Anaesthetics

Question 1

Triad of analgesia

Answer 1

Hypnosis
Muscle relaxation
Analgesia

Question 2

Most common IV Hypnotic agents

Answer 2

Propofol (the most commonly used)

Ketamine

Thiopental sodium (less common)

Question 3

Most common inhaled Hypnotic agents

Answer 3

Sevoflurane (the most commonly used)

Desflurane (less favourable as bad for the environment)

Nitrous oxide (combined with other anaesthetic medications – may be used for gas induction in children)

Question 4

volatile anaesthetic agents - explain

Answer 4

Liquid at room temperature

Administered inhaled and so need to be vaporised

Question 5

Depolarising Muscle relaxant

Answer 5

suxamethonium

Question 6

Non-depolarising Muscle relaxant

Answer 6

rocuronium and atracurium

Question 7

Which drugs can reverse the effects of neuromuscular blocking medications

Answer 7

Cholinesterase inhibitors (e.g., neostigmine)

Question 8

Which is used specifically to reverse the effects of certain non-depolarising muscle relaxants

Answer 8

Sugammadex

Question 9

Malignant hyperthermia cause

Answer 9

hypermetabolic response to anaesthesia. The risk is mainly with:

Volatile anaesthetics (isoflurane, sevoflurane and desflurane)

Suxamethonium

Question 10

Surgical anti-emetics

Answer 10

Ondansetron (5HT3 receptor antagonist) – avoided in patients at risk of prolonged QT interval

Dexamethasone (corticosteroid) – used with caution in diabetic or immunocompromised patients

Cyclizine (histamine (H1) receptor antagonist) – caution with heart failure and elderly patients

Question 11

Malignant hyperthermia causes what symptoms?

Answer 11

Increased body temperature (hyperthermia)
Increased carbon dioxide exhalation
Tachycardia
Muscle rigidity
Acidosis
Hyperkalaemia

Question 12

Malignant hyperthermia Tx

Answer 12

dantrolene

Question 13

Surgical analgesia

Answer 13

Fentanyl
Alfentanil
Remifentanil
Morphine

Question 14

What is train-of-four (TOF)

Answer 14

nerve is stimulated four times to see if the muscle responses remain strong - (usually ulanr nerve or facial nerve)

Question 15

Pre-surgical fasting

Answer 15

6 hours of no food or feeds before the operation

2 hours of no clear fluids (fully “nil by mouth”)

Question 16

Central Neuraxial Anaesthesia location and why?

Answer 16

Caesarean sections
Transurethral resection of the prostate (TURP)
Hip fracture repairs

L3/4 or L4/5 subarachnoid spaces.

AKA spinal block - different to Epidural

Question 17

Epidural Anaesthesia location

Answer 17

epidural space in the lower back. This is outside the dura mater, separate from the spinal cord and CSF

Usually Levobupivacaine is often used, with or without fentanyl.

Question 18

When Epidural used for analgesia in labour, the risks include:

Answer 18

Prolonged second stage

Increased probability of instrumental delivery

Question 19

Stages of difficult airway management

Answer 19

Plan A – laryngoscopy with tracheal intubation
Plan B – supraglottic airway device
Plan C – face mask ventilation and wake the patient up
Plan D – cricothyroidotomy

Question 20

respiratory alkalosis most common causes

Answer 20

hyperventilation syndrome - High PaO2

PE - low PaO2

Question 21

Causes of metabolic acidosis

Answer 21

Raised lactate – lactate is released during anaerobic respiration (indicating tissue hypoxia)

Raised ketones – typically in diabetic ketoacidosis

Increased hydrogen ions – due to renal failure, type 1 renal tubular acidosis or rhabdomyolysis

Reduced bicarbonate – due to diarrhoea (stools contain bicarbonate), renal failure or type 2 renal tubular acidosis

Question 22

Metabolic alkalosis features

Answer 22

Raised pH

Raised bicarbonate

Question 23

Metabolic alkalosis causes

Answer 23

Loss of H+ ions - from:

Gastrointestinal tract – due to vomiting (the stomach produces hydrochloric acid)

Kidneys – usually due to increased activity of aldosterone, which results in hydrogen ion excretion