Anaesthetics Flashcards

1
Q

what are the 2 types of anaesthesia?

A
  • general

- regional

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2
Q

what is true NBM pre-operatively?

A
  • 6h no food

- 2h no clear fluids

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3
Q

which medications can be offered pre-op? give the indication for each one

A
  • BDZ, e.g. midazolam (anxiolytic)
  • opiates, e.g. alfentanil (reduces pain and HTN in response to laryngoscope)
  • alpha-2-adrenergic agonists, e.g. clonidine (sedation and pain relief)
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4
Q

why and when is rapid sequence induction used?

A
  • to gain airway control as quickly and safely as possible
  • emergencies
  • GORD
  • pregnancy
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5
Q

key complication in RSI? how can this be avoided?

A
  • aspiration of stomach contents into lungs

- apply cricoid pressure

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6
Q

what is the triad of GA?

A
  • hypnosis
  • muscle relaxation
  • analgesia
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7
Q

what is the role of hypnotic agents in GA?

A

to make the pt unconscious

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8
Q

hypnotic agents which can be administered IV?

A

used to induce LOC:

  • propofol
  • ketamine
  • thiopental sodium
  • etomidate (rare)
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9
Q

hypnotic agents which are inhaled?

A

mostly used to maintain LOC

volatile:

  • sevoflurane
  • desflurane
  • isoflurane

non-volatile:
- nitrous oxide

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10
Q

where do muscle relaxants act?

A

NMJ

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11
Q

name a depolarising muscle relaxant

A

suxamethonium

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12
Q

name a non-depolarising muscle relaxant

A
  • rocuronium

- atracurium

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13
Q

how can a muscle relaxant’s actions be reversed?

A
  • neostigmine

- sugammadex (only for non-depolarising ones)

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14
Q

give examples of analgesic agents used in GA?

A

all opiates:

  • fentanyl
  • alfentanil
  • remifentanil
  • morphine
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15
Q

which antiemetics are used prophylactically post-op?

A
  • ondansetron
  • dexamethasone
  • cyclizine
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16
Q

drug class of ondansetron?

A

5HT3 (serotonin) receptor antagonist

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17
Q

drug class of dexamethasone?

A

corticosteroid

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18
Q

drug class of cyclizine?

A

H1 (histamine) receptor antagonist

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19
Q

who should cyclizine be used with caution in?

A
  • pts with HF

- elderly

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20
Q

who should dexamethasone be used with caution in?

A
  • pts with DM

- immunocompromised pts

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21
Q

how can you test if the muscle stimulant has worn off?

A
  • train-of-four stimulation
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22
Q

describe train-of-four stimulation

A
  • try to stimulate a nerve 4 times

- if the muscle responses get weaker with each stimulation, it means the relaxant has not yet worn off

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23
Q

what is malignant hyperthermia?

A

rare but dangerous hypermetabolic response to anaesthesia

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24
Q

which agents carry a risk of malignant hyperthermia?

A
  • volatile anaesthetics (isoflurane, sevoflurane, desflurane)
  • suxamethonium
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25
presentation of malignant hyperthermia?
- increased body temp LMAO - increased CO2 exhalation - high HR - muscle rigidity - acidosis - high K+
26
management of malignant hyperthermia?
dantrolene
27
how is a peripheral nerve block carried out?
- LA injected under ultrasound guidance - pt remains conscious - usually done to numb a single limb
28
indications for a spinal block?
- C-sections - TURP - hip fracture repairs
29
how is a spinal block carried out?
- LA injected into subarachnoid space in CSF - anywhere between L3 and L5 - all nerves below level of injection are numbed - cold spray used to test if it has worked
30
typical indication for an epidural?
woman in labour with vaginal delivery
31
how is an epidural carried out?
- catheter inserted into epidural space (OUTSIDE of CSF and spinal cord) - levobupivacaine inserted +/- fentanyl
32
key risks of using epidural in labour?
- prolonged second stage of labour | - increased chances of needing instrumental delivery
33
why is it important that a pt is able to do a straight leg raise under epidural anaesthesia?
- if not, catheter may be in subarachnoid space | - needs urgent anaesthetic review
34
example of LA?
lidocaine
35
examples of indications for LA use?
- skin sutures in A&E - dental procedures - carpal tunnel syndrome surgery - inserting central line - PCI
36
indications for a tracheostomy?
- resp failure where long-term ventilation will be needed (e.g. following brain injury) - prolonged weaning from mechanical ventilation - upper airway obstruction - to manage resp secretions - to reduce risk of aspiration (in unsafe swallow)
37
what can an arterial line be used for?
- measuring BP - getting ABG samples - NEVER to give drugs
38
where might a central venous catheter (central line) be inserted?
- internal jugular vein - subclavian vein - femoral vein
39
define chronic pain
pain that has been present for 3+ months
40
what is allodynia?
when pain is experienced with sensory inputs which should not cause pain, e.g. light touch
41
features of neuropathic pain?
- burning - tingling - pins and needles - electric shocks - loss of touch sensation in affected area
42
what are the 3 steps of the WHO analgesic ladder?
1. non-opioids (paracetamol, NSAIDs) 2. weak opioids (codeine, tramadol) 3. strong opioids (morphine, oxycodone, fentanyl, buprenorphine)
43
which adjuvants can be used to treat neuropathic pain?
- amitriptyline - duloxetine - gabapentin - pregabalin - capsaicin cream
44
common side effects of NSAIDs?
- indigestion - stomach ulcers - asthma exacerbations - HTN - renal impairment - CAD, HF strokes (rare)
45
in which pts are NSAIDs inappropriate / contraindicated?
- asthma - CKD - heart disease - uncontrolled HTN - pts with stomach ulcers
46
which drugs are co-prescribed with NSAIDs?
PPIs (e.g. omeprazole)
47
key side effects of opioids?
- constipation - pruritus - nausea - altered mental state - resp depression
48
how is opioid overdose reversed?
naloxone
49
how are opioids prescribed in palliative care?
- background opioids | - plus rescue doses for breakthrough pain
50
how is the rescue dose of an opioid calculated for palliative care?
rescue dose = 1/6 of total background dose over 24 hrs
51
how is bradycardia secondary to patient-controlled analgesia overuse managed?
atropine
52
common areas affected by chronic pain?
- headaches - lower back pain - neck pain - knee / hip pain
53
describe the analgesic ladder for treating pain secondary to OA
1. PO paracetamol + topical NSAIDs 2. add PO NSAIDs (+PPI) 3. consider opioids
54
which 4 medications are used first-line in the treatment of neuropathic pain?
- amitriptyline - duloxetine - gabapentin - pregabalin
55
1st line treatment for trigeminal neuralgia?
carbamazepine (different to other neuropathic pain conditions!)
56
describe the different "levels" of patient care needs in a hospital
- level 1 = ward-based care - level 2 = HDU - level 3 = ICU (highest level of support needed)
57
common reasons for ICU admission?
- following major surgery, e.g. AAA repair - severe sepsis - major trauma - following CPR - acute resp / renal / liver failure
58
how can enteral nutrition be given in the ICU setting?
- orally - NG tube - PEG
59
why is TPN given via central line rather than a cannula?
- it irritates peripheral veins | - causes thrombophlebitis
60
complications of mechanical ventilation?
- alveolar damage from over-inflation - barotrauma - pneumonia - cor pulmonale
61
which drug can be administered to treat agitated pts with delirium in ICU setting?
dexmedetomidine