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MD Olivia Drugs > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

anaesthetics are either delivered…

A

IV or inhalational

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2
Q

what anaesthetics are the fastest in inducing anaesthesia?

A

propofol and etomidate ~ 30 secs

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3
Q

what is unique about propofol as an induction anaesthetic?

A

Of the available induction agents, propofol has a unique ability to suppress airway reflexes and to produce apnea

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4
Q

How might we clarify correct airway placement of the endotracheal tube?

A
  • Effective manual ventilation.
    ●Symmetrical chest rise.
    ●Visible condensation in mask or tube of airway device.
    ●End-tidal CO2 waveform on gas analyzer.
    ●If endotracheal tube placed, right mainstem bronchus intubation and esophageal intubation must be ruled out with bilateral breath sounds and lack of sounds of air entry into stomach, and CO2 wave form detection. Especially in thin patients, air entry into the stomach may be heard in the chest and mistaken for breath sounds.
    ●If a SGA is used, air leak should occur at high enough peak pressure to allow adequate tidal volume, 18 to 20 cm H2O.
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5
Q

another name for suxamethonium?

A

succinylcholine

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6
Q

3 stages of anaesthesia

A
  1. Induction
  2. Maintenance
  3. Reversal
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7
Q

what are the 2 forms of GA?

A
  1. Spontaneous ventilation (Laryngeal mask airway- supraglottis airway)
  2. Assisted ventilation with NM blocking agent (endotracheal tube)
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8
Q

what are the 3 types of anaesthesia?

A
  1. General Anaesthesia
  2. Regional anaesthesia
  3. Local anaesthesia
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9
Q

what are 2 forms of regional anaesthesia?

A

Epidural

Spinal

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10
Q

when would we consider Assisted ventilation with NM blocking agent and ETT for GA?

A 
Would use assisted ventilation for Neurosurgery, Major cavity surgery, Long surgery and for special anaesthetic indications such as:
	• Non fasting- trauma
	• GORD
	• Pregnancy > 20 weeks 
	• Obesity
	• OSA
etc
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11
Q

complications of anaesthesia?

A 
• Allergy/anaphylaxis
	• Malignant hypertension
	• Risk of respiratory depression
	• Aspiration risk
	• Damage to spinal nerve (regional)
	• BLEEDING
	• INFECTION
\+ PONV
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12
Q

where is a spinal anaesthesia injected?

A

Injected into the Subarachnoid space below L1-L2

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13
Q

what drugs can we use for induction of anaesthesia with spontaneous ventilation?

A

IV Midazolam
IV Fentanyl
IV Propofol ( the main one)

Or Etomidate

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14
Q

what neuromuscular blocking drugs are there?

A

Recuronium
/Veccuronium
/atrecurium

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15
Q

describe the procedure of induction of anaesthesia?

A
  1. Place oxygen mask on patient
  2. Ask the patient to take nice deep breaths to fill lungs with oxygen. = PRE-OXYGENATION
  3. If spontaneous ventilation- laryngeal mask airway- insert and inflate. Attach mask to it.
    OR
  4. NM blockers= AcH R competitive antagonists. Non depolarising. If used, must ventilate the patient with endotracheal tube!!
  5. Intubate with laryngoscope and inflate ETT. Attach mask to it
  6. Listen to the left hand side bc most likely go down R main bronchus.
  7. Check CO2 levels
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16
Q

what inhaled drug do we use during maintenance of anaesthesia?

A

sevoflurane

17
Q

what other adjunct drugs do we use during maintenance of anaesthesia?

A

oxygen

morphine IV

18
Q

what do we do when we reverse anaesthesia?

A
  1. Turn off all anaesthetics running
  2. Turn the oxygen up to 100%
  3. Maintain analgesia
  4. If used NM block need neostigmine, which is acetylcholinesterase inhibitor. + atropine (antimuscarinic)
  5. SLUD effects and bradycardia

Extubate- deflate endotracheal tube

19
Q

Tell me about ketamine

A

Dissociative anaesthetic drug
Commony used in developing countries
Causes hypersalivation
Doesn’t ablate reflexes so hard to intubate

20
Q

what drugs do we use to reverse NM blocking drugs?

A

Neostigmine
Atropine
Glycopyrolate
Sugammadex

21
Q

what drugs in particular do sugammadex reverse?

A

rocuronium and vercuronium

22
Q

define MAC for inhaled anaesthetics

A

Each agent has a specific minimum alveolar concentration (MAC), defined as the amount of vapour (%) needed to render 50% of spontaneously breathing patients unresponsive to a standard painful surgical stimulus. MAC is inversely proportional to potency.

23
Q

Why dont we use desflurane for induction anaesthesia?

A

causes respiratory and salivary secretions

24
Q

what type of allergy do we need to worry about with propofol anaesthetic?

A

egg allergy as propofol emulsion contains egg

25
Q

is thiopental suitable for maintenance anaesthesia?

A

no. it has zero order kinetics and rather slow metabolism

26
Q

what kind of drug is thiopental?

A

thiobarbituate anaesthetic drug

27
Q

adverse effects and contraindications for thiopental?

A

hangover effect, histamine release–> inflammation and contraindicated in porphyria

28
Q

what are the two groups of local anaesthetics?

A

amine and esters

29
Q

which form of local anaesthetic- charged or uncharged, can pass the cell membrane?

A

uncharged

30
Q

what is the molecular target for action of local anaesthetics?

A

blocks sodium channels

31
Q

tell me about suxamethonium?

A

suxamethonium is a depolarising neuromuscular blocking drug, that binds to AcH receptors on post synaptic membrane and prevents AcH from binding. Is metabolised by cholinesterase. Very fast acting.

32
Q

SE of suxamethonium?

A 
Malignant hyperthermia
apnea
anaphylaxis
hyperkalemia
increased intraocular pressure
myalgia
bradycardia
histamine release
33
Q

how do non depolarising neuromuscular blockers work?

A

they reversibly competitively antagonise Ach receptor

34
Q

what are the two types of non depolarising neuromuscular blockers?

A

aminosteroids and benzylisoquinoliniums

35
Q

where does neostigmine act?

A

acts on both muscarinic and nicotinic receptors hence SLUD effects

36
Q

what is neostigmine always administered with?

A

atropine or glycopyrolate to reduce SLUD effects

37
Q

how do we assess neuromuscular activity during general anaesthesia using muscle relaxant?

A

apply charge to ulnar nerve and look for T1 movement. TOF

38
Q

what kind of drug is metaraminol? why is it used in anaesthetics

A

metaraminol is an alpha 1 agonist that mediates peripheral vasoconstriction. used for hypotension

MD Olivia Drugs (27 decks)

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