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Pharmacology Drugs > Anaesthetic > Flashcards

Anaesthetic Flashcards

1
Q

What are the anaesthetic techniques?

A

General

  • Inhalational or volatile
  • Intravenous

Local
-Regional

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2
Q

What is conscious sedation?

A

Use of small amounts of anaesthetic or benzodiazepines to produce a sleepy like state.

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3
Q

What are the practical aspects of anaesthesia?

A
  • Premedication (Hypnotic-benzodiazepine).
  • Induction (usually intravenous but may be inhalational).
  • Intraoperative analgesia (usually an opioid).
  • Muscle paralysis by facilitating intubation/ventilation/stillness.
  • Maintenance (intravenous and/or inhalational).
  • Reversal of muscle paralysis and recovery which includes postoperative analgesia (opioid/NSAID/paracetamol).
  • Provision for PONV.
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4
Q

How are anaesthetics administered?

A
  • Gases: Volatiles are delivered via the lungs

- Intravenous with Propofol, barbiturates, Etomidate, Ketamine

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5
Q

Describe Stage 1 of Guedel’s signs.

A

Analgesia and consciousness

  • Muscle tone is normal
  • Breathing is normal
  • Eye movement is slight
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6
Q

Describe Stage 2 of Guedel’s signs.

A

Unconscious, breathing erratic but delirium could occur, leading to an excitement phase.

  • Muscle tone is normal to markedly increased
  • Breathing is reduced
  • Eye movement is moderate
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7
Q

Describe Stage 3 of Guedel’s signs

A

Surgical anaesthesia, with four levels describing increasing depth until breathing weak.

  • Muscle tone gets increasingly relaxed
  • Breathing is increasingly reduced
  • Eye movement goes from slight to none
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8
Q

Describe Stage 4 of Guedel’s signs

A

Respiratory paralysis and death.

  • Muscle tone is flaccid
  • Breathing is markedly reduced
  • Eye movement is not existent
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9
Q

What is the MAC?

A
  • Minimum Alveolar Concentration at which 50% of subjects fail to move to surgical stimulus
  • At equilibrium the alveolar concentration = spinal cord
  • Anatomical substrate for MAC is spinal cord
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10
Q

What are the factors affecting induction and recovery?

A
  • Low value for Blood:Gas partition results in fast induction and recovery
  • Oil:Gas partition determine potent and slow accumulation due to partition in fat
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11
Q

Why do obese people sometimes take longer to wake up form anaesthetic?

A

-Anaesthetic accumulates in fat and can move into blood

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12
Q

When is MAC increased?

A
  • Age (High in infants lower in elderly)
  • Hyperthermia (increased);
  • Pregnancy (increased)
  • Alcoholism (increased)
  • Central stimulants (increased)
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13
Q

When is MAC decreased?

A
  • Hypothermia (decreased)
  • Other anaesthetics and sedatives (decreased)
  • Opioids (decreased)
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14
Q

How does nitrous oxide affect the MAC?

A
  • Nitrous oxide is very often added to other volatile agents (reduced dosing)
  • Decrease the MAC so greater potency of the anaesthetic
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15
Q

What is the relationship between anaesthetic, Lipid and GABA?

A

-Anaesthetic potency correlates lipid solubility and GABA activity

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16
Q

Why is GABA important?

A
  • GABA receptors are a critical target.

- They are a major inhibitory transmitter

17
Q

How is GABA activity potentiated?

A
  • LGIC potentiates GABA activity

- This leads to Anxiolysis, Sedation and Anaesthesia

18
Q

How do anaesthetic work?

A
  • Anaesthetic potentate GABA mediated Cl- conductance to depress CNS activity
  • NMDA is probably another side

Except XeN2O and Ketamine

19
Q

How is brain consciousness varied?

A
  • Consciousness is a balance between excitation (glutamate) and inhibition (GABA)
  • Anaesthetics modulate this balance
20
Q

How does anaesthetic affect the brain circuitry?

A
  • Reticular formation depressed resulting in lost of connectivity
  • Thalamus transmits and modifies sensory information
  • Hippocampus depressed
  • Brainstem s depressed
  • Spinal cord depressed by affecting the dorsal horn and motor neuronal activity
21
Q

What are the main intravenous anaesthetics?

A
  • Propofol (rapid)
  • Barbiturates (rapid)
  • Ketamine (slower).
22
Q

How do intravenous anaesthetics work?

A
  • Can be uses as sole anaesthetic in TIVA

- All potentiate GABA with exception of ketamine

23
Q

How Do We Describe Intravenous Anaesthetic Potency?

A

-Plasma concentration to achieve a specific end point (loss of eyelash reflex or a BIS value)

24
Q

Describe the methods of administering Intravenous Anaesthetic Potency?

A
  • For induction in mixed anaesthesia : Bolus to end point then switch to volatile.
  • TIVA uses a defined PK based algorithm to infuse at a rate to maintain set point. Preceded by a bolus.
25
Q

What are the characteristics of local anaesthetics?

A
  • Increased lipid solubility so greater potency
  • Faster onset due to lower pKa
  • Increased metabolism
  • Increased duration of protein binding
26
Q

How does Bupivacaine stimulate wound analgesia?

A
  • Cocaine archetypal
  • Amide so longer duration
  • Block is use dependant
  • Blocks small myelinated nerves in preference hence nociceptive and sympathetic blocked
  • Increases duration of adrenaline
27
Q

Describe the features of regional anaesthesia.

A
  • As the name suggests selectively anaesthetising a part of the body.
  • Often described as a ‘block’ of a nerve and hence the patient remains awake.
  • Uses local anaesthetic and or an opioid.
28
Q

What are common uses of regional anaesthetics?

A
  • Upper extremity (e.g.,); interscalene, supraclavicular, infraclavicular, axillary.
  • Lower extremity (e.g.,) ; femoral, sciatic, popliteal, saphenous.
  • Extradural / Intrathecal / Combined (labour).
29
Q

What are the main side effects of general anaesthesia?

A
  • Opoids in particular can cause post operative nausea and vomiting
  • Hypotension
  • Post operative cognitive decline
  • Chest infection
  • Allergic reaction/Anaphylaxis
30
Q

What are the main side effects with local and regional anaesthesia?

A

-Depends on the agent used and usually result from systemic spread for example Locals are Na+ channel blockers so cardiovascular toxicity.

31
Q

What are exmaples of local anaethetics?

A
  • Lidocaine
  • Bupivacaine
  • Ropivacaine
  • Procaine.

Pharmacology Drugs (22 decks)

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