Anaesthetics Flashcards
Regarding the triad of anaesthetic medications, state what they are:
From the anaesthetic drug classes below, state what part of the triad above they predominantly act upon:
a) Opiates
b) GA
c) LA
d) Muscle relaxants
• Hypnosis
• Analgesia
• Relaxation
a) Opiates: analgesia
b) GA: hyponosis
c) LA: analgesia
d) Muscle relaxants: relaxation
As a general rule of thumb, when prescribing maintanence fluids, how many mmol/kg/24h of SODIUM do people require?
1 mmol/kg/24h
Name the drug classes used in each of the 3 steps of the WHO pain ladder. Give an example of a drug in each class.
Explain how to use the WHO pain ladder.
Step 1: NSAIDs & paracetemol
~ Aspirin, Ibuprofen, Diclofenac
Step 2: Mild opioids (codeine/ tramadol) +/- NSAIDs/ paracetemol
Step 3: Strong opiods (morphine/ fentanyl) +/- NSAIDs/ paracetemol
Start with step 1, if pain not tolerated, add in mild opioid. If not tolerated, swap mild opioid fo strong one with NSAID/ paracetemol still
What is the ASA grading system used for in anaesthetics?
Describe each ASA grade 1-6:
ASA used to identify how healthy the patient is in order to stratify the risk of surgery on the patient
ASA1: Healthy patient, non-smoker
ASA2: Mild systemic disturbance/ smoker/ obesity (eg, well controlled diabetes/ hypertension)
ASA3: Severe systemic disturbance (eg, poorly controlled diabetes/ hypertension)
ASA4: Life threatening disease (eg, recent MI/ sepsis)
ASA5: Moribund patient (unlikely to survive the surgery)
ASA6: Organ retrieval (patient is brain dead)
Give 3 examples of crystalloid fluids that can be used for maintenance:
- 5% dextrose
- 0.9% saline
- Hartmanns
Now-a-days most medications aren’t stopped before surgery, even if patients are NBM…!
List 3 medications that would never be stopped before a surgery:
List 2 medications that may be stopped before a surgery:
Never stop:
• Inhalers
• Anti-anginals (GTN)
• Anti-epileptics
Sometimes may stop:
• Diabetic meds
• Anti-coagulants
When should an ADR be reported to the yellow card scheme? (3)
- Any ADR seen in a new drug
- Any ADR in children
- Any serious ADR, even if the ADR is already known about (eg neutropenia/ agranulocytosis etc)
Medications that are associated with dependence which have the potential to be abused are classed as what types of drug?
Controlled drugs
What are the 7 phases that anaethetists go through to manage a patient?
~ Note which ones are the 4 phases of anaesthesia
1) Pre-operative care/ planning
2) Preparation
* 3) Induction*
* 4) Maintenance*
* 5) Emergence (waking patient up)*
* 6) Recovery*
7) Post-operative care
Describe the location & level of support provided in each level 1-3 of the organ system support:
Level 1 care: medical ward based care
Level 2 care: HDU - offers single organ support (eg heart failure)
Level 3 care: ICU - offers multiple organ support
List some patient factors that an anaesthetist would aim to optimise in their pre-operative assessment: (6)
- Diabetes control
- Hypertension control
- COPD
- Epilepsy
- Heart failure
- Lifestyle: weight, exercise tolerance, smoking cessation
Describe what nociceptive pain is:
Describe what neuropathic pain is:
Note whether they have a protective function or not.
Nociceptive pain = pain when there is tissue injury or illness (eg when you cut yourself)
~ has a protective function (the pain causes you to stop whatever is causing the pain)
Neuropathic pain = pain caused by nervous system damage / abnormality
~ no protective function, often occurs long after there has been trauma!
What is an unliscenced drug?
What is an ‘off label’ drug?
Unliscenced drug: the drug is used in other countries but has not been approved in the UK (or it is being used in a different form to what it is liscened as, eg powdered tablet for children instead of the tablet)
- *Off label drug:** the drug is liscenced by the MRHA but not for the treatment of the condition you are prescribing for
- or* it is being used in a different age group to that listed on the liscence
What is calculated alongside the ASA grade to risk stratify the patient before surgery?
~ a score of what makes them a high risk patient?
How is a patients exercise tolerance graded? (what unit is used?)
~ What score would the following exercise tolerances be given:
a) walking around the house
b) walk 100-200m on flat
c) strenuous exercise
Cardiac risk index - score 2+ = high risk patient!
METs
a) 2 METs
b) 4 METs
c) 9 METs
(Eg, diabetes, renal failure, ischaemic heart disease, congestive heart failure etc)
You are working in A&E and a patient is hypotensive. What do you do to increase the BP?
How much of this would you give and over what time?
IV fluid resuscitation
500ml saline or plasmalyte bolus over 15 mins
List some reasons to intubate a patient: (4)
- Protection from aspiration
- Muscle relaxation is needed for the operation
- Shared airway (the surgery invovles the airways areas)
- Need for tight CO2 control
Name the 2 types of fluids available to be prescribed:
Which type of fluid is able to diffuse accross cell membranes?
Crystalloids, colloids
Crystalloids
What type of pain will the WHO pain ladder be successful at helping?
What is the treatment for the other type of pain? (name 2 examples of drugs used)
Nociceptive pain = use WHO pain ladder
Neuropathic pain - WHO pain ladder doesn’t work
~ amitriptylline
~ gabapentin
~ duloxetine
Name the drug classes used in each of the 3 steps of the WHO pain ladder. Give an example of a drug in each class.
Explain how to use the WHO pain ladder.
Step 1: NSAIDs & paracetemol
~ Aspirin, Ibuprofen, Diclofenac
Step 2: Mild opioids (codeine) +/- NSAIDs/ paracetemol
Step 3: Strong opiods (morphine) +/- NSAIDs/ paracetemol
Start with step 1, if pain not tolerated, add in mild opioid. If not tolerated, swap mild opioid fo strong one with NSAID/ paracetemol still
TRUE/ FALSE:
- Blood pressure normally goes up under anaesthesia.
- End tidal CO2 measures how much CO2 the patient breathes in.
- There are 5 pieces of monitoring that must be present before a GA is given.
- Only some patients require airway management whilst under anaesthesia.
False - anaesthetics commonly make BP fall
False - the amount of CO2 breathed out
True - BP, SATs, ECG, end tidal CO2, airway pressure
False - every patient will require some degree of airway management
In the RAT approach to pain management, what does R, A, T stand for?
How would a patient describe nociceptive pain?
How would a patient describe neuropathic pain?
- *R** - recognise pain
- *A** - assess pain type/ severity
- *T** - treat pain
Nociceptive pain:
• Sharp/ dull pain
• Well localised (patient can point to location of pain)
Neuropathic pain:
• Burning/ shooting pain
• Pins & needles
• Numbnesss
How many days supply of controlled drugs are given at any time?
Up to 30 day supply
Regarding fluids, (colloid & crystalloid’s):
1) give an example of each type commonly used in hospital
2) describe the size of the molecules they contain & the consequence of this on fluid compartments within the body
3) state a contraindiction in each type
- *1) Colloid**: fluid containing starch/ gelatin
- *Crystalloid**: plasmalyte/ hartmans/ dextrose/ 0.9%NaCl
- *2) Colloid:** large molecules → more fluid is retained in the blood vessels
- *Crystalloid:** small molecules → some fluid remains in blood vessels & some moves into the tissues/ cells
- *3)** Colloid: the large molecules can cause kidney damage (so cannot be used in patients with renal failure)
- *Crystalloid:** 0.9%NaCl has a high Na conc so can cause hypernatraemia
What 3 things are included in the triad of anaesthesia? (targets of drug action)
- Analgesia
- Hypnosis
- Relaxation (of muscles)
What are the 5 standard things that the anaesthetic machine monitors?
- ECG
- SATs
- BP
- End tidal CO2
- Airway pressure
