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CPT (My own) > Anaesthetics > Flashcards

Anaesthetics Flashcards

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1
Q

What are the types of anaesthetics?

A

General and local

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2
Q

What are the subdivisions of general anaesthesia?

A

Onhalation or volatile

IV

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3
Q

WHat is the other less common category of anaesthesia?

A

Conscious sedation- small amounts of anaesthetic or benzodiazepine to produce a sleepy state

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4
Q

WHart are the stages of anaesthesia in surgery?

A 
Predication
Induction
Intraoperative analgesia
Muscle paralysis- intubation
Maintencance
Reversal of muscle paralysis and recovery which includes [pstoperative analgesia
Provision for PNV
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5
Q

What are some examples of IV general anaesthetics?

A

Popofol
Barbiturates
Etomidate
Ketamine

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6
Q

What are some examples of volatile general anaesthetics?

A 
N2O
Chloroform
Cycloporpane
Diethyl-ether
Fluroxene
Xenon
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7
Q

WHat are the stages in Guedel’s sign?

A

Stage 1- analgesia and consciousness
Stage 2- unconscious, breathing erratic with delirium–> excitement phase
Stage 3- Surgical anaesthesia with 4 subdivisions
Stage 4- respiratory paralysis and death

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8
Q

WHat is weird about the stages of Guedel’s sign?

A

Stage 2, instead of further relaxing, leads to an excitement phase with stecatic breathing

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9
Q

For volatile general anaesthetics, what is used to describe potency?

A

MAC- Minimum alveolar concentration

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10
Q

What is the definition of MAC?

A

[Alveolar] at 1 atm at which 50% of subjects fail to move to a surgical stimulus (premeditated breathing O2/air)

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11
Q

What factors affect induction and recovery?

A

Partition coefficients

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12
Q

What are partition coefficients also known as?

A

Solubility

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13
Q

What are the subdivisions of partial coefficients?

A

Blood: Gas partition (in the blood)
- low value fast induction and recovery e.g. deslurane
Oil:Gas partition (in fat)
Determines potency and slow accumulation due to partition into fat

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14
Q

What affects MAC

A

Age (High in infants, lower in elderly)
Hyperthermia (increased); Hypothermia (decreased)
Pregnancy (Increased)
Alcoholism (Increased)
Central stimulants (Increased)
Other anaesthetics and sedatives (decreased)
Opioids (decreased)- have a MAC sparing efefct

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15
Q

What is the result of the combination of MAC and NO?

A

MAC sparing, so to get same surgical plane and alagesia, need to use a lot less analgesia if NO is used as well

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16
Q

Describe the relationship between potency and GABA interaction?

A

Anaesthetic agents partition into fat and interact with GABA receptors

17
Q

Why are GABA receptors critical targets for anaesthetics?

A

It is a major inhibitory transmitter in the CNS that allows Cl- condictance

18
Q

WHat are the results of potentiating GABA activity?

A

ANxiolysis
Sedation
Anaesthesia

19
Q

What are exceptions to the use of GABA receptors as a target? What receptors do they target instead?

A

Xe
N2O
Ketamine
They use NMDA receptors

20
Q

What balance do anaesthetics modulate?

A

In the CNS, the balance between excitation (Glutamate) and inhibition (GABA)

21
Q

WHat are the brain circuitry targets in general anaesthetics?

A

Reticular formation is depressed (conscious control)
Thalamus (sensory)
Hippocampus is depressed (Memory)
Brainstem depressed (resp and some CVS)
Dorsal horn in spinal cord ( analgesia) and moror neuronal activity (MAC)

22
Q

WHat are the target sites for IV anaesthetics?

A

Same as inhalation- so GABA receptors and NMDA by the exceptions

23
Q

How do we describe IV anaesthetic potency?

A

TIVA (Total IV Anaesthesia) is sued to define pk based on algorithm to infuse as a rate to maintain the set point

24
Q

What are IV anaesthetics used in conjunction with and when does the switch occur?

A

Bolus iV to end pt and then switch to volatile

25
Q

What are examples of uses of local and regional anaesthesia?

A 
Dentistry
Obstretrics
Regional surgery
Post io
Chronic pain management
26
Q

What are some examples of local anaesthetics?

A

Lidocaine
Bupivacaine
Ropivacaine
Procaine

27
Q

Describe the structure of a basically local anesthetic

A

Aromatic ring - Link- Amine

28
Q

What are the 2 types of links in the structure of local anaesthetics

A

Ester link

Amide Link

29
Q

Which of the 2 types of links leafs to showered duration of action?

A

Ester link because plasma is full of esterases

30
Q

What is the relationship of lipid solubility with potency?

A

Higher solubility leads to higher potency

31
Q

Describe the mechanism of action of local anaesthetics

A

Bind to voltage gated Na channels and blocks the Na influx therefore AP is blocked
They block small myelinated afferent nerves preferentially and hence lead to nociceptive and symptoms block

32
Q

What does use dependant block mean?

A

The more active the channel, the greater the local anaesthetic effect

33
Q

Where are upper extremity regional anaesthetics administered?

A

Interscalene, supraclavicular, infraclavicular, axillary

34
Q

Where are lower extremity regional anaesthetics administered?

A

Femoral, sciatic, popliteal and sphenous

35
Q

What are the main anaesthetic side effects of general anaesthetics?

A 
PONV (opioids)
CVS- hypotension
POCD (cognitive dysfunction)
Chest infection
BEWARE ALLERGIES

CPT (My own) (6 decks)

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