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ACC > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

3 A’s of anaesthesia

A

Amnesia
Analgesia
Akinesia

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2
Q

Induction agent you CANNOT use in porphyria

A

Thiopentone

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3
Q

Induction agent used for RSI

A

Thiopentone

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4
Q

Induction agent you CAN’T use in sepsis

A

Etomidate

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5
Q

How long do induction agents last

A

4-10 minutes

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6
Q

MAC of sevoflourane

A

2%

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7
Q

MAC of isoflourane

A

1.15%

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8
Q

Indication of isoflourane

A

Organ donation - doesn’t affect blood flow to organs

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9
Q

Indication for desflourane as maintenance

A

Long operation (doesn’t accumulate in fat)

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10
Q

Anti-emetics given DURING surgery

A

Dexamethasone

Ondansetron

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11
Q

Post-op anti-emetic

A

Cyclizine

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12
Q

Define amnesia in terms of anaesthetics

A

Lack of response and recall to noxious stimuli (e.g. unconscious)

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13
Q

What are the biggest cannulas?

A 
Orange
Grey
White
Green
pink
blue
yellow
violet
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14
Q

Effect of propofol on HR and BP

A

Reduces both HR and BP

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15
Q

Effect of thiopentone on HR and BP

A

Drops BP

Increases HR

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16
Q

Which anaesthetic tends to be used in neurosurgery and why?

A

Thiopentone –> antiepileptic properties and neuroprotective

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17
Q

When would etomidate be used for induction?

A

Haemodynamic instability e.g. heart failure

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18
Q

Which induction agent has the highest incidence of PONV

A

Etomidate

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19
Q

Why cannot etomidate be used in septic shock?

A

Causes adreno-cortical suppression

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20
Q

What maintenance agent would you use for organ donation and why?

A

Isoflourane because it has the least effect on blood flow

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21
Q

What maintenance agent is commonly used in children?

A

Sevoflourane

22
Q

What maintenance agent is commonly used in long procedures and why?

A

Desflurane - less accumulates in fat so more rapid onset and offset

23
Q

What is the mac of sevoflourane?

A

2%

24
Q

MAC of desflourane

A

6%

25
Q

MAC of isoflurane

A

1.15%

26
Q

Which short acting opioids are most commonly used and fastest acting?

A

Most common = fentanyl

Fastest acting = remifentanyl (IV infusion)

27
Q

Side effects of NSAIDS as pain relief

A

Gastric and renal SEs
Interfere with clotting
(CI in asthma)

28
Q

What does activating alpha receptors in vascular smooth muscle cause and which commonly used drugs do this?

A

Induces smooth muscle contraction (vasoconstriction). Works through second messenger (cAMP) model. Happens in both arteries and veins but more pronounced affect in arteries.

Vasopressors (systemic vasoconstrictors) –> metaraminol, phenylephrine, ephedrine.

29
Q

What does activating beta receptors in vascular smooth muscle cause and which commonly used drugs do this?

A

Beta receptors are mainly in cardiac smooth muscle. Activating them causes cardiac stimulation (increased HR, contractility, cardiac output) and increased vasodilation systemically.

Ionotropes = adrenaline, ephedrine, dobuatmine

30
Q

What does hypertension during anaesthesia indicate?

A

Inadequate anaesthesia - give more + analgesics

31
Q

Difference between crystalloid and colloid fluids

A

Crystalloid = crystalline solids dissolved in water e.g. NaCl. Either hypotonic or isotonic.

Colloid = high molecular weight particles e.g. albumin. Expand intravascular volume. Risk of anaphylaxis.

32
Q

What is Hartmann’s V 0.9% saline

A

Both isotonic crystallines.

Hartmann’s contains sodium, chloride, potassium, lactate

33
Q

At what % of blood volume loss would you consider blood replacements and activating MHP

A

30% volume loss = blood replacement

MHP = >70ml/kg blood loss

34
Q

What is the MHP

A

RBCs, FFP, platelets in 1:1:1

35
Q

Ondansentron MOA

A

Serotonin blocker

36
Q

Dexamethasone MOA

A

Steroid

37
Q

Cyclizine MOA

A

Anti-histamine

38
Q

Prochlorperazine MOA

A

Phenothiazine

39
Q

Pre-op assessment

A

PMHx -
AIRWAY - teeth, dentures, neck pain
BREATHING/RESP - asthma, cough, trouble breathing, smoker
CIRCULATION - CV problems, lying flat, orthopnoea, exercise tolerance
GI - GORD, last meal
OTHER - diabetes, epilepsy, CKD, thyroid, stroke
MEDS - anticoagulation/antiplatelets, insulin, analgesia

ANA Hx - problems (MH, ICU, pain, PONV, airway), FHx, Pain relief

EXAMINATION - mallampatti (class 1-4), neck and jaw movements, pregnancy, BMI

ASA GRADE and PRE-OP IX

40
Q

ASA Grades

A
  • Grade I: healthy, no systemic disease
  • Grade 2: mild systemic disease, no functional limitations
  • Grade 3: severe systemic disease, substantive functional limitations
  • Grade 4: severe systemic disease which is a constant threat to life
  • Grade 5: at point of death, not expected to survive with or without operation
  • Grade 6: brain-stem dead, organs being donated
41
Q

Investigations indicated in everyone above >80

A

FBC
U&E
ECG
(if ASA 3/4: clotting, lung function/ ABG)

42
Q

When would CXR be indicated as pre-op investigation?

A

If ICU admission or respiratory disease in ASA 3 or 4

43
Q 
Fasting time for:
Solid food
Clear fluids
Alcohol
Breast feeding
Children water
A 
Solid food - 6 hours
Clear fluids - 2 hours
Alcohol - 24 hours
Breast feeding -  4 hours
Children water - 30ml max one hour before
44
Q

Lignocaine dose

A

3mg/kg (7mg/kg w adrenaline)

45
Q

Bupivicaine dose

A

2mg/kg (2mg/kg)

46
Q

Prilocaine dose

A

6mg/kg (9mg/kg)

47
Q

Anti-emetic generally used in surgery

A

Dexamethasone

48
Q

Anti-emetic generally used post-surgery

A

Ondansentron

49
Q

Give an example of colloid fluids

A

Gelofusine
Isoplex
Gelaspan

50
Q

Give an example of colloid fluids

A

Gelofusine
Isoplex
Gelaspan

51
Q

Adult requirements for fluid and electrolytes for maintenance?

A

25-30ml/kg water
1mmol / kg potassium, sodium, chloride
50-100g/day glucose

ACC (3 decks)

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