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ACC > anaesthetics > Flashcards

anaesthetics Flashcards

1
Q

what are the doses of local anaesthetic?

A

lignocaine 3mg/kg +7
prilocaine 6+ 9
bupivocaine 2+ 2

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2
Q

what 3 things should be provided by general anaesthetic?

A

amnesia
akinesis
analgesia

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3
Q

What is used to provide amnesia?

A 
induction agent (fast acting, 10-20 seconds but only last up to 10 minutes)
inhalational/ volatile agents  for maintenance
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4
Q

name the 4 induction agents

A

propofol, ketamine, thiopentone, etomidate

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5
Q

what are the advantages of propofol?

A

good suppression of airway reflexes

less PONV

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6
Q

what are the disadvantages of propofol?

A

drop in HR and BP
pain on injection
involuntary movements

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7
Q

which induction agent is used for RSI?

A

thiopentone

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8
Q

which induction agent has antiepileptic properties?

A

thiopentone

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9
Q

what are the disadvantages of thiopentone?

A

rise in HR and drop in BP

rash/ bronchospasm

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10
Q

which induction agent provides amnesia and analgesia?

A

ketamine

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11
Q

which induction agent has the slowest onset?

A

ketamine

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12
Q

what are the disadvantages of ketamine?

A

PONV

emergence phenomenon

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13
Q

which induction agent is most haemodynamically stable?

A

Etomidate

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14
Q

what are the disadvantages of etomidate?

A

pain on injection
spontaneous movements
adreno-cortico suppression (so reduced response to sepsis or blood loss)
lots of PONV

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15
Q

what are the 3 volatile agents?

A

isoflurane
sevoflurane
desflurane

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16
Q

what are the advantages of sevoflurane?

A

sweet smelling so often used for inhalational induction

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17
Q

what are the advantages of desflurane?

A

rapid onset/ offset

used for long operations

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18
Q

what are the advantages of isoflurane?

A

least effect on organ flow

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19
Q

what is the MAC?

A

Minimum alveolar concentration- concentration needed to prevent reaction to skin incision in 50% of people

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20
Q

what is the MAC of the inhalational agents?

A

sevoflurane 2%
isoflurane 1.15%
enflurane 1.6%

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21
Q

what else can be used for maintenance if not using inhalational agents?

A

propofol infusion

22
Q

name some short-acting opioids

A

fentanyl
alfentanil
remifentanil

23
Q

name some long-acting opioids

A

morphine

oxycodone

24
Q

what are the weaker opioids?

A

tramadol

dihydrocodeine

25
Q

what are some contraindications to opioids?

A

respiratory disease
caution in hepatic/ renal impairment
tramadol lowers seizure threshold

26
Q

what are the adverse effects of opioids?

A

nausea
constipation
respiratory/ neuro depression
long term use-> tolerance/ dependence

27
Q

which NSAIDs can you give IV?

A

ketorolac/ parecoxib

28
Q

how do NSAIDs work?

A

inhibit COX therefore synthesis of prostaglandins

29
Q

what are contraindications to NSAIDs?

A

renal impairment
CVD/ HF
peptic ulcers

30
Q

what are side effects of NSAIDs?

A

GI bleed
renal impairment
increase risk of CV events

31
Q

what are contraindications to paracetamol?

A

anything which increases NAPQI- chronic alcohol abuse or low glutathione stores (low BMI, hepatic impairment)

32
Q

what are adverse effects of paracetamol?

A

in overdose NAPQI builds up causing hepatocellular necrosis

33
Q

What are the 2 classes of muscle relaxants?

A

non-depolarising (block ACh receptors therefore muscle relaxes)
depolarising (bind to nicotinic receptors but not broken down easily therefore muscle contracts-> fatigues and relaxes)

34
Q

name a depolarising muscle relaxant

A

suxamethonium, used for RSI

35
Q

what are the adverse effects of suxamethonium?

A

muscle pain/ fasciculation
hyperkalaemia
malignant hyperthermia
rise in ICP/ IOP

36
Q

name short acting non-depolarising muscle relaxants

A

atracurium

mivacurium

37
Q

name intermediate acting non-depolarising muscle relaxants

A

vecuronium

rocuronium

38
Q

name a long acting non-depolarising muscle relaxant

A

pancuronium

39
Q

what is used to reverse non-depolarising muscle relaxants?

A

neostigmine and glycopyrrolate (to prevent muscarinic effects eg bradycardia)

40
Q

name the 5 classes of antiemetic

A 
5HT3 blockers
anti-histamine
steroid (dexamethasone)
phenothiazine
anti-dopaminergic
41
Q

name a 5HT3 blocker

A

ondansetron

42
Q

what should odansetron be avoided in

A

prolonged QT interval

43
Q

name an anti-histamine used as an antiemetic

A

cyclisine, rarely used operatively. Adverse effects include dry mouth and palpitations

44
Q

name a phenothiazine

A

prochlorperazine, often not first line as can cause an acute dystonic reaction

45
Q

name an antidopaminergic

A

metoclopramide

46
Q

how does metaclopramide work?

A

inceases peristalsis so reduces intestinal transit time

47
Q

contraindications to metaclopramide?

A

GI obstruction/ perforation
haemorrhage
cardiac conduction disturbances

48
Q

Adverse effects of metaclopramide

A

muscle spasms

acute dystonic reactions

49
Q

what would you give to increase BP and HR

A

Ephedrine

50
Q

what would you give to increase BP but lower HR

A

phenylephrine

metaraminol

51
Q

what is used to increase BP in ICU

A

NA/ adrenaline

52
Q

If struggling to insert an ETT what device can help?

A

bougie

ACC (4 decks)

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