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3rd year > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

What is general anaesthetic?

A

Produces insensibility in the whole body, usually causing unconsciousness.
Centrally acting drugs - hypnotics/analgesics.

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2
Q

What is regional anaesthetic?

A

Producing insensibility in an area or region of body. Applied to nerves supplying relevant area.

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3
Q

What is local anaesthetic?

A

Producing insensibility in an only the relevant part of the body. Applied directly to the tissues.

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4
Q

What types of anaesthetics are there?

A 
Inhalational 
Intravenous 
Muscle relaxants 
Local anaesthetics 
Analgesics
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5
Q

What techniques are used?

A 
Tracheal intubation 
Ventilation 
Fluid therapy 
Regional anaesthesia 
Monitoring
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6
Q

What does the triad of Anaesthesia consist of?

A

Analgesia, Hypnosis, Relaxation.

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7
Q

What are the problems with polypharmacy?

A

Increased chance of drug reactions / allergies.

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8
Q

Problems with muscle relaxation?

A

Requirement for artificial ventilation.

Means of airway control.

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9
Q

Problems with separation of relaxation and hypnosis?

A

Need to have a greater awareness. Patients can be awake but paralysed.

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10
Q

How do general anaesthetic agents work?
Inhalational:
IV:

A

Interfere with neuronal ion channels.
I: Dissolve in membranes - direct physical effect.

IV: Allosteric binding - GABA receptors - open chloride channels.

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11
Q

What do general anaesthetic agents do?

A

Provide unconsciousness as well as a small degree of muscle relaxation. Also provide some analgesia to different extents. Except ketamine all are negligible.

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12
Q

What functions are lost in General?

A

Cerebral function “lost from top down”.
Most complex processes interrupted first.
LOC early - hearing later.
More primitive functions lost later.

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13
Q

Why are reflexes relatively spared?

A

Primitive and small number of synapses.

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14
Q

What are the main things to note when using general?

A

ABC - long drawn out resuscitation.

Mandates airway management.

Impairment of Resp function and control of breathing.

CVS impact.

Care for unconscious patient.

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15
Q

Why is there a rapid recovery and onset with IV? (propofol)

A

1 arm - brain circulation time.

Rapid recovery - due to disappearance of drug from circulation. Redistribution V’s metabolism.

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16
Q

Why are inhalational slower?

A

Halogenated hydrocarbons.
Uptake and excretion via the lungs.
Conc G – lungs - blood - brain.

MAC - low number = high potency.

Slow induction - breathe in a washout to reverse conc gradient.

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17
Q

What is most common sequence of General?

A

IV induction followed by inhlational maintanence.

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18
Q

What are the physiological effects on the CVS system using general?

A

Central - depresses CV centre - reduces symp outflow.

Direct - negatively inotropic, vasodilation, venodilation (decreased venous return)

MAP = CO x SVR

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19
Q

Physiological effects on Resp system?

A

Resp depressants - reduce hypoxic and hypercarbic drive. Decreased TV and Increased rate.

Paralyse cilia.

Decrease FRC - lower lung volumes, VQ mismatch. Can be prolongued.

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20
Q

What are the indications for Muscle relaxants?

A

Ventilation and intubation.
Immobility is essential.
Body cavity surgery.

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21
Q

What are the problems with using muscle relaxants?

A

Awareness
Incomplete reversal - airway obstruction, vent insufficiency in immediate postop.
Apnoea = depends on airway and vent support.

POSSIBLE TO PARALYSE SOMEONE BUT GIVE AN INSUFFICIENT DOSE OF ANAESTHITIC - AWAKE DURING PROCEDURE.

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22
Q

Why use local and regional analgesia?

A

Retain awareness / consciousness
Lack of global effects of GA.
Derangement of CVS physiology.
Relative sparing of resp function.

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23
Q

What is a limiting factor when using local?

A

Toxicity - high plasma levels.

Signs and symptoms – Tinnitus, visual disturbance, drowsiness, coma.

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24
Q

How can LA block be used?

A

Due to differential penetration into different nerve types.

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25
Q

What do anaesthetist do?

A 
Pre -op Assessment and care
Critical care / intensive care 
Pain management 
Anaesthesia 
Post-op care
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26
Q

What is usually used in IV induction?

A

Propofol.

Quietness - gas or IV - careful monitoring of conscious level.

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27
Q

When would gas induction usually be used?

A

Young children. (Sevoflurane)

Adults with special needs.

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28
Q

What are the planes of anaesthesia?

A 
Analgesia / sedation 
Excitation 
Anaesthesia: Light --> deep.
Overdose 
Or
Sleepy / Excited // Anaesthetised.
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29
Q

How is conscious level monitored?

A 
Loss of verbal contact
Movement 
Resp Pattern 
Processed EEG 
'Stages" of anaesthesia.
30
Q

What is the simple manoeurve used for airway maintenance?

A

Head tilt / Chin Lift / Jaw Thrust. (firm)

Always required in general anaesthesia.

31
Q

What simple apparatus is used in Anaesthesia?

A

Face mask - allow gas-tight seal.
Oropharyngeal (“Guedel”) Airway - Only unconscious patient.
Nasopharygeal Airway.

32
Q

More advanced airway management includes what?

A

Laryngeal mask airway:
Cuffed tube with mask sitting over glottis.
Maintains but doesn’t protect.

i-gel - easy to use - often by paramedics.

33
Q

What is Laryngospasm?

A

Larygeal spasm
Forced reflex adduction of the vocal cords.
May result in complete airway obstruction.

34
Q

What foreign materials could get in lower airway?

A

Gastric contents, blood, surgical debris.

Anaesthesia means loss of protective airway reflexes - gag, swallow,cough.

35
Q

What is difference between maintained and protecting airway?

A

Maintained = open and unobstructed

Protected = Cuffed tube in trachea.

36
Q

Why do we intubate?

A

Protect airway from gastric contents.

Need for muscle relaxation.

Shared airway with risk of blood contamination.

Need for tight control of blood gases

Restricted access to airway.

37
Q

What are the risks to an unconscious patient?

A 
Airway 
Temperature
Loss of protective reflexes
Venous thromboembolism 
Consent and identification 
Pressure areas
Patient position
38
Q

What needs to be monitored?

A 
SpO2, ECG, NIBP, FiO2, ETCO2.
Resp parameters 
Agent monitoring 
Temperature, Urine output, NMJ
Invasive venous / Arterial monitoring 
Processed EEG
39
Q

What causes most problems?

A

Airway
Breathing
Circulation
Unconsciousness

40
Q

What is Post Anaesthsia Care unit?

A 
Dedicated area with trained staff
Continuing responsibility of anaesthetist 
Problems with A,B,C
Pain control 
Post-operative Nausea and Vomiting 
Set criteria for discharge back to ward.
41
Q

What is critical care?

A

Organ system support.

Initial assessment: ABCDE

42
Q

What type of Resp failures are there?

A

Type 1: Oxygenation failure.

Type 2: oxygenation and ventilation failure. (more serious)

43
Q

How are type 1 and 2 treated in critical care?

A

1 - HFT nasal cannula
2 - HFT mask
For emergency - Inflatable cuff through mouth.

44
Q

What is the most common cause of CV failure?

A

Shock - acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in cellular hypoxia.

Distributive / septic (most common) 
Hypovolaemic 
Anaphylactic 
Neurogenic 
Cardiogenic (acute / chronic)
45
Q

CV failure: What are vasopressors?

A

Alpha 1 agonists:
Metaraminol
Noradrenaline

46
Q

CV failure: What are inotropes?

A

Improve contractility.
Dobutamine - beta 1, CO2 can go down.
Adrenaline - alpha and beta receptor - heart rate, contractility (avoid as first line)

47
Q

What are some of the different fluids?

A

Colloid - big molecules e.g. albumin
Crystalloids - small molecules e.g. Na, Cl.
Plasmolyte - Na, Cl, K, Mg.

48
Q

What is the fluid limit?

A

30ml/kg

49
Q

What can cause neurological failure?

A

Metabolic - DKA, SIADH
Trauma - head injury
Infection - meningitis
Stroke

50
Q

What can be complications of general anaesthesia?

A

Drug induced reversible coma.
CNS, cardiac and resp depression.
Drug interactions.

51
Q

What can be complications of regional anaesthesia?

A

Profound sympathectomy.

Neurological sequelae.

52
Q

What do anaesthtists do pre-op? (elective, emergent, urgent)

Why?

A 
Assess
Identify high risk.
Optimise
Minimise risk 
Inform and support patients decisions
Consent

To reduce anxiety, delays, cancellations, length of stay, mortality.

53
Q

What key point are taken from a history?

A

Known and unknown co-morbidities.

Ability to withstand stress - exercise tolerance.

D&A

Previous surgery and anaesthesia.

Potential problems:
Airway, obesity,fam history.

54
Q

What are most important pre-op?

A

ASA grade 1-6.
Surgery grade
Co-morbidities

55
Q

What is cardiac risk index?

A

For each co-morbidity you score 1 point.
Above 4 = high risk.
Congestive heart failure, Ischaemic heart failure etc…

56
Q

What are METs?

A

Exercise tolerance test scores:
From 2 - 9
4 or more = concerned.

57
Q

What is done in a high risk emergency patient?

A 
Informed consent 
Anaesthetic pain 
Invasive monitoring 
Senior management 
Post - op critical care.
58
Q

What can cause falls in elderly?

A 
Drugs (anti-hypertensives)
Neurological (stroke, dementia)
Sensory (Visual impairment)
Cardio (Heart failure, Postural hypertension)
Generally unwell
Incontinence
59
Q

How do drugs cause falls?

A

Decrease blood pressure, heart rate, awareness.

Increase urine output, sedation, hallucinations, dizziness, qTC.

60
Q

What are the main drugs that cause falls?

A 
Antihypertensives 
Beta Blcokers 
Sedatives 
Anticholinergics 
Opiods 
Alcohol
61
Q

How can pain be classified into 3 categories?

A

Duration - acute, chronic, acute on chronic.

Cause - cancer, non-cancer

Mechanism - nociceptive, neuropathic.

62
Q

What is nociceptive pain?

A

Obvious tissue injury or illness.
Protective function
Sharp / dull
Well localised

63
Q

What is neuropathic pain?

A 
Nervous system damage or abnormality
Tissue injury may not be obvious 
Does not have protective function 
Burning, shooting / numbness, pins and needles. 
Not well localised.
64
Q

What are the 4 physiology steps of pain?

A

Periphery - tissue injury, stimulation of pain receptors.
Spinal cord - Dorsal horn first relay station, A delta and C nerves synapse with second nerve - travels up opposite side of SC.
Brain - Thalamus 2nd relay station - connects to cortex, limbic, brainstem.
Pain perception occurs in cortex.
Modulation - Descending pathway from brain to dorsal horn. Decreases pain signal.

65
Q

Treatment for periphery

A

Non-drug (ice)
NSAIDS
Local anaesthetics.

66
Q

Treatment for Spinal Cord

A

Accupunture, TENS
Local anaesthtics
Opiods
Ketamine

67
Q

Treatment for Brain

A 
Psychological
Drug treatments 
- paracetomol
-opiods 
- Amitriptyline (TCA)
- Clonidine
68
Q

What is the RAT approach to pain?

A

Recognize
Assess - severity, type, other factors.
Treat - non-drug treatments, drug treatments.

69
Q

How do we pain assess?

A 
Verbal rating score
Numerical rating score
Visual analogue score 
Smiling faces
Abbey pain scale (confused patients)
Functional pain
70
Q

What is the WHO pain ladder?

A

Used for nociceptive pain:

71
Q

ASA system

A

Fitness of patient before surgery.
1-5
1 - being fit
5 - morbid shouldn’t be having surgery.

72
Q

What is MAC

A

Minimum alvolar concentration

Potency inhaled anaesthesia

3rd year (22 decks)

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