dominant inheritance of mutated ryanodine receptor 1
mx = dantrolene
3 common IV GA and side effects
ketamine = increased ICP
propofol = propofol related infusion syndrome, hypotension
sodium thiopentane
what is propofol related infusion syndrome
causes type b lactic acidosis
renal failure, arrhythmia, rhabdomyolysis
Mx: dialysis
2 main neuromuscular blocks
rocoronium
suxamethonium
rigid muscles esp diaphragm, therefore still needs ventilatory support
what is this complication?
suxamethonium apnea
signs of local anaesthetic toxicity and Mx
confusion, drowsiness, bradycardia
Mx: lipid emulsion, atropine for bradycardia
indications for Rapid Sequence Induction
full stomach, intact gag reflex, risk of aspiration
steps for Rapid Sequence Induction
- prep
- pre oxygenation for 5 mins
- pretreatment
- paralysis (rocoronium) and anaesthetic (ketamine)
- pressure and positioning of airway
- placement and proof of tube
- post-intubation taping etc
smaller trace on capnography and asymmetrical chest rise
endobronchial intubation
no trace on capnography
incorrectly placed intubation
3 ways to check if intubation has been placed correctly
- direct vision (of epiglottis)
- bilateral auscultation
- trace on capnography
what is the correct peri-operative insulin regime
continue long acting insulin
stop short acting insulin
switch to a variable rate insulin infusion
effect of Alpha 1 receptor
calcium release from the sarcoplasmic reticulum
vasoconstriction
effect of beta 1 receptor
increased cardiac output
positive inotropy
increased renin release
effect of beta 2 receptor
smooth muscle relaxation
blood vessels (vasodilation), bronchi
effect of adrenaline
dose-dependant effect
low dose: mainly beta effect (increased CO, smooth muscle relaxation)
high dose: mainly alpha effect (vasoconstriction)
effect of noradrenaline
mainly alpha effect
effect of dopamine
low dose: beta 1 effect (increased CO)
high dose: alpha effect ( vasoconstriction)
what score is used to determine chance of post op nausea and vomiting
what is included
apfel score
- female
- non smoker
- previous PONV
- post op opioid use