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Hugh's MD2 Surgery > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

How do you treat malignant hyperthermia?

A

Dantrolene

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2
Q

Into which space do epidural blocks go?

A

Epidural space

(Intrathecal)

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3
Q

What is the main advantage of a endotracheal tube?

A

Airway protection

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4
Q

Into which space do spinal blocks go?

A

Subarachnoid

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5
Q

Which broad class of agents are used for muscle relaxant? What are some called? How do they work?

A

Non-depolarising muslce relaxants

Rocuronium, Vecuronium, Atracurium, Sistracurium

Blocking post synaptic ACh receptor at the neuromuscular junction

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6
Q

What are some options for local anaesthetics? What are their strength and weaknesses’?

A

Lignocaine - Fast acting, short acting, highly toxicity

Bupivicaine - Slow onset, long acting, low toxicity

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7
Q

What is the dose of suxamethonium for rapid sequence induction intubation?

A

1-2mg/kg TBW

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8
Q

Which agent is used for maintenance?

A

Sevofluorone - inhaled volatile agent

Morphine

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9
Q

What is the best measure of the success of ventilation in a GA?

A

Expired CO2

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10
Q

Which type of regional block has a quicker onset?

A

Spinal

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11
Q

What are the three phases of anaesthetics?

A

Induction

Maintenance

Reversal

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12
Q

Which type of regional block uses a greater volume of anaesthetic, spinal or epidural?

A

Epidural

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13
Q

Which agent is used rapid sequence induction? Why? How does it work?

A

Suxamethonium

It has a rapid onset ~1min

It is a ACh receptor agonist > causes complete depolarisation that lasts for ~3-5mins

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14
Q

What are some indications for muscle relaxant GA?

A

Thoracic/Abdo/Neuro surgery

Prone position

Long procedure

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15
Q

How does morphine work?

A

It’s an agonist to the Mu receptors in the CNS

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16
Q

Compare the location of administration of spinal and epidural blocks?

A

Spinal is below L1/L2 and it will travel throughout the space

Epidurals are administered at the target site

17
Q

What are some downsides of suxamethonium?

A

Causes myalgia

Can trigger malignant hyperthermia

Some patients are deficient in pseudo cholinesterase - sux takes a long time to wean from = ICU on ventilator

18
Q

What is the utility of spinal blocks?

A

Caesarians - can’t expose babies to GA

Orthopaedics

19
Q

What are you concerned about when using regional blocks? How do you manage it?

A

Both can cause a loss of sympathetic tone and vasodilatation (esp spinals)

Preload the patient with 1L of Hartman’s and prepare a vasopressor

20
Q

How do you reverse a spontaneous ventilation GA?

A

Turn O2 up to 100% (turning off the volatile maintenance)

21
Q

What deficiency causes malignant hyperthermia?

A

Ryanodine receptor gene deficiency

22
Q

What are some induction agents? What are their specific roles/doses?

A

Benzodiazapene - Anxiolytic - 2-5mg IV

Fentanyl - Reduce broncho spasm - 100mcg IV

Propofol - Induce hypnosis - 200mg IV

23
Q

How are muscle relaxants blocked? What is the name of one such agent?

A

Acetylcholinesterase inhibitors to increase the ACh at the neuromuscular junction - Neostigmine

ACh is a muscarinic agonist therefore cause bradycardia so must be accompanied with atropine or glycopyyrolate

24
Q

What is the triad of anaesthetics?

A

Hypnosis

Analgesia

Immobility

25
Q

Which patients are at higher risk of aspiration?

A

Trauma/ED

Full stomach

GORD

Pregnant

Bowel obstruction

OSA

Obesity

26
Q

What are the two types of GA’s?

A

Spontaneous ventilation

Muscle relaxant GA

27
Q

What type of airway aduvant is required for a spontaneous ventilation GA?

A

Laryngeal mask

28
Q

When is rapid sequence induction required?

A

When there is high risk of aspiration, usually due to a full stomach - trauma/ED cases

29
Q

What are some risk factors for developing post operative NV (OPNV)

A

Female

Younger age

Non-smoking

Hx of OPNV

30
Q

When is spontaneous ventilation GA indicated?

A

Quick

Minimally invasive

Superficial procedures

Hugh's MD2 Surgery (29 decks)

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