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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
what induction agent should be used if a patient has a history of cardiac disease or cardiac failure?
etomidate
26
Etomidate should never be used for critically ill patients with septic shock - why?
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
27
What induction agent may be considered for a short procedure?
Ketamine as it is short-acting
28
Why is etomidate rarely used?
adrenocortical suppression and high incidence of PONV
29
Why would a patient require a rapid sequence induction?
If a patient had a full stomach for any reason
30
Which volatile agent can be used without IV access?
Sevoflurane
31
Which volatile agent has a sweet smell?
sevoflurane
32
which volatile agent is the most appropriate for a transplant operation? why?
Isoflurane as it has the least effect on organ blood flow
33
Which volatile agent would be most appropriate for the use in a long operation?
Desflurane as it's low lipid solubility leads to a rapid onset and offset
34
why is analgesia necessary?
Analgesia is required for insertion of the airway, intra-operative pain and post-operative pain.
35
How long does it take for analgesic agents to take effect?
1- 5 minutes, so they are generally given before induction agents
36
What are the 2 groups of muscle relaxants?
depolarising and non-depolarising
37
Is suxamethonium depolarising or non-depolarising?
depolarising
38
what is the safe dose of suxamethonium?
1-1.5mg/kg
39
What is used to reverse the effect of non-depolarising medications?
neostigmine and glycopyrrolate
40
what is glycopyrrolate?
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
what is neostigmine?
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
What are the side effects of neostigmine?
nausea and vomiting
43
Why are vaso-active drugs necessary in anaesthetics?
to treat the hypotension caused on induction
44
What is the action of ephedrine?
It has direct and indirect action on both alpha and beta receptors to increase BP (by increasing contractility) and increasing HR
45
what is the action of phenylephrine?
Direction action on the alpha receptors to increase blood pressure (via vasoconstriction) and decrease HR (reflex)
46
Which vast-active drug is longer acting: | Ephedrine or phenylephrine?
phenylephrine
47
Which vast-active drugs are most likely to be used on ICU?
Noradrenaline, adrenaline or dobutamine
48
What is the action of metaraminol?
increase BP and decrease HR by direct and indirect action on the alpha receptors
49
What is the first choice of anti-emetic?
Ondansetron
50
What is the second choice anti-emetic?
dexamethasone
51
What is the 3rd choice anti-emetic?
Cyclizine
52
What is the order of administration when using an LMA?
1. Oxygen 2. Opioid 3. Induction agent 4. Volatile agent 5. Bag Valve Mask Ventilation 6. LMA insertion
53
What is the order of administration when using intubation?
1. Oxygen 2. Opioid 3. Induction agent 4. Volatile agent 5. Bag Valve Mask Ventilation 6. Muscle relaxant 7. ET intubation
54
How would you pre oxygenate a patient of a RSI?
Use a face mask for 3 minutes or 5 full capacity breaths until the end tidal o2 concentration is >90
55
Why do we pre oxygenate patients before RSI?
to replace the functional residual capacity with oxygen
56
What medications are used for RSI?
Thiopentone (4-5mg/kg), Propofol (1.5-2.5mg/kg) and suxamethonium (1.15mg/kg)
57
What is the technique for RSI?
1. Pre oxygenation 2. Drugs 3. Cricoid pressure 4. Apnoeic ventilation 5. Intubation
58
Which volatile agent can also be used as an induction agent?
Sevoflurane
59
Which short acting analgesia is most commonly used?
fentanyl, commonly used with midazolam
60
Which long acting analgesias is commonly used?
1. Morphine | 2. Oxycodone
61
What is fentanyl often used in combination with? What is the dose of this drug?
Midazolam, 1mg IV administered over 2 minutes
62
What is the antidote for opioids?
Naloxone
63
What is the most common post-op analgesic drugs combination?
1. Paracetamol 2. NSAIDs 3. Dihydrocodeine
64
What is diclofenac?
an NSAID
65
What is parecoxib?
an NSAID
66
What is Ketorolac?
an NSAID
67
What is lignocaine?
a local anaesthetic
68
What is the max dose of lignocaine without adrenaline?
3mg/kg
69
What is the max dose of lignocaine with adrenaline?
7mg/kg
70
What kind of duration does lignocaine have?
short
71
What is bupivacaine?
a local anaesthetic
72
What is the max dose of without adrenaline bupivacaine?
2mg/kg
73
what is the max dose of bupivacaine with adrenaline?
2mg/kg
74
What is prilocaine?
a local anaesthestic
75
what is the max dose of prilocaine with adrenaline?
6mg/kg
76
What is the max dose of prilocaine without adrenaline?
9mg/kg
77
Why is adrenaline given with some local anaesthetics?
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
How do you work out the max dose of local anaesthetic for a patient?
Weight of patient (kg) x max dose of drug --------------------------------------- Concentration (%) x 10 (to convert to mg/ml)
79
What are the early symptoms of local anaesthetic toxicity?
tingling sensation around mouth and ringing in ears
80
What is the antidote for local anaesthetics?
intralipid

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