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Anaesthetics Flashcards

1
Q

General Anaesthesia

what are the 2 main categories of anaesthesia

A

General anaesthesia: making the pt unconscious

Regional anaesthesia: blocking feeling to an isolated area of body eg limb

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2
Q

General Anaesthesia

what happens during general anaesthetic

A

pt intubated or has a supraglottic airway device

breathing supported and controlled by a ventilator

pt continuously monitored at all times immediately before, during and after general anaesthesia

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3
Q

General Anaesthesia

what is the purpose of fasting before a planned general anaesthetic

A

to make sure they have an empty stomach

to reduce the risk of the stomach contents refluxing into the oropharynx (throat)

then being aspirated into the trachea (airway)

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4
Q

General Anaesthesia

what happens if gastric contents gets into the lungs

A

an aggressive inflammatory response, causing pneumonitis

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5
Q

General Anaesthesia

when is risk of aspiration highest

A

before and during intubation and when they are extubated

once the endotracheal tube is correctly fitted, the airway is blocked and protected from aspiration

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6
Q

General Anaesthesia

what are major causes of morbidity and mortality in anaesthetics

A

aspiration pneumonitis and pneumonia

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7
Q

General Anaesthesia

what does fasting for an operation typically involve

A
  • 6h no food or fedes before operation

- 2h no clear fluids (fully nil by mouth)

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8
Q

General Anaesthesia

what is preoxygenation

A

before being put under general anaesthetic, the pt will have a period of several minutes where they breathe 100% O2

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9
Q

General Anaesthesia

why do you preoxygenate a pt before surgery

A

it gives them a reserve of O2 for the period between they lose consciousness and intubated and ventilated (in case difficulty establishing airway)

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10
Q

General Anaesthesia

what premedication is given and why

A

benzodiazepines eg midazolam: to relax the muscles and reduce anxiety (also causes amnesia)

opiates eg fentanyl or alfentanyl: to reduce pain and reduce the hypertensive response to the laryngoscope

alpha-2-adrenergic agonists eg clonidine: sedation + pain

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11
Q

General Anaesthesia

when is Rapid Sequence Induction/intubation used?

A

to gain control over the airway as quickly and safely as possible where a pt is intubated in an emergency scenario and detailed pre-planning is not possible

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12
Q

General Anaesthesia

what non-emergency situations is RSI used

A

when the airway needs to be secured quickly to avoid aspiration eg GOR or pregnancy

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13
Q

General Anaesthesia

why is RSI more riskt

A
  • not fasted so risk of aspiration

- no plan for individual factors and potential problems eg difficult airway

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14
Q

General Anaesthesia

RSI procedure

A

endotracheal tube intubation asap after induction

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15
Q

General Anaesthesia

biggest concern in RSI

A

aspiration of stomach contents into the lungs

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16
Q

General Anaesthesia

what can be done to reduce the risk of aspiration in RSI

A
  • position bed more upright

- cricoid pressure: compresses oesophagus

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17
Q

General Anaesthesia

what is the triad of general anaesthesia

A
  • hypnosis
  • muscle relaxation
  • analgesia
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18
Q

General Anaesthesia

what are hypnotic agents used for

A

to make the pt unconscious

IV med will be used as an induction agent and inhaled med will be used to maintain the general anaesthetic during the operation

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19
Q

General Anaesthesia

IV options for hypnotic agents

A
  • Propofol (most common)
  • Ketamine
  • Thiopental sodium (less common)
  • Etomidate (rarely used)
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20
Q

General Anaesthesia

inhaled options for hypnotic agents

A
  • Sevoflurane (most common)
  • Desflurane
  • Isoflurane (rarely)
  • NO (combined with other med - may be used for gas induction in children)
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21
Q

General Anaesthesia

why is Desflurane less favourable than Sevoflurane

A

its bad for the environment

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22
Q

General Anaesthesia

what are Sevoflurane, desflurane and isoflurane?

A

volatile anaesthetic agents - liquid at room temp and need to be vaporised into a gas to be inhaled

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23
Q

General Anaesthesia

how are volatile anaesthetic agents vapourised?

A

the liq med is poured into the vaporiser machine which turns it into vapour and mixes it with air in a controlled way

during the anaesthesia, the conc can be altered to control the depth of anaesthesia

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24
Q

General Anaesthesia

inhaled or IV quicker to reach an effective conc

A

IV as they are infused directly into the blood whereas inhaled meds need to diffuse across the lung tissue and into the blood

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25
General Anaesthesia what is total intravenous anaesthesia (TIVA)
using an IV medication for induction AND maintenance of the general anaesthetic propofol is most common. Can give a nicer recovery
26
General Anaesthesia how do muscle relaxants work
they block the neuromuscular junction from working ACh is released by the axon but is blocked from stimulating a response from the muscle
27
General Anaesthesia why are muscle relaxants given
to relax and paralyse the muscles to make intubation and surgery easier
28
General Anaesthesia what are the 2 categories of muscles relaxants
- depolarising | - non-depolarising
29
General Anaesthesia name an example of a depolarising muscle relaxant
suxamethonium
30
General Anaesthesia name an example of a non-depolarising muscle relaxant
rocuronium | atracurium
31
General Anaesthesia what can reverse the effects if neuromuscular blocking medications
Cholinesterase inhibitor eg neostigmine
32
General Anaesthesia what is used specifically to reverse the effects of certain non-depolarising muscle relaxants (rocuronium and vecuronium)
Sugammadex
33
General Anaesthesia what common agents are used for analgesia
opiates: - fentanyl - alfentanil - remifentanil - morphine
34
General Anaesthesia why are antiemetics often given at the end
to prevent post-op N + V
35
General Anaesthesia antiemetics: Ondansetron
- 5HT3 receptor antagonist | - avoided in patients at risk of prolonged QT interval
36
General Anaesthesia antiemetics: Dexamethasone
- corticosteroid | - caution in diabetics or immunocompromised pts
37
General Anaesthesia antiemetics: Cyclizine
- histamine 1 receptor antagonist | - caution with HF + elderly pts
38
General Anaesthesia what is 'awareness under anaesthesia'
pt regains consciousness whilst still paralysed the muscle relaxant needs to be worn off before waking the patient
39
General Anaesthesia what is used to ensure the muscle relaxant effects have ended
nerve stimulator 'the twitchy machine'
40
General Anaesthesia where can the nerve stimulator test on?
- ulnar nerve at wrist: watch thumb twitch | - facial nerve: movement in the orbiculares oculi
41
General Anaesthesia what is train-of-four stimulation
the nerve is stimulated 4 times to see if the muscle responses remain strong (indicating it has worn off) or whether they get weaker with additional stimulation (indicating it has not fully worn off)
42
General Anaesthesia what are common adverse effects of general anaesthesia
- sore throat | - post-op N+V
43
General Anaesthesia what are some significant risks of general anaesthesia
- accidental awareness (waking during the anaesthetic) - aspiration - dental injury (laryngoscope) - anaphylaxis - CV events (MI, stroke, arrhythmias) - Malignant hyperthermia (rare) - death
44
General Anaesthesia what is malignant hyperthermia
hypermetabolic response to anaesthesia genetic mutations increase the risk. Autosomal dominant
45
General Anaesthesia what agents are a risk for malignant hyperthermia
- volatile anaesthetics: isoflurane, sevoflurane, desflurane | - Suxamethonium
46
General Anaesthesia what does malignant hyperthermia cause
- increased body temp (hyperthermia - increased CO2 exhalation - tachycardia - muscle rigidity - acidosis - hyperkalaemia
47
General Anaesthesia what is malignant hyperthermia treated with
dantrolene
48
General Anaesthesia how does dantrolene work when treating malignant hyperthermia
it's a muscle relaxant that works by interfering with the movement of Ca+ in skeletal muscle
49
Post-op N+V name 3 types of antiemetics
- 5HT3 receptor antagonist - D2 receptor antagonist - H1 receptor antagonist
50
Post-op N+V what type of antiemetic is ondansetron
5HT3 receptor antagonist
51
Post-op N+V 5HT3 receptor antagonist: site of action
- chemoreceptor trigger zone | - GI tract
52
Post-op N+V 5HT3 receptor antagonist: mechanism
prevents stimulation of vagus nerve by emetogenic stimuli in the gut (a substance that causes vomiting)
53
Post-op N+V 5HT3 receptor antagonist: side effects
- prolonged QT interval - headaches - constipation - diarrhoea
54
Post-op N+V 5HT3 receptor antagonist: useful in?
- Chemoreceptor trigger zone stimulation e.g. drugs | - visceral stimuli e,g, gut infection, radiotherapy
55
Post-op N+V 5HT3 receptor antagonist: avoid in?
pt taking other drugs that prolong the QT interval e.g. antipsychotics, SSRIs
56
what type of anti-emetic is Metclopramide
D2 receptor antagonist
57
what type of anti-emetic is domperidone
D2 receptor antagonist
58
Post-op N+V D2 receptor antagonist: site of action
- chemotrigger zone | - upper GI tract
59
Post-op N+V D2 receptor antagonist: mechanism
prokinetic: - relaxes the pylorus - decreases lower oesophagus sphincter tone - increases gastric peristalsis
60
Post-op N+V D2 receptor antagonist: SEs of metclopramide
ESPEs: acute dystonia because it crosses the BBB | more common in young females
61
Post-op N+V D2 receptor antagonist: SEs of domperidone
does not cross the BBB so no ESPEs
62
Post-op N+V D2 receptor antagonist: general SE
diarrhoea
63
Post-op N+V D2 receptor antagonist: useful in?
- CTZ stimualtion (drugs) | - decreased gut motility e.g. opioids, diabetic gastro paresis
64
Post-op N+V D2 receptor antagonist: avoid in?
GI obstruction , perforation
65
what type of antiemetic is cyclizine
H1 receptor antagonist
66
what type of antiemetic is cinnarizine
H1 receptor antagonist
67
what type of antiemetic is promethazine
H1 receptor antagonist
68
Post-op N+V H1 receptor antagonist: site of action
vomiting centre, vestibular system
69
Post-op N+V H1 receptor antagonist: SEs
anti-cholinergic effects: - drowsiness - dry mouth - blurred vision transient tachycardia after IV
70
Post-op N+V H1 receptor antagonist: useful in?
motion sickness and vertigo
71
Post-op N+V H1 receptor antagonist: avoid in?
prostatic hypertrophy as it can precipitate urinary retention
72
what is ondansetron used in
5HT3 - PONV - vomiting after acute opioid administration
73
what is cyclizine used in
H1 - PONV - motion sickness - vomiting after acute opioid administration
74
what is metclopramide used in
long term opioid use | (opioids cause gastric stasis which can be counteracted by prokinetic effect of metclopromide
75
what is domperidone used in
premedication for pts at risk of PONV
76
what is prochlorperazine used in
vertigo
77
Local what us the principle drug used in spinal anaesthesia
Bupivacaine
78
Local what is bupivacaine especially used in
continuous epidural analgesia in labour or for posop pain relief
79
Local what is the duration and onset of action in bupivacaine
- longer duration fo action that other locals | - takes up to 30m for full effect
80
Local what is Levobupivacaine
an isomer of bupivacaine but fewer adverse effects
81
Local solutions of lidocaine should not exceed what % strength
1% except for surface and dental anaesthesia
82
Local what is the duration of block (w/ adrenaline) of lidocaine
90m
83
Local what happens to blood vessels
they dilate
84
Local why is a vasconstrictor (adrenlaine) added to the local
it diminishes local blood flow, slowing the rate of absorption and therefore prolonging the anaesthetic effect
85
Local when should you not add adrenaline to local?
in pts with severe HTN or unstable cardiac rhythm
86
Local toxicity can lead to>
cardiovascular toxicity --. cardiac arrest
87
Local mnx of local anaesthetic-induced cardiac arrest
1. standard resus 2. 20% lipid emulsion (Intralipid) bolus then infusion 3. 5 min? 2 more boluses and increase infusion rate
88
what is the anti-emetic of choice in bowel obstruction
Cyclizine
89
which anti-emetic is more suitable for patients with bowel obstruction secondary to stasis or ileus.
metclopromide because it increases intestinal peristalsis
90
which anti-emetic is prescribed for nausea and vomiting secondary to chemotherapy
Ondansetron
91
SE of ondansetron
constipation
92
what is rapid sequence induction
- administration of rapidly acting induction agents - to produce anaesthesia and muscle relaxation - followed by prompt intubation - resulting in a secure airway with the minimal risk of aspiration
93
what are the steps forming the sequence of RSI
1) Preparation: optimise environment - equipment, staff 2) Preoxygenation: high flow O2 for 5m prior 3) Pretreatment: opiate analgesia or fluid bolus to counteract hypotensive effect of anaesthesia 4) Paralysis: induction agent (e.g. Propofol or Sodium Thiopentone) + paralysing agent (e.g. Suxamethonium or Rocuronium) 5) Protection + positioning: Cricoid pressure to protect airway 6) Placement and proof: Intubation via laryngoscopy, with proof obtained (direct vision, end-tidal CO2, bilateral auscultation) 7) Post-intubation management Taping or tying the endotracheal tube, initiating mechanical ventilation + sedation agents
94
what is a complication from epidural anaesthesia (c-section)
Maternal and foetal distress secondary to hypotension
95
how much to increase opioid dose if pain is not controlled
increase total dose by 1/3
96
what is the method of delivering oxygen to treat type II respiratory failure
BiPAP
97
what is the first line treatment for spasmodic pain in palliative care patients
diazepam
98
family history of difficulty ventilating during anaesthesia, which drug to aid intubation and why
Rocuronium risk of suxamethonium apnoea if Suxamethonium used
99
what is the total recommended maintenance fluid a day
25-30ml/day
100
mnx for patients peri op if anaemic
blood transfusion unless pt has CKD4 (as less EPO so anaemia is normal for them)
101
at what GCS score should intubation be considered
GCS <8
102
How do you predict a difficult intubation?
- previous difficult intubation - small mouth opening - Mallampti score - BMI - neck mobility
103
What from the WHO checklist do you do once the patient has arrived for surgery before anaesthetic (4)
- Check pt name, number and DOB - allergies - check consent form - check operation Mark site - machine and drug check - pulse check - assess airway risk - ask blood loss risk
104
which airway device provides protection for the lungs from regurgitated stomach contents?
Tracheal tube
105
What is the purpose of cricoid pressure
It prevents the passage of gastric contents into the airway

Finals (47 decks)

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