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ACC > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

What are the three elements of general anaesthesia?

A
  1. Amnesia
  2. Analgesia
  3. Akinesis
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2
Q

What do induction agents do?

A

induce loss of consciousness (amnesia)

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3
Q

What is the most common induction agent?

A

propofol

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4
Q

What is the safe dose of propofol?

A

1.5-2.5mg/kg

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5
Q

True or false: Propofol increases post-operative vomiting and nausea

A

FALSE - It decreases PONV

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6
Q

How does propofol effect a patient’s heart rate and blood pressure?

A

It causes them to drop

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7
Q

What is the second choice of induction agent?

A

Thiopentone

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8
Q

what is the safe dose of thiopentone?

A

4-5mg/kg

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9
Q

which induction agent will take effect faster - propofol or thiopentone?

A

Thiopentone

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10
Q

What induction agent should be considered in a patient needs a rapid sequence induction?

A

Thiopentone

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11
Q

why is thiopentone useful for neurosurgery?

A

It has anti-epileptic properties

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12
Q

How long should induction agents take to send a patient to sleep?

A

15-20 seconds!

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13
Q

Why does induction happen so quickly?

A

They are lipid soluble and can quickly cross the blood brain barrier

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14
Q

How does thiopentone effect the heart rate and blood pressure of a patient?

A

drop in BP but increase in HR

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15
Q

When is thiopentone contradicted?

A

porphyria

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16
Q

Which induction agent is associated with dissociative anaesthesia?

A

Ketamine

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17
Q

Which induction agent is associated with the emergence phenomenon?

A

Ketamine - it is only used in 1-2% of patients as a result

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18
Q

Which has a slower onset - Ketamine or etomidate?

A

Ketamine - approx 90 seconds for induction

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19
Q

What is the safe dose of ketamine?

A

1-1.5mg

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20
Q

What effect does ketamine have on a patient’s heart rate and blood pressure?

A

It will increase both HR and BP

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21
Q

With which of these induction agents would you expect pain on injection? 1. Etomidate 2. Ketamine 3. Thiopentone 4. Propofol

A
  1. Etomidate and 4. Propofol
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22
Q

How long do induction agents last?

A

4-10 mins

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23
Q

How do you maintain amnesia after induction?

A

Inhalation (volatile) agents

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24
Q

What is the safe dose of etomidate?

A

0.3mg/kg

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25
Q

what induction agent should be used if a patient has a history of cardiac disease or cardiac failure?

A

etomidate

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26
Q

Etomidate should never be used for critically ill patients with septic shock - why?

A

Etomidate is steroid based, continuous infusion can lead to adrenocortical dysfunction which can prevent the body bringing the BP back to normal and thus worsening shock

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27
Q

What induction agent may be considered for a short procedure?

A

Ketamine as it is short-acting

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28
Q

Why is etomidate rarely used?

A

adrenocortical suppression and high incidence of PONV

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29
Q

Why would a patient require a rapid sequence induction?

A

If a patient had a full stomach for any reason

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30
Q

Which volatile agent can be used without IV access?

A

Sevoflurane

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31
Q

Which volatile agent has a sweet smell?

A

sevoflurane

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32
Q

which volatile agent is the most appropriate for a transplant operation? why?

A

Isoflurane as it has the least effect on organ blood flow

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33
Q

Which volatile agent would be most appropriate for the use in a long operation?

A

Desflurane as it’s low lipid solubility leads to a rapid onset and offset

34
Q

why is analgesia necessary?

A

Analgesia is required for insertion of the airway, intra-operative pain and post-operative pain.

35
Q

How long does it take for analgesic agents to take effect?

A

1- 5 minutes, so they are generally given before induction agents

36
Q

What are the 2 groups of muscle relaxants?

A

depolarising and non-depolarising

37
Q

Is suxamethonium depolarising or non-depolarising?

A

depolarising

38
Q

what is the safe dose of suxamethonium?

A

1-1.5mg/kg

39
Q

What is used to reverse the effect of non-depolarising medications?

A

neostigmine and glycopyrrolate

40
Q

what is glycopyrrolate?

A

It is an anti-muscarinic that is given to increase HR when given with neostigmine [to overall reverse non-depolarising akinesis medications] as neostigmine can cause bradycardia

41
Q

what is neostigmine?

A

an anti cholinesterase - this will block acetylcholinesterase so there will be an increase in acetylcholine in the synapse. As this is involved in the parasympathetic nervous system it can cause bradycardia

42
Q

What are the side effects of neostigmine?

A

nausea and vomiting

43
Q

Why are vaso-active drugs necessary in anaesthetics?

A

to treat the hypotension caused on induction

44
Q

What is the action of ephedrine?

A

It has direct and indirect action on both alpha and beta receptors to increase BP (by increasing contractility) and increasing HR

45
Q

what is the action of phenylephrine?

A

Direction action on the alpha receptors to increase blood pressure (via vasoconstriction) and decrease HR (reflex)

46
Q

Which vast-active drug is longer acting:

Ephedrine or phenylephrine?

A

phenylephrine

47
Q

Which vast-active drugs are most likely to be used on ICU?

A

Noradrenaline, adrenaline or dobutamine

48
Q

What is the action of metaraminol?

A

increase BP and decrease HR by direct and indirect action on the alpha receptors

49
Q

What is the first choice of anti-emetic?

A

Ondansetron

50
Q

What is the second choice anti-emetic?

A

dexamethasone

51
Q

What is the 3rd choice anti-emetic?

52
Q

What is the order of administration when using an LMA?

A
  1. Oxygen
  2. Opioid
  3. Induction agent
  4. Volatile agent
  5. Bag Valve Mask Ventilation
  6. LMA insertion
53
Q

What is the order of administration when using intubation?

A
  1. Oxygen
  2. Opioid
  3. Induction agent
  4. Volatile agent
  5. Bag Valve Mask Ventilation
  6. Muscle relaxant
  7. ET intubation
54
Q

How would you pre oxygenate a patient of a RSI?

A

Use a face mask for 3 minutes or 5 full capacity breaths until the end tidal o2 concentration is >90

55
Q

Why do we pre oxygenate patients before RSI?

A

to replace the functional residual capacity with oxygen

56
Q

What medications are used for RSI?

A

Thiopentone (4-5mg/kg), Propofol (1.5-2.5mg/kg) and suxamethonium (1.15mg/kg)

57
Q

What is the technique for RSI?

A
  1. Pre oxygenation
  2. Drugs
  3. Cricoid pressure
  4. Apnoeic ventilation
  5. Intubation
58
Q

Which volatile agent can also be used as an induction agent?

A

Sevoflurane

59
Q

Which short acting analgesia is most commonly used?

A

fentanyl, commonly used with midazolam

60
Q

Which long acting analgesias is commonly used?

A
  1. Morphine

2. Oxycodone

61
Q

What is fentanyl often used in combination with? What is the dose of this drug?

A

Midazolam, 1mg IV administered over 2 minutes

62
Q

What is the antidote for opioids?

63
Q

What is the most common post-op analgesic drugs combination?

A
  1. Paracetamol
  2. NSAIDs
  3. Dihydrocodeine
64
Q

What is diclofenac?

65
Q

What is parecoxib?

66
Q

What is Ketorolac?

67
Q

What is lignocaine?

A

a local anaesthetic

68
Q

What is the max dose of lignocaine without adrenaline?

69
Q

What is the max dose of lignocaine with adrenaline?

70
Q

What kind of duration does lignocaine have?

71
Q

What is bupivacaine?

A

a local anaesthetic

72
Q

What is the max dose of without adrenaline bupivacaine?

73
Q

what is the max dose of bupivacaine with adrenaline?

74
Q

What is prilocaine?

A

a local anaesthestic

75
Q

what is the max dose of prilocaine with adrenaline?

76
Q

What is the max dose of prilocaine without adrenaline?

77
Q

Why is adrenaline given with some local anaesthetics?

A

to prolong the duration of action - it does this via vasoconstriction which increases the time it will take for the anaesthetic to become metabolised

78
Q

How do you work out the max dose of local anaesthetic for a patient?

A

Concentration (%) x 10 (to convert to mg/ml)

79
Q

What are the early symptoms of local anaesthetic toxicity?

A

tingling sensation around mouth and ringing in ears

80
Q

What is the antidote for local anaesthetics?

A

intralipid

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