anaesthetics

Question 1

what are the doses of local anaesthetic?

Answer 1

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

Question 2

what 3 things should be provided by general anaesthetic?

Answer 2

amnesia
akinesis
analgesia

Question 3

What is used to provide amnesia?

Answer 3

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

Question 4

name the 4 induction agents

Answer 4

propofol, ketamine, thiopentone, etomidate

Question 5

what are the advantages of propofol?

Answer 5

good suppression of airway reflexes

less PONV

Question 6

what are the disadvantages of propofol?

Answer 6

drop in HR and BP
pain on injection
involuntary movements

Question 7

which induction agent is used for RSI?

Answer 7

thiopentone

Question 8

which induction agent has antiepileptic properties?

Answer 8

thiopentone

Question 9

what are the disadvantages of thiopentone?

Answer 9

rise in HR and drop in BP

rash/ bronchospasm

Question 10

which induction agent provides amnesia and analgesia?

Answer 10

ketamine

Question 11

which induction agent has the slowest onset?

Answer 11

ketamine

Question 12

what are the disadvantages of ketamine?

Answer 12

PONV

emergence phenomenon

Question 13

which induction agent is most haemodynamically stable?

Answer 13

Etomidate

Question 14

what are the disadvantages of etomidate?

Answer 14

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

Question 15

what are the 3 volatile agents?

Answer 15

isoflurane
sevoflurane
desflurane

Question 16

what are the advantages of sevoflurane?

Answer 16

sweet smelling so often used for inhalational induction

Question 17

what are the advantages of desflurane?

Answer 17

rapid onset/ offset

used for long operations

Question 18

what are the advantages of isoflurane?

Answer 18

least effect on organ flow

Question 19

what is the MAC?

Answer 19

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

Question 20

what is the MAC of the inhalational agents?

Answer 20

sevoflurane 2%
isoflurane 1.15%
enflurane 1.6%

Question 21

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

Answer 21

propofol infusion

Question 22

name some short-acting opioids

Answer 22

fentanyl
alfentanil
remifentanil

Question 23

name some long-acting opioids

Answer 23

morphine

oxycodone

Question 24

what are the weaker opioids?

Answer 24

tramadol

dihydrocodeine

Question 25

what are some contraindications to opioids?

Answer 25

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

Question 26

what are the adverse effects of opioids?

Answer 26

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

Question 27

which NSAIDs can you give IV?

Answer 27

ketorolac/ parecoxib

Question 28

how do NSAIDs work?

Answer 28

inhibit COX therefore synthesis of prostaglandins

Question 29

what are contraindications to NSAIDs?

Answer 29

renal impairment CVD/ HF peptic ulcers

Question 30

what are side effects of NSAIDs?

Answer 30

GI bleed renal impairment increase risk of CV events

Question 31

what are contraindications to paracetamol?

Answer 31

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

Question 32

what are adverse effects of paracetamol?

Answer 32

in overdose NAPQI builds up causing hepatocellular necrosis

Question 33

What are the 2 classes of muscle relaxants?

Answer 33

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

Question 34

name a depolarising muscle relaxant

Answer 34

suxamethonium, used for RSI

Question 35

what are the adverse effects of suxamethonium?

Answer 35

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

Question 36

name short acting non-depolarising muscle relaxants

Answer 36

atracurium | mivacurium

Question 37

name intermediate acting non-depolarising muscle relaxants

Answer 37

vecuronium | rocuronium

Question 38

name a long acting non-depolarising muscle relaxant

Answer 38

pancuronium

Question 39

what is used to reverse non-depolarising muscle relaxants?

Answer 39

neostigmine and glycopyrrolate (to prevent muscarinic effects eg bradycardia)

Question 40

name the 5 classes of antiemetic

Answer 40

``` 5HT3 blockers anti-histamine steroid (dexamethasone) phenothiazine anti-dopaminergic ```

Question 41

name a 5HT3 blocker

Answer 41

ondansetron

Question 42

what should odansetron be avoided in

Answer 42

prolonged QT interval

Question 43

name an anti-histamine used as an antiemetic

Answer 43

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

Question 44

name a phenothiazine

Answer 44

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

Question 45

name an antidopaminergic

Answer 45

metoclopramide

Question 46

how does metaclopramide work?

Answer 46

inceases peristalsis so reduces intestinal transit time

Question 47

contraindications to metaclopramide?

Answer 47

GI obstruction/ perforation haemorrhage cardiac conduction disturbances

Question 48

Adverse effects of metaclopramide

Answer 48

muscle spasms | acute dystonic reactions

Question 49

what would you give to increase BP and HR

Answer 49

Ephedrine

Question 50

what would you give to increase BP but lower HR

Answer 50

phenylephrine | metaraminol

Question 51

what is used to increase BP in ICU

Answer 51

NA/ adrenaline

Question 52

If struggling to insert an ETT what device can help?

Answer 52

bougie