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Finals > Anaesthetics > Flashcards

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
Q

General Anaesthesia

what is total intravenous anaesthesia (TIVA)

A

using an IV medication for induction AND maintenance of the general anaesthetic

propofol is most common. Can give a nicer recovery

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26
Q

General Anaesthesia

how do muscle relaxants work

A

they block the neuromuscular junction from working

ACh is released by the axon but is blocked from stimulating a response from the muscle

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27
Q

General Anaesthesia

why are muscle relaxants given

A

to relax and paralyse the muscles to make intubation and surgery easier

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28
Q

General Anaesthesia

what are the 2 categories of muscles relaxants

A
  • depolarising

- non-depolarising

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29
Q

General Anaesthesia

name an example of a depolarising muscle relaxant

A

suxamethonium

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30
Q

General Anaesthesia

name an example of a non-depolarising muscle relaxant

A

rocuronium

atracurium

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31
Q

General Anaesthesia

what can reverse the effects if neuromuscular blocking medications

A

Cholinesterase inhibitor eg neostigmine

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32
Q

General Anaesthesia

what is used specifically to reverse the effects of certain non-depolarising muscle relaxants (rocuronium and vecuronium)

A

Sugammadex

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33
Q

General Anaesthesia

what common agents are used for analgesia

A

opiates:

  • fentanyl
  • alfentanil
  • remifentanil
  • morphine
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34
Q

General Anaesthesia

why are antiemetics often given at the end

A

to prevent post-op N + V

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35
Q

General Anaesthesia

antiemetics: Ondansetron

A
  • 5HT3 receptor antagonist

- avoided in patients at risk of prolonged QT interval

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36
Q

General Anaesthesia

antiemetics: Dexamethasone

A
  • corticosteroid

- caution in diabetics or immunocompromised pts

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37
Q

General Anaesthesia

antiemetics: Cyclizine

A
  • histamine 1 receptor antagonist

- caution with HF + elderly pts

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38
Q

General Anaesthesia

what is ‘awareness under anaesthesia’

A

pt regains consciousness whilst still paralysed

the muscle relaxant needs to be worn off before waking the patient

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39
Q

General Anaesthesia

what is used to ensure the muscle relaxant effects have ended

A

nerve stimulator ‘the twitchy machine’

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40
Q

General Anaesthesia

where can the nerve stimulator test on?

A
  • ulnar nerve at wrist: watch thumb twitch

- facial nerve: movement in the orbiculares oculi

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41
Q

General Anaesthesia

what is train-of-four stimulation

A

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)

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42
Q

General Anaesthesia

what are common adverse effects of general anaesthesia

A
  • sore throat

- post-op N+V

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43
Q

General Anaesthesia

what are some significant risks of general anaesthesia

A
  • accidental awareness (waking during the anaesthetic)
  • aspiration
  • dental injury (laryngoscope)
  • anaphylaxis
  • CV events (MI, stroke, arrhythmias)
  • Malignant hyperthermia (rare)
  • death
44
Q

General Anaesthesia

what is malignant hyperthermia

A

hypermetabolic response to anaesthesia

genetic mutations increase the risk.

Autosomal dominant

45
Q

General Anaesthesia

what agents are a risk for malignant hyperthermia

A
  • volatile anaesthetics: isoflurane, sevoflurane, desflurane

- Suxamethonium

46
Q

General Anaesthesia

what does malignant hyperthermia cause

A
  • increased body temp (hyperthermia
  • increased CO2 exhalation
  • tachycardia
  • muscle rigidity
  • acidosis
  • hyperkalaemia
47
Q

General Anaesthesia

what is malignant hyperthermia treated with

A

dantrolene

48
Q

General Anaesthesia

how does dantrolene work when treating malignant hyperthermia

A

it’s a muscle relaxant that works by interfering with the movement of Ca+ in skeletal muscle

49
Q

Post-op N+V

name 3 types of antiemetics

A
  • 5HT3 receptor antagonist
  • D2 receptor antagonist
  • H1 receptor antagonist
50
Q

Post-op N+V

what type of antiemetic is ondansetron

A

5HT3 receptor antagonist

51
Q

Post-op N+V

5HT3 receptor antagonist: site of action

A
  • chemoreceptor trigger zone

- GI tract

52
Q

Post-op N+V

5HT3 receptor antagonist: mechanism

A

prevents stimulation of vagus nerve by emetogenic stimuli in the gut (a substance that causes vomiting)

53
Q

Post-op N+V

5HT3 receptor antagonist: side effects

A
  • prolonged QT interval
  • headaches
  • constipation
  • diarrhoea
54
Q

Post-op N+V

5HT3 receptor antagonist: useful in?

A
  • Chemoreceptor trigger zone stimulation e.g. drugs

- visceral stimuli e,g, gut infection, radiotherapy

55
Q

Post-op N+V

5HT3 receptor antagonist: avoid in?

A

pt taking other drugs that prolong the QT interval e.g. antipsychotics, SSRIs

56
Q

what type of anti-emetic is Metclopramide

A

D2 receptor antagonist

57
Q

what type of anti-emetic is domperidone

A

D2 receptor antagonist

58
Q

Post-op N+V

D2 receptor antagonist: site of action

A
  • chemotrigger zone

- upper GI tract

59
Q

Post-op N+V

D2 receptor antagonist: mechanism

A

prokinetic:
- relaxes the pylorus
- decreases lower oesophagus sphincter tone
- increases gastric peristalsis

60
Q

Post-op N+V

D2 receptor antagonist: SEs of metclopramide

A

ESPEs: acute dystonia because it crosses the BBB

more common in young females

61
Q

Post-op N+V

D2 receptor antagonist: SEs of domperidone

A

does not cross the BBB so no ESPEs

62
Q

Post-op N+V

D2 receptor antagonist: general SE

A

diarrhoea

63
Q

Post-op N+V

D2 receptor antagonist: useful in?

A
  • CTZ stimualtion (drugs)

- decreased gut motility e.g. opioids, diabetic gastro paresis

64
Q

Post-op N+V

D2 receptor antagonist: avoid in?

A

GI obstruction , perforation

65
Q

what type of antiemetic is cyclizine

A

H1 receptor antagonist

66
Q

what type of antiemetic is cinnarizine

A

H1 receptor antagonist

67
Q

what type of antiemetic is promethazine

A

H1 receptor antagonist

68
Q

Post-op N+V

H1 receptor antagonist: site of action

A

vomiting centre, vestibular system

69
Q

Post-op N+V

H1 receptor antagonist: SEs

A

anti-cholinergic effects:

  • drowsiness
  • dry mouth
  • blurred vision

transient tachycardia after IV

70
Q

Post-op N+V

H1 receptor antagonist: useful in?

A

motion sickness and vertigo

71
Q

Post-op N+V

H1 receptor antagonist: avoid in?

A

prostatic hypertrophy as it can precipitate urinary retention

72
Q

what is ondansetron used in

A

5HT3

  • PONV
  • vomiting after acute opioid administration
73
Q

what is cyclizine used in

A

H1

  • PONV
  • motion sickness
  • vomiting after acute opioid administration
74
Q

what is metclopramide used in

A

long term opioid use

(opioids cause gastric stasis which can be counteracted by prokinetic effect of metclopromide

75
Q

what is domperidone used in

A

premedication for pts at risk of PONV

76
Q

what is prochlorperazine used in

A

vertigo

77
Q

Local

what us the principle drug used in spinal anaesthesia

A

Bupivacaine

78
Q

Local

what is bupivacaine especially used in

A

continuous epidural analgesia in labour or for posop pain relief

79
Q

Local

what is the duration and onset of action in bupivacaine

A
  • longer duration fo action that other locals

- takes up to 30m for full effect

80
Q

Local

what is Levobupivacaine

A

an isomer of bupivacaine but fewer adverse effects

81
Q

Local

solutions of lidocaine should not exceed what % strength

A

1% except for surface and dental anaesthesia

82
Q

Local

what is the duration of block (w/ adrenaline) of lidocaine

A

90m

83
Q

Local

what happens to blood vessels

A

they dilate

84
Q

Local

why is a vasconstrictor (adrenlaine) added to the local

A

it diminishes local blood flow, slowing the rate of absorption and therefore prolonging the anaesthetic effect

85
Q

Local

when should you not add adrenaline to local?

A

in pts with severe HTN or unstable cardiac rhythm

86
Q

Local

toxicity can lead to>

A

cardiovascular toxicity –. cardiac arrest

87
Q

Local

mnx of local anaesthetic-induced cardiac arrest

A
  1. standard resus
  2. 20% lipid emulsion (Intralipid) bolus then infusion
  3. 5 min? 2 more boluses and increase infusion rate
88
Q

what is the anti-emetic of choice in bowel obstruction

A

Cyclizine

89
Q

which anti-emetic is more suitable for patients with bowel obstruction secondary to stasis or ileus.

A

metclopromide because it increases intestinal peristalsis

90
Q

which anti-emetic is prescribed for nausea and vomiting secondary to chemotherapy

A

Ondansetron

91
Q

SE of ondansetron

A

constipation

92
Q

what is rapid sequence induction

A
  • 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
Q

what are the steps forming the sequence of RSI

A

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
Q

what is a complication from epidural anaesthesia (c-section)

A

Maternal and foetal distress secondary to hypotension

95
Q

how much to increase opioid dose if pain is not controlled

A

increase total dose by 1/3

96
Q

what is the method of delivering oxygen to treat type II respiratory failure

A

BiPAP

97
Q

what is the first line treatment for spasmodic pain in palliative care patients

A

diazepam

98
Q

family history of difficulty ventilating during anaesthesia, which drug to aid intubation and why

A

Rocuronium

risk of suxamethonium apnoea if Suxamethonium used

99
Q

what is the total recommended maintenance fluid a day

A

25-30ml/day

100
Q

mnx for patients peri op if anaemic

A

blood transfusion

unless pt has CKD4 (as less EPO so anaemia is normal for them)

101
Q

at what GCS score should intubation be considered

A

GCS <8

102
Q

How do you predict a difficult intubation?

A
  • previous difficult intubation
  • small mouth opening
  • Mallampti score
  • BMI
  • neck mobility
103
Q

What from the WHO checklist do you do once the patient has arrived for surgery before anaesthetic (4)

A
  • 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
Q

which airway device provides protection for the lungs from regurgitated stomach
contents?

A

Tracheal tube

105
Q

What is the purpose of cricoid pressure

A

It prevents the passage of gastric contents into the airway

Finals (47 decks)

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