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Medicine year 3 > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

what are the 4 stages of anesthesia?

A
  1. induction
  2. maintenance
  3. emergence
  4. recovery
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2
Q

what are the main observations (5) taken while someone is under general anesthetic

A
  1. ECG (3 lead or 5 lead in vascular)
  2. 02 saturation (finger, ear, lip, probes)
  3. Non-invasive BP
  4. End Tidal C02 (amount of C02 breathed out during a normal breath)
  5. airway pressure (patency of airway)
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3
Q

Why is end total C02 volume measured?

A
  1. patent airway - if gas is leaving the lungs
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4
Q

why is supplemental oxygen given before being put to sleep? (pre-oxygenation)

A

Safety - remain oxygenaed between awake-sleep

  • increase the time until desaturation occurs
  • reduced functional residual capacity under anaesthesia (what is left in lungs after a normal breath) important volume because it allows 02 to continue to go into the blood when you are not breathing
  • mechanics of breathing decrease (all muscles relax/reduced tension)
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5
Q

which two ways can induction medications be given?

A

IV injection

or gasesous (takes a little longer)

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6
Q

which 2 classes of drugs are given during induction

A
  1. analgesic (fast actin opiate)
  2. hypnotic
  3. muscle relaxantt (not always)
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7
Q

what are the planes of anaesthesia in regards to consciousness?

A
  1. conscious sedation (analgesia and amnesia)
  2. delirum to unconsciousness (disinhibited)
  3. surgical anestheisa*** - no movement or response
  4. Apnoea to death (not breathing, autonmoic dysfunction, arrythmias, CV instability)
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8
Q

why is airway management important?

A
  • there is a loss of airway reflex
  • and relaxation of tissues

(no longer cough in response to secretions being in the larynx, swallow or protect lungs) - all of the soft tissues are relaxed

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9
Q

what is the triple airway manouvere

A
  1. head tilt
  2. jaw thrust
  3. open mouth

*this is done everytime

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10
Q

an endotracheal tube (ETT) passes beyond the vocal cords

a. true
b. false

A

a. true

stops anything going into patients lungs - FULLY PROTECTS THE AIRWAY and is positive pressure management

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11
Q

what device is needed to fit an endotracheal tube?

A

laryngoscope

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12
Q

reasons to intubate a patient?

A
  • fully protect airway - from aspiration
  • need for muscle relaxation
  • shared airway (Surgery in the airway)
  • need for tight C02 control -
  • minimal acess to patient

if complete control is needed!

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13
Q

name three ways patients breathing can be described

A
  1. spontaneous ventiliation - breathes for themselves
  2. controlled ventilation - you do it for them
  3. supported ventilation - help/halfway boost
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14
Q

how often is BP checked

A

every 5 minutes

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15
Q

risks associated with anaesthetics

A
  • anaphylaxis (lots of IV drugs)
  • regurgitation and aspiration (stomach content - into lungs) - manage airway
  • airway obstruction and hypoxia (pre-oxygenate)
  • larnygospasm (stimulates vocal cords - snap shut)
  • cardiovascular instability
  • cardiac arrest
  • eye trauma
  • VTE
  • pressure injury
  • hypothermia
  • nerve injury

-> also awareness (sounds, pain,)

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16
Q

why are the eyes taped shut?

A

risk of corneal abrasion

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17
Q

there is a risk of hypothermia

a. true
b. false

A

a.true

  • open body cavity, exposed

(cover all areas, blow hot air)

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18
Q

which nerves are often at risk due to long term positioning

A

the common perineal nerve (fibula head)

ulnar nerve (elbow)

brachial plexus

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19
Q

how is anaestheisa maintained

A
  1. vapour - gas
  2. IV anaesthesia (TIVA) continuous infusion
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20
Q

what is documented

A
  • prescription record of drugs used
  • observation NEWS chart
  • Ventilation chart
  • fluid balance
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21
Q

how does emergent phase occur

A

reversal of neuromuscular blocks

anaesthic agent is stopped

(there is return of spontaneous breathing and airway reflexes i.e. swallowing and couhging, suction and removal of airway device) transfer to recovery

22
Q

what happens in recovery

A
  • manage ABC until awake
  • analgesia
  • management of nausea
  • handover to ward
23
Q

what is the triad of drugs in anaestheisa

A
  1. analgesia
  2. hypnotics
  3. paraylsis
24
Q

outline IV induction phase

A
  • propofol + opiod

+/- muscle relaxant

25
Q

outline inhalational induction

A

volatile (Sevoflurane)

26
Q

outline inhalation maintance

A

volatile (sevoflurane) +/- opioid

27
Q

outline IV maintainece

A

propofol +/- opioid (TIVA)

+/- muscle relaxant

28
Q

which label colour are for induction agents?

A

YELLOW

29
Q

most common induction agent?

A

propofol (hyponotic) 1%

yellow label - activates inhibitory channels (GABA-A)

sevoflurane (hypnotic) for inhaled

30
Q

propofol reduces the resting membrane potential

a. true
b. false

A

a. true

-90-> more negative - cannot get excited

31
Q

what colour of label are opiates in

A

blue

usually given with an induction agent , thoughtout and at the end

32
Q

when are opioids usually given

A

with induction agent, throught and end

33
Q

short acting opiates

A

fentanyl

afentanyl

given as bolus -do not accumulate

34
Q

morphine is a weaker opiate with slower onset (5 mins IV),

a. true
b. false

A

a. true

has a longer duration of action

35
Q

what is remifentanyl

A

opioid often given as part of TIVA as infusion because it does not accumulate

36
Q

what colour of labour are muscle relaxanats

A

red label

  • work at neuromuscular junction (block ACh receptors)
  • only given once asleep/when sleeping
37
Q

How does anaesthetics affect CVS

A

reduces MAP because it reduces

HR and SV (reduced BP)

reduces systemic vascular resistence

MAP = CO x SVR

38
Q

effect of anaesthetis on RR

A

RR and tidal volume are reduced due to depresison of respiratory centres

why patients are ventilated or tube

39
Q

type 1 respiratory failure

A

oxygenation failure

  • give 02 and it will go up

hypoxaemia (PaO2 <8 kPa / 60mmHg) with normocapnia (PaCO2 <6.0 kPa / 45mmHg)

40
Q

type 2 respiratory failure

A

oxygenation and ventilation

  • C02 clearance is also poor - usually something needing to be fixed re. mechanisms of breathing

hypoxaemia (PaO2 <8 kPa / 60mmHg) with hypercapnia (PaCO2 >6.0 kPa / 45mmHg)

41
Q

BiPAP

A

more commonly used in type 2 respiratory failure because it provides two levels of pressure: a higher inspiratory pressure (IPAP) and a lower expiratory pressure (EPAP). This helps to assist both ventilation (getting rid of CO2) and oxygenation (getting O2 into the lungs).

42
Q

CPAP

A

e helpful in maintaining airway pressure and preventing collapse of alveoli, is more commonly used for oxygenation support in conditions like type 1 respiratory failure (hypoxemic respiratory failure).

43
Q

what is shock

A

acute circulatory failure with inadequete distributed tissue persuion resulting in cellular hypoxia

44
Q

cardiogenic shock is due to

A

pump failure - of heart (HF, ACS)

45
Q

What is hypovolaemic shock due to

A

loss of blood - GI, or high output from stomas

46
Q

response to septic shock

A

dilated BP vessels cause BP to drop

-> give fluids

47
Q

what 3 factors affect Stroke volume

A
  1. preload
  2. contracility
  3. afterload
48
Q

where might an arterial line be inserted

A

radial, brachial, femoral

  • blood samples for ABG
49
Q

where might central line be inserted

A

big vessels near the heart

50
Q
A

Medicine year 3 (14 decks)

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