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5 > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

3 components of anaesthesia?

A
  1. Analgesia
  2. Sedation/Hypnosis
  3. Muscle relaxation
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2
Q

3 different states of hypnosis?

A
  1. Awake
  2. Sedated
  3. Asleep
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3
Q

Define Anaesthesia

A

Pharmacologically induced, reversible state of sleep characterised by lack of pain, awareness of surroundings and memory of events

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4
Q

3 main risks to a patient undergoing surgery?

A
  1. Surgery itself - damage to structures, blood loss, complications
  2. Effects of anaesthesia
  3. Pre-existing disease
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5
Q

List 3 potential intra-operative problems

A
  1. Fluid balance
  2. Hypoxia
  3. Hypothermia
  4. Pain
  5. Anaphylaxis
  6. PE
  7. Death
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6
Q

What type of post-operative drugs may be written up for a patient?

A
  1. Analgesia, e.g. paracetamol, codeine, tramadol

2. Anti-emetic, e.g. ondansetron

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7
Q

Anaesthesia. What are the three broad classes of anaesthesia?

A
  1. Local (regional or neuraxial)
  2. Sedation
  3. General
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8
Q

Anaesthesia. Which type of anaesthetic goes into the CSF?

A

Spinal (type of local)

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9
Q

Anaesthesia. Which type of anaesthetic goes into the space between the ligamentum flavum and the dura?

A

Epidural (type of local)

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10
Q

Anaesthesia. Which has a faster onset; Spinal or Epidural?

A

Spinal

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11
Q

How do local anaesthetics act?

A
  1. Reversibly block sodium channels

2. Inhibit generation of action potentials within nerve cells

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12
Q

Local Anaesthetics. Which type of nerve fibres are blocked first?

A

Small diameter and unmyelinated

B
C and Ad
Ab
Aa and Ag

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13
Q

Local Anaesthetics. What is the effect of blocking B fibres?

A

Vasodilation

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14
Q

Which fibres are responsible for pain and temperature?

A

C and A-delta

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15
Q

Which fibres are responsible for light touch and pressure?

A

A-beta

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16
Q

Which fibres are responsible for motor and proprioception?

A

A-alpha and A-gamma

17
Q

Give 2 reasons why adrenaline is often given with local anaesthetics

A

Adrenaline causes vasoconstriction, resulting in:

  1. Reduced blleding
  2. Prolonged LA effect through reduced reabsorption from tissues
18
Q

Could you use adrenaline with a local anaesthetic in end arteries, e.g. the fingers?

A

No - causes vasoconstriction

19
Q

2 key local anaesthetic agents?

A
  1. Lidocaine

2. Bupivacaine

20
Q

How long does Lidocaine take to work? How long does it last?

A

Immediate onset

Lasts 15 mins

21
Q

How long does Bupivacaine take to work? How long does it last?

A

10 mins to onset

Anaesthesia lasts 2 hours; analgesia lasts 12-24 hrs

22
Q

Sedation. Give 3 key effects of drugs given for sedation

A
  1. Reduce anxiety
  2. Reduce consciousness
  3. Reduce irritability of the airway
  4. Induce amnesia
23
Q

Sedation. What type of sedation is IV Midazolam used for?

A

Short-term; i.e. endoscopy, regional anaesthesia

24
Q

Sedation. What drug may be given for long-term sedation?

A

IV Propofol +/- alfentanil

25
Q

Sedation. Give 2 situations in which IV Propofol might be used as sedation?

A
  1. Intensive care

2. Intubated patients for theatre or transfer

26
Q

Sedation. What are the 3 main inhalation agents used?

A
  1. Isoflurane (cheapest - used to maintain)
  2. Sevoflurane (used to induce +/- maintain)
  3. Desflurane (v bad for the environment)
27
Q

Sedation. What are the 3 key intravenous agents?

A
  1. Propofol
  2. Thiopenthal (most common in emergency anaesthetics)
  3. Ketamine (used in CVS instability)
28
Q

Sedation. Aside from sedation, what is another useful property of propofol?

A

Anti-emetic

Fast redistribution; rapid recovery of consciousness

29
Q

Sedation. Which is faster; intravenous or inhalational induction?

A

Intravenous

30
Q

Sedation. Risk of intravenous induction?

A

Depresses airway reflexes (cough/gag)

Apnoea is common

31
Q

Sedation. Risk of inhalational induction?

A

May irritate airway

?^risk PONV

32
Q

Once the patient is deeply sedated, they may stop breathing. How can the airway be managed?

A
  1. Spontaneous breathing

2. Controlled ventilation

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