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Anaesthetics Flashcards

1
Q

The effects of Adrenaline:

A

Receptors affected: α1 β1 β2

Inotropic
Chronotropic
Vasopressor

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2
Q

The effects of dobutamaine:

A

Receptors affected: β1 β2

Inotropic
Chronotropic

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3
Q

The effects of Noradenaline:

A

Receptors affected: α1 β1

Inotropic
Vasopressor

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4
Q

The effects of Phenylephrine:

A

Receptors affected: α1

Vasopressor

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5
Q

How are patients on ICU sedated?

A

A continuous intravenous infusion of Propofol

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6
Q

What can insufficient sedation of a patient on ICU lead to?

A

Agitation and poor ventilation

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7
Q

What can over sedation of a patient on ICU increase the risk of?

A

Chest infection
Neuropathies
Venous thromboembolism

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8
Q

What urine output indicated a developing AKI?

A

less than 0.5ml/kg/hour

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9
Q

Stop which drugs during an AKI?

A

Stop the DAMN drugs

Diuretics
ACEs and ARBs
Metformin
NSAIDs

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10
Q

What are the target saturations for a COPD patient?

A

88-92%

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11
Q

What type of respiratory support may be indicated for worsening Type 1 respiratory failure?

A

CPAP

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12
Q

What type of respiratory support may be indicated for worsening Type 2 respiratory failure?

A

BiPAP

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13
Q

What may be indicated if non invasive ventilation methods fail?

A

Intermittent positive-pressure ventilation (IPPV)

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14
Q

What is the safe dose of Lignocaine without adrenaline?

A

3mg/kg

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15
Q

What is the safe dose of Lignocaine with adrenaline?

A

7mg/kg

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16
Q

What is the safe dose of Bupivacaine / levobupivacaine ? (with or without adrenaline)

A

2mg/kg

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17
Q

What is the safe dose of Prilocaine?

A

6mg/kg

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18
Q

What are the fasting guidelines for clear fluids?

e.g. water, black tea, black coffee, fruit juice without pulp

A

2 hours

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19
Q

What are the fasting guidelines for breast milk?

A

4 hours

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20
Q

What are the fasting guidelines for cows milk or a light meal?

A

6 hours

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21
Q

What drugs are traditionally used in a Rapid Sequence Induction?

A

Thiopentone (4-5mg/kg)

Suxamethonium (1-1.5mg/kg)

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22
Q

What should a General Anaesthesia achieve?

A

Amnesia – lack of response and recall to noxious stimuli

Analgesia – pain relief

Akinesis – immobilisation / paralysis

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23
Q

Name 4 induction agents

A

Thiopentone
Propofol
Ketamine
Etomidate

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24
Q

What are the properties of Propofol and its benefits as an induction agent?

A

Propofol 1.5 – 2.5 mg/kg
Lipid based (white emulsion)
Excellent suppression of airway reflexes
Decreases incidence of PONV

25
What are the problems with Propofol as an induction agent?
Propofol 1.5 -2.5 mg/kg Unwanted effects: Marked drop in HR and BP Pain on injection Involuntary movements
26
What are the properties of Thiopentone and its benefits as an induction agent?
Thiopentone 4–5 mg/kg Barbiturate - Faster than propofol Used mainly for rapid sequence induction Antiepileptic properties and protects brain
27
What are the problems with Thiopentone as an induction agent?
Thiopentone 4-5 mg/kg ``` Unwanted effects: Drops BP but rise in HR Histamine release = Rash / Bronchospasm Intraarterial injection: thrombosis and gangrene Contraindicated in Porphyria ```
28
What are the properties of Ketamine and its benefits as an induction agent?
``` Ketamine 1-1.5 mg/kg Dissociative anaesthesia Anterograde amnesia and profound analgesia Slow onset (90 seconds) Rise in both HR and BP Bronchodilation ```
29
What are the problems with Ketamine as an induction agent?
Ketamine 1-1.5 mg/kg Nausea and vomiting Emergence phenomenon: vivid dreams, hallucinations
30
What are the properties of Etomidate and its benefits as an induction agent?
Etomidate 0.3 mg/kg Rapid onset Hemodynamic stability Lowest incidence of hypersensitivity reaction
31
What are the problems with Etomidate as an induction agent?
Adreno-cortical suppression Pain on injection Spontaneous movements High incidence PONV
32
A patient with porphyria comes for an inguinal hernia repair which induction agent do you use? which do you definitely not use?
Use propofol Avoid thiopentone
33
Which induction agent is best used for changing burns dressings?
Ketamine
34
A patient with intestinal obstruction requires an emergency laparotomy, which induction agent do you use?
Thiopentone
35
A patient with a history of heart failure requires a general anaesthetic, which induction agent do you use?
Etomidate
36
Which induction agent can cause adrenal-cortical suppression?
Etomidate
37
Name the 5 common inhalation agents and consider their MACs
``` Nitrous oxide: 104% Sevoflurane: 2% Isoflurane : 1.15% Desflurane : 6% Enflurane : 1.6 % ```
38
Which inhalation agent can be used for a gas induction in children with no IV access?
Sevoflurane
39
Which inhalation agent will be used for a long operation lasting several hours?
Desflurane
40
Which induction agent would be used during an organ retrieval from a donor?
Isoflurane
41
How do you assess and manage a patient with postoperative pain?
ABCDE assessment Pain assessment (0-3 score) Analgesic ladder Acute pain service
42
Analgesics for a postoperative pain score of 0
PRN - Paracetamol
43
Analgesics for a postoperative pain score of 1
Regular- Paracetamol PRN - NSAID, Weak Opioid
44
Analgesics for a postoperative pain score of 2
Regular - Paracetamol, NSAID and Weak Opioid PRN - Strong Opioid
45
Analgesics for a postoperative pain score of 3
Regular - Paracetamol and NSAID PRN - Strong opioid or Standard PCAS, Epidural or Spinal
46
What is the definition of chronic pain?
Persistent and intractable pain lasting more than 3 months
47
Diclofenac, Ketorolac and Parecoxib are example of what?
IV NSAIDs
48
Which opioid is commonly used during induction?
Fentanyl
49
What are the properties of suxamethonium and what are its benefits?
Suxamethonium 1 -1.5 mg/kg Depolarising muscle relaxant - agonist of nicotinic receptors Rapid Sequence Induction (Rapid onset - Rapid offset)
50
What are the adverse affects of suxamethonium?
``` muscle pains, fasciculations, hyperkalemia malignant hyperthermia, rise in ICP, IOP and gastric pressure ```
51
What are the short acting non depolarising muscle relaxants?
Atracurium, Mivacurium
52
What are the intermediate acting non depolarising muscle relaxants?
Vecuronium, Rocuronium
53
What are the long acting non depolarising muscle relaxants?
Pancuronium
54
What drugs can be used to reverse non depolarising muscle relaxants?
Neostigmine & Glycopyrrolate
55
What are the mechanism of action of neostigmine and glycopyrrolate?
Used for reversal of non depolarising muscle relaxants Neostigmine is an anti-cholinesterase Prevents breakdown of acetylcholine Muscarinic effects of acetylcholine = Bradycardia etc Glycopyrrolate is an antimuscarinic Reduces unwanted effects of neostigmine
56
Best vasoactive agent for a patient with a low BP and a low HR?
Ephedrine Raises BP and HR
57
Best vasoactive agent for a patient with a low BP and a high HR?
Phenylephrine or Metaraminol Raise the BP by vasoconstriction
58
How do you manage a local anaesthetic overdose?
Stop local anaesthetic ABCDE assessment and management Control seizures Give IV Lipid emulsion

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