ANAESTHETICS Flashcards
does smoking make you hyper-coagulable or hypo-coagulable?
hyper
does alcohol make you hyper-coagulable or hypo-coagulable?
hypo
what are the components of an anaesthetic pre-assessment?
social history current health physical examination drug history past medical/surgical hx blood tests hospital anxiety & depression scale
what are the 3 different types of anaesthetic?
general
regional
local
which of these is not a component of general anaesthesia?
a) amnesia
b) analgesia
c) apyrexia
d) akinesis
c) apyrexia
what is the CEPOD classification in surgery?
a) urgency
b) anaesthesia
c) open vs keyhole
d) morbidity
a) urgency
which of these is NOT a classification under the CEPOD urgency of surgery system?
a) immediate
b) urgent
c) expedited
d) elective
e) non-urgent
e) non-urgent
which of these is NOT a form of cardiovascular monitoring used whilst a patient is under general anaesthetic?
a) central venous catheter
b) ECG
c) NIBP
a) central venous catheter
which of these is NOT an air gas regularly monitored when a patient is under general anaesthetic?
a) O2
b) Nitrogen
c) CO2
d) vapour
e) pressure
b) Nitrogen
which of these is the largest IV venflon cannula?
a) 14G
b) 24G
a) 14G
how long do induction agents take to induce loss of consciousness?
a) 2-5secs
b) 10-20secs
c) 30-40secs
d) 1 min
b) 10-20secs
how long do induction agents’ effects last?
a) 1-2 mins
b) 4-10 mins
c) 15-30 mins
d) 30mins - 1 hour
b) 4-10 mins
what is the most common induction agent used?
propofol
what is an added bonus of propofol as an induction agent?
a) suppresses airway reflexes
b) anti-pyretic properties
c) anti-bacterial properties
d) anti-secretions
a) suppresses airway reflexes
fill in the gap: propofol causes a \_\_\_\_\_ in heart rate and \_\_\_\_\_ is blood pressure when used a) drop; drop b) raise; raise c) drop; raise d) raise; drop
a) drop; drop
which is the fastest induction agent to use?
a) propofol
b) thiopentone
c) ketamine
d) etomidate
b) thiopentone
which induction agent is used in rapid sequence induction?
a) propofol
b) thiopentone
c) ketamine
d) etomidate
b) thiopentone
what is an added bonus of thiopentone as an induction agent?
a) suppresses airway reflexes
b) anti-pyretic properties
c) anti-bacterial properties
d) anti-epileptic properties
d) anti-epileptic properties
fill in the gap: thiopentone causes a \_\_\_\_\_ in heart rate and \_\_\_\_\_ is blood pressure when used a) drop; drop b) raise; raise c) drop; raise d) raise; drop
d) raise; drop
true or false:
propofol is painful on injection
true
why can thiopentone result in a rash and/or bronchospasm?
a) dopamine release
b) bradykinin release
c) histamine release
d) choline release
c) histamine release
which induction agent is contraindicated in porphyria?
a) propofol
b) thiopentone
c) ketamine
d) etomidate
b) thiopentone
which induction agent has the slowest onset (around 90secs)
a) propofol
b) thiopentone
c) ketamine
d) etomidate
c) ketamine
fill in the gap: ketamine causes a \_\_\_\_\_ in heart rate and \_\_\_\_\_ is blood pressure when used a) drop; drop b) raise; raise c) drop; raise d) raise; drop
b) raise; raise
which induction agent is the most haemo-dynamically stable?
a) propofol
b) thiopentone
c) ketamine
d) etomidate
d) etomidate
what is the benefit of etomidate being haemo-dynamically stable?
useful in patient’s with heart failure
which induction agent has the lowest incidence of hypersensitivity?
a) propofol
b) thiopentone
c) ketamine
d) etomidate
d) etomidate
which induction agent has the lowest incidence of nausea & vomiting?
a) propofol
b) thiopentone
c) ketamine
d) etomidate
a) propofol
which induction agent has the highest incidence of nausea & vomiting?
a) propofol
b) thiopentone
c) ketamine
d) etomidate
d) etomidate
true or false:
thiopentone is painful on injection
false
true or false:
ketamine is painful on injection
false
true or false:
etomidate is painful on injection
true
which induction agent causes adreno-cortical suppression?
a) propofol
b) thiopentone
c) ketamine
d) etomidate
d) etomidate
the patient may need to be given supplementary cortisol following ‘stress’ periods e.g. bleeding
give an example of an amnesic vapour
isoflurane
sevoflurane
desflurane
which amnesic vapour affects organ blood flow THE LEAST?
a) isoflurane
b) sevoflurane
c) desflurane
a) isoflurane
which amnesic vapour has the lowest MAC?
a) isoflurane
b) sevoflurane
c) desflurane
a) isoflurane
what does MAC stand for (in terms of amnesic agents?)
a) maximum arterial concentration
b) my ass is candy
c) minimum alveolar concentration
d) maximum affected cells
c) minimum alveolar concentration
which amnesic vapour has a sweet smell?
a) isoflurane
b) sevoflurane
c) desflurane
b) sevoflurane
which amnesic vapour is most suitable for long operations?
a) isoflurane
b) sevoflurane
c) desflurane
c) desflurane
give an examples of a short acting analgesic used in patients under general anaesthetic
fentanyl
alfentanyl
(sometimes remifentanil)
give an example of a long-acting analgesic used intra and post-operatively for patients under general anaesthetic
morphine
oxycodone
diclofenac, parecoxib (IV) and ketorolac (IV) are examples of what type of analgesic?
NSAIDS
true or false
tramadol can be used with morphine
true
fill in the gaps:
muscle contraction occurs when ______ enters the ___-_______ junction. ___ is released at the _________ junction leading to depolarisation of _________ receptors
potassium, calcium, sodium, ACh, ACh-esterase
pre-synaptic, post-synaptic, inter-synaptic, neuromuscular, nicotinic
calcium pre-synaptic ACh neuromuscular nicotinic
how do depolarising muscle relaxants work?
act like ACh but are broken down more slowly by ACh-esterase
this leads to extended muscle contraction and fatigue (as calcium needed for contraction is used up). the muscle relaxes
is suxamethonium an example of a depolarising or non-depolarising muscle relaxant?
depolarising
true or false:
suxamethonium is used in rapid sequence induction
true (rapid onset of 30-60secs)
how long does suxamethonium last?
a) 1-2 mins
b) 6-10 mins
c) 20-30 mins
c) 60 mins
b) 6-10 mins
which of these is NOT a side effect of suxamethonium?
a) fasciculations
b) hyperkalaemia
c) rise in OCP/IOP/gastric pressure
d) hearing loss
d) hearing loss - that’s gentamicin bro
how can use of suxamethonium lead to hyperkalaemia?
potassium released if muscle fibres break
how do non-depolarising muscle relaxants work?
block nicotinic receptors leading to muscle relaxation
is atracurium an example of a depolarising or non-depolarising muscle relaxant?
non-depolarising
true or false:
atracurium is used in rapid sequence induction
false - all non-depolarising muscle relaxants have a slow onset
which group of muscle relaxants have LESS side effects?
a) depolarising
b) non-depolarising
b) non-depolarising
give an example of a short acting muscle relaxant (30 mins)
atracurium
mivacurium
give an example of an intermediate acting muscle relaxant (60 mins)
vecuronium
rocuronium
give an example of an long acting muscle relaxant (90 mins)
pancuronium
name a drug used to reverse non-depolarising muscle relaxants and it’s mechanism
neostigmine - ACh inhibitor
glycopyrrolate - muscarinic antagonist (protects against bradycardia)
put the following drugs in order of administration in the general anaesthetic process: muscle relaxant short-acting analgesic amnesic vapour induction agent long-acting analgesic
short-acting analgesic induction agent muscle relaxant amnesic vapour long-acting analgesic
what percentage of patients experience PONV?
a) 5-10%
b) 20-30%
c) 50-60%
d) 80-90%
b) 20-30%
name the most commonly used anti-emetic for PONV
ondansetron
then dexamethasone, then cyclizine
name a type of surgery which pre-disposes to PONV
ENT
eye
laparotomy
gynae
name a demographic factor which can predispose to PONV
female previous PONV motion sickness non-smoker obese
give an indication for rapid sequence induction
emergency situation when there is a full stomach
how long should you pre-oxygenate the patient before rapid sequence induction
a) you don’t need to
b) 1 min
c) 3 mins
d) 7 mins
c) 3 mins
what 3 drugs are used in rapid sequence induction?
thiopentone
propofol
suxamethonium
fill in the blanks:
cardiac output = ____ ____ x ____ ____
stroke volume
heart rate
fill in the blanks:
mean arterial pressure = ____ ____ x ____ ____ _____
cardiac output
systemic vascular resistance
which 2 of these spinal regions does the sympathetic nervous system NOT originate from?
a) cranial
b) cervical
c) thoracic
d) lumbar
a) cranial
d) lumbar
which of these is NOT a receptor used by the sympathetic nervous system?
a) ACh
b) nicotinic
c) dopaminergic
c) dopaminergic
true or false:
the sympathetic nervous system is associated with ‘fight or flight’
true
do alpha 1 receptors act pre- or post- synaptically?
post-synamptically
which intracellular messanger do alpha 1 receptors increase when activated?
a) sodium
b) calcium
c) potassium
d) noradrenaline
b) calcium
which of these actions is NOT increased by alpha-1 receptors?
a) heart rate
b) vasoconstriction
c) peripheral resistance
d) systemic arterial pressure
a) heart rate
do alpha 2 receptors act pre- or post- synaptically?
pre-synaptically
which intracellular messenger do alpha 2 receptors inhibit when activated?
a) sodium
b) calcium
c) potassium
d) noradrenaline
d) noradrenaline (inhibition results in inhibition of caMP)
what is the result of beta 1 receptor activation?
a) increased contractility and heart rate
b) smooth muscle relaxation (vascular & non-vascular)
a) increased contractility and heart rate
also increase cAMP formation
what is the result of beta 2 receptor activation?
a) increased contractility and heart rate
b) smooth muscle relaxation (vascular & non-vascular)
b) smooth muscle relaxation (vascular & non-vascular)
also increase cAMP formation
what type of receptor does the parasympathetic nervous system act on?
muscarinic
ephedrine, phenyephrine, metaraminol, methoxamine, xylometazoline, oxymetalozine, adrenaline and noradrenaline are examples of drugs which act on which receptors?
alpha 1
VASOCONSTRICTION
phenyephrine can cause reflex bradycardia
clonidine is an example of a drug which works on which receptors?
alpha 2 - sedative
isoprenaline, salbutamol and adrenaline are examples of drugs which act on which receptors?
beta
adrenaline = beta 1
isoprenaline = beta 1 & 2
salbutamol = beta 2
give an example of an alpha blocker and a beta blocker
doxazocin
labetalol
give an example of an ACh inhibitor
neostigmine
give some examples of muscarinic receptor antagonists
atropine
glycopyrrolate
ipatropium
what is the name of this law?
as a myocyte stretches, its contractility increases, therefore the greater the volume of blood in the heart during diastole, the more forceful the cardiac contraction (up to a point e.g. HF)
starling’s law
what do you give in the occurence of local anaesthetic toxicity?
intralipid IV
what is the difference in location between the epidural and spinal anaesthetics?
epidural is in epidural space LOL
spinal is in subarachnoid
why is the epidural needle curved?
to allow fitting of catheter
makes a ‘pop’ sound after it pierces ligamentum flavum so you know you’re in the right place
what is recommended treatment for post epidural/spinal/LP headache?
lie on back, drink caffeine - conservative
if still not working can do spinal tap - blood clot to block hole
are amide or ester LAs used most commonly nowadays?
amides
give an example of a short, medium and long acting LA
short - prilocaine (ester)
med - lignocaine (amide) long - bupivicaine (amide)
what is the dose of lignocaine, prilocaine & bupivicane with and withut adrenaline
lignocaine = 3ml/kg or 7 w adrenaline prilocaine = 6ml/kg or 9 w adrenaline bupivicaine = 2ml/kg or 2 w adrenaline
why would you give adrenaline with LAs?
causes vasoconstriction
reduces systemic absorption
increases conc in area injected
which ASA grade is this?
healthy patient, no co-morbidities or significant PMHx
ASA 1
which ASA grade is this?
mild systemic disease
ASA 2
which ASA grade is this?
severe systemic disease
ASA 3
which ASA grade is this?
severe systemic disease that is a constant threat to life
ASA 4
which ASA grade is this?
moribund, won’t survive without this operation
ASA 5
which ASA grade is this?
brain dead, organs being removed (cheerful thought)
ASA 6
what is the most common patient position
supine
when would yu tilt a supine patient to the left?
risk of SVC compression e.g. pregnancy, obese
what is the trendelenburg position?
45’ head down
reverse trendelenburg equals opposite duh (e.g. for raised ICP or GORD)
what is the lloyd davis/lithotomy position?
legs in stirrups
what is a major complication of the lloyd davis/lithotomy position?
calf compression - DVT and compartment syndrome
what is the lateral position
patient laid on side
one lung is underventilated compared to the other
