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Finals - Acute & Critical Care & Anaesthetics > Anaesthetic Drugs > Flashcards

Anaesthetic Drugs Flashcards

1
Q

What is the triad of anaesthesia?

A

Hypnosis (unconscious)
Relaxation
Analgesia (pain-free)

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2
Q

What agents are used for hypnosis?

A

Anaesthetic agents (IV or Inhaled)

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3
Q

What agents are used for relaxation?

A

Muscle relaxants (depolarising or non-depolarising)

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4
Q

What agents are used for analgesia?

A

Analgesia (fentanyl or morphine)

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5
Q

What are the commonly used IV anaesthetic (hypnosis) agents?

A

Propofol - most common UK
Thiopentone
Ketamine
Etomidate

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6
Q

What is propofol?

A

An IV anaesthetic agent - ‘milk of anaesthesia’

Used for induction and maintenance

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7
Q

What is the dose of propofol for induction?

A

1.5-2.5 mg/kg

Less in elderly, more in children

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8
Q

When TICA is used for anaesthesia what does this refer to?

A

When an IV agent e.g. Propofol is used as a bolus for induction and then as an infusion for maintenance during the surgery

Total IV anaesthesia
CANULA MUST ALWAYS BE VISIBLE

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9
Q

What are the respiratory effects of Propofol?

A

Respiratory - short period of apnoea and suppression of larygeal reflex
Allows insertion of I-gel without muscle relaxant

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10
Q

What are the cardiovascular effects of Propofol?

A

Reduction in SVR (systemic vascular resistance), CO and BP

*risk in elderly

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11
Q

What are the CNS effects of Propofol?

A

Reduced intracranial pressure and cerebral oxygen concentration

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12
Q

What are the other effects of Propofol?

A

Anti-emetic effects

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13
Q

What is Thiopentone?

A

IV anaesthetic agent - Thiobarbiturate

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14
Q

In what situation is Thiopentone commonly used?

A

RSI - Rapid sequence induction

often in maternity unit

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15
Q

What is the dose of Thiopentone?

A

4-6 mg/kg

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16
Q

What is another use for Thiopentone?

A

Used in status epilepticus

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17
Q

What are the CNS effects of thiopentone?

A

Reduced intracranial pressure and metabolic rate of oxygen.

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18
Q

What are the CVS effects of thiopentone?

A

Reduction in SVR, CO and BP

Causes compensatory tachycardia

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19
Q

What are the respiratory effects of thiopentone?

A

Respiratory depression

Unlike propofol the reflexes are preserved so not suitable for use alone with laryngeal mask airway

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20
Q

What are the other effects of thiopentone?

A

Extravasation can cause pain and tissue damage due to high pH
Always flush with saline and avoid in porphyria

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21
Q

What is Ketamine?

A

IV anaesthetic agent - Antagonist of NMDA receptor

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22
Q

What is the dose of Ketamine?

A

1-2 mg/kg

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23
Q

What routes can ketamine be used by?

A

IV, IM, Rectally, Nasally, Epidurally

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24
Q

What patients is Ketamine commonly used in?

A

Shocked, burned or paediatric patients (haemodynamically compromised)
‘Field anaesthesia’

Also potent analgesic

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25
Q

What are the CNS effects of ketamine?

A

Analgesia, raised ICP, hallucinations, dissociative anaesthetic

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26
Q

What are the CVS effects of ketamine?

A

Increases BP and HR, increased CO

Why useful in haemodynamically unstable patient

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27
Q

What are the respiratory effects of ketamine?

A

Preserved laryngeal reflexes (may cause laryngospasm), bronchodilator, minimal effect on central respiratory drive.

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28
Q

What is etomidate?

A

IV anaesthetic agent - agonist activation of GABA receptors

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29
Q

What is the dose of etomidate?

A

0.3 mg/kg

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30
Q

What are the benefits of etomidate?

A

Patients who require highly cardiovascular stability profile.

31
Q

What is the downside of etomidate?

A

Inhibits adrenocortical steroid synthesis, observed endocrine effects.
Reduction in cortisol and aldosterone.
Increased N&V

32
Q

What are the CVS effects of etomidate?

A

Stable CV profile (benefit)

Minimal effect on myocardial contractility

33
Q

What are the CNS effects of etomidate?

A

Cerebral vasoconstriction, may cause involuntary muscle movements and tremor

34
Q

What are the respiratory effects of etomidate?

A

Transient apnoea,

Coughing and hiccupping are common during induction

35
Q

What are the other effects of etomidate?

A

Increased incidence of post-op N&V
Pain on injection
Potent inhibitor of steroidogenesis in adrenal cortex
Unsuitable in porphyria

Not commonly used anymore

36
Q

What are the three major volatile inhalation anaesthetic agents?

A

Sevoflurane
Isoflurane
Desflurane

37
Q

What is sevoflurane?

A

Volatile inhalation anaesthetic agent

Can be used in gaseous induction or maintenance
Good in young children who won’t tolerate canula

38
Q

What is MAC?

A

Minimum alveolar concentration - alveolar concentration of gaseous agent required to ensure 50% of test population don’t respond to surgical incision

39
Q

What is isoflurane?

A

Volatile inhalation anaesthetic agent

Cheaper and more potent than sevoflurane but irritant with a pungent smell - cannot be used for gaseous induction

40
Q

What is desflurane?

A

Volatile inhalation anaesthetic agent

Pungent - not suitable for gaseous induction
Must be shielded from light and have Tec 6 vaporiser

41
Q

What is a risk of all volatile inhalation agents?

A

Malignant hyperthermia

42
Q

What are the two types of muscle relaxants?

A

Depolarising and non depolarising

43
Q

What is the only depolarising muscle relaxant used in clinical practice?

A

Suxamethonium (Sux)

44
Q

What is the function of Suxamethonium?

A

(Similar to ACh)

Agonist at post junctional NAChR (Nicoticic ACh receptor)

45
Q

What are the uses of Suxamethonium?

A

Rapid and short periods of muscle relaxation (Rapid Sequence Induction), ECT

Muscle function returns within 5 mins.

46
Q

What is the dose of Suxamethonium?

A

1-1.5 mg/kg

47
Q

What is the onset of Suxamethonium?

A

Rapid onset - 90% laryngeal muscle block in 50 seconds

Recovery begins after 3-5 minutes, complete within 12-15 min

48
Q

What are the downsides to Suxamethonium?

A

Myalgia

Elevation of serum potassium (wouldn’t use if already raised)

49
Q

What are the potential complications of suxamethonium?

A

Bradycardia
Anaphylaxis
Malignant hyperthermia (rigidity, high temp)
Prolonged block - sux apnoea

50
Q

What is the treatment of malignant hyperthermia?

A

Dantrolene

51
Q

What is malignant hyperthermia?

A

Autosomal dominant condition in which certain drugs induce increased muscle metabolism and dangerous hyperthermia

52
Q

What are the non-depolarising muscle relaxants?

A 
Rocuronium - Aminosteroid
Vecuronium - "
Pancuronium - "
Atracurium - Bis-benzylisoquinolinium
Cisatracurium - "
Mivacurium - "
53
Q

What are the two groups of non-depolarising muscle relaxants?

A

Animosteroids - CURONIUM

Bis-benzylisoquinoliums - CURIUM

54
Q

How do non-depolarising muscle relaxants work?

A

Compete for the same binding site as ACh

Reducing potential number of interations - reducing in liklihood of action potential being reached

55
Q

What side effects are reduced with non-depolarising muscle relaxants?

A

No fasiculations
No myalgia
No potassium released
No malignant hyperthermia

56
Q

What is Rocuronium?

A

Non-depolarising muscle relaxant - Aminosteroid

57
Q

What is the intubating dose of Rocuronium?

A

0.6 mg/kg

58
Q

What is the onset of rocuronium?

A

Rapid 75s duration 33m
Rapid onset, low potency
Can be used as an alternative to Sux for RSI

59
Q

How can rocuronium be reversed?

A

Sugammadex

60
Q

What do the aminosteroid non-polarising muscle relaxants (NMBA’s) rely on for elimination?

A

Renal and hepatic function

61
Q

What is Atracurium?

A

Non-depolarising muscle relaxant - Bis-benzylisoquinoliniums

62
Q

What is the intubating dose of Atracurium?

A

0.5 mg/kg

63
Q

What is the onset of Atracurium?

A

Slow onset time 110 seconds, not suitable for RSI

64
Q

What population is Atracurium suitable in?

A

Elimination independent of liver and kidney function so suitable for use in critically ill patients.

65
Q

What are the two main options for analgesia?

A

Fentanyl and Morphine

66
Q

What is Fentanyl?

A

Synthetic morphine, potent agonist at mu opioid receptor

67
Q

What is the potency of fentanyl?

A

100 x more potent than morphine, short acting

68
Q

What dose of morphine is given at induction?

A

1-3 ug/kg often given at induction before IV induction agent

69
Q

What function aside from analgisia does Fentanyl have?

A

Reduced response to laryngoscopy

70
Q

What are the downsides to fentanyl?

A 
Metabolised in the liver
Bradycardia and low BP common
Can cause respiratory depression
N&V post-op
Urinary retention
Constipation and itching
Chest wall rigidity
71
Q

When are fentanyl and morphine usually used?

A

Fentanyl for induction (5m before)

Morphine during the operation

72
Q

What is morphine?

A

Naturally occurring opiate

73
Q

What is the potency and onset of morphine?

A

Less potent, slower onset than fentanyl

74
Q

What are the downsides to morphine?

A 
Metabolism occurs in the liver
May reduce BP and HR
Respiratory depression
N&V post op
Urinary retention
Constipation
Itching
Histamine release - asthmatic bronchospasm

Finals - Acute & Critical Care & Anaesthetics (7 decks)

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