ANAESTHETICS Flashcards
INDUCTION AGENT: (KEPT)
PROPOFOL
1.5-2.5 lower PO N+V PROPERLY Supresses airway reflexes Pain on injection involuntary movements decreases HR + BP
INDUCTION AGENT: (KEPT)
THIOPENTONE
4-5
fast –> RAPID SEQUENCE INDUCTION
(thigh-o-pentone = thighs needed for fast running - build up lactic acid = porphorpyia = build up of porphoryins)
- antiepileptic and protects brain
does NOT suppress airway
increase HR decrease BP!! so cant use if low bp
XXXX IN porphoryia
- S/E rash + bronchosplasm
careful use intarterial as risk of thrombosis and gangrene
INDUCTION AGENT: KETAMINE: (KEPT)
1-1/5 SLOW ONSET - used for short procedures increase HR and bP N+V AND EMERGENCE phenomenom dissociative amnesia - Preserves blood pressure and does not cause cardiosuppression = better in low BP RSI
INDUCTION AGENT: (KEPT)
- Etomidate
0.3 HAEMODYNAMICALLY STABLE Decreased allergic reactions GOOD in limited cardiac resevre patients highest PO N+V
INHALATIONAL ANAESHTHETICS - amnesia maintainance
- SIDE
SEVOFLURANE
2% dont need IV
“sweet smelling = inhailed”
INHALATIONAL ANAESTHETICS - amnesia maintainance
- SIDE
ISOFLURANE
1.5%
least affect on blood flow
= “iso’ tonic affect on blood flow
INHALATIONAL ANAESHTHETICS - amnesia maintainance
- SIDE
DESFLURANE
6%
DESparately longer operations
DESparately slow
rapid onset and offset
INHALATIONAL ANAESHTHETICS - amnesia maintainance
- SIDE
ENFLURANE
1.6%
MUSCLE RELAXANT
DEPOLARISING
- Suxamethonium = 1-1.5, rapid onset and offset
= USED FOR RAPID SEQUENCE INDUCTIONS
X increases potassium + pressure in brain, eyes and gastric pressure
Causes MALIGNANT HYPERTHERMIA + Muscle pains
Treat the malignant hyperthermia with DANTROLENE
MUSCLE RELAXANT
Examples of names?
NON-DEPOLARISING = Nicotinic receptors
Reversed with???
Short: Atravarium, mivacarium
intermediate: vercuronum
Long: pancuronium
-SLOW ONSET
VARIABLE DURATION
LESS SIDE EFFECTS
Reversal with NEOSTIGMINE + GLYCOPYROLATE
LOCAL ANAESTHETICS
LIGNOCAINE
3 –> 7 with adrenaline
medium acting
amide
LOCAL ANAESTHETICS
BUPIVACAINE / LEVOBUBPIVACAINE
2–> 2 same with adrenaline
long acting
amide
LOCAL ANAESTHETICS
Prilocaine
6–> 8 with adrenaline
short acting
Esther
VASOACTIVE DRUGS
- Ephedrine increases HR + BP
- other 2 phenylepherine and metaraminol increase BP but decrease HR
- adreanaline and noradrenaline used in ICU
MALLAMPATI SCORE
CLASS 1
can see soft palate, uvula, fauces and pillars
SUFP
MALLAMPATI SCORE
CLASS 2
can see soft palate, uvula and fauces
SUF
MALLAMPATI SCORE
CLASS 3
can see soft palate and base of uvula
SU
MALLAMPATI SCORE
CLASS 4
can see only hard palate
HARD PALATE ONLY
ASA GRADE 1
healthy patient with no systemic disease and non smoker and only mild drinker
ASA GRADE 2
mild-moderate systemic disease NO functional limitation e.g. well controlled asthma, pregnancy smoker
BMI 30-40
ASA GRADE 3
Severe systemic disease and FUNCTIONAL limitation.
e..g unstable angina, diabetic thats obese, BMI 40+
ASA GRADE 4
severe systemic disease CONSTANT THREAT TO LIFE
e.g.. MI
ASA GRADE 5
moribound patient NOT EXPECTED TO SURVIVE e.g. AAA
ASA GRADE 6
brainstem dead
CEPOD emergency
emergency - minutes life and organ saving/ limb
each surgery is dependent on situatio!
CEPOD urgent
hours
potential risk to life limb
CEPOD expedited
days
no immediate life limb threat
CEPOD elective
WEEKS- planned
human requirements water NA K urine output
water 30-40/kg/day
NA 1.5-2 mmol/kg/day
K 1mmol/kg/day
urine output >0.5ml/kg/hour
FASTING food + milk breastfed infant water smoking after 2 hours...ml water
food + milk 6hrs breastfed infant 4 hrs water 2 hours smoking 2 hours ...30ml
NO ALCOHOL 24HRS
SPINAL
into csf lumbar
BELOW L2
between arachnoid and pia mater
EPIDURAL
anywhere in epidural space
act on spinal roots
ultrasound
high freq
low freq
high = high resolution, low depth
low freq = low resoltion, high depth
a1 and b1 receptors
a1 = more peripheral - blood vessels. Norarednealine main agent b1 = more central- cardiac- adrenaline main agent
RF for post op nausea and vomiting
TX
Female, previous PONV, motion sickness, non smokers, obesity, dehydration, ent and gynae surgery
TX: Ondansetron, Dexamethasone, Cyclizine, Prochlorprazine
Calculation for local anaesthetic?
(Weight) X safe dose / % drug X 10 = how much local anaesthetic to use in ML
When should women stop taking their combined COCP before surgery?
4 weeks before surgery.
prior to surgery for patients taking prednisolone what is needed?
Hydrocortisone supplementation is required
WHO surgical checklist order..
Sign in - before induction
Time out - before the first incision
Sign out - after last incision and before patient leaves the operating room
Local anesthetic toxicity treatment?
IV 20% lipid emulsion
