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O&G > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

Types of anaesthesia

A

General anaesthesia- total loss of sensation
Regional anaesthesia- loss of sensation to a region or part of the body
Local anaesthesia- Topical, infiltration

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2
Q

Components of general anaesthesia

A

Amnesia- unconsciousness
Analgesia
Akinesis- immobilisation

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3
Q

What happens during GA

A

Monitoring
IV access
Start the process- induction of anaesthesia, analgesia and muscle relaxation
Maintenance

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4
Q

Monitoring in GA

A

ECG
SP02
NIPB
Airway gases- oxygen, CO2 and vapour
Airway pressure
Nerve stimulator- if a muscle relaxant is used
Temperature monitoring- temp should be 37 before surgery

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5
Q

Next step after monitoring

A

IV access

Attached to fluids

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6
Q

Start the process of GA

A

Drugs- amnesia- induction agents

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7
Q

Induction agents

A

Propofol
Thiopentone
Ketamine
Etomidate

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8
Q

Propofol

A 
Most commonly used
Dose- 1.5-2.5 mg/kg
Lipid based
Excellent suppression of airway reflexes
Decreases incidence of PONV- post-op nausea and vomiting
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9
Q

Unwanted effects of propofol

A

Marked drop in HR and BP
Pain on injection
Involuntary movements

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10
Q

Thiopentone

A

Barbiturate
Dose- 4-5 mg/kg
Faster than propofol
Used mainly for rapid sequence induction- (when induction is required quickly to prevent aspiration)
Antiepileptic properties and cerebral protective

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11
Q

Unwanted effects of thiopentone

A

Fall in bp but rise in hr
Rash/bronchospasm
Intra-arterial injection- thrombosis and gangrene
contraindicated in porphyria

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12
Q

Ketamine

A

Dissociative anaesthesia- anterograde amnesia and profound analgesia
Used for sole anaesthetic for short procedures- pulling of wires, burn dressing change
Dose- 1-1.5 mg/kg
Slow onset (90 secs)
Rise in HR/BP, bronchodilation
In a patient with heart failure

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13
Q

Unwanted side effects of ketamine

A

Nausea and vomiting

Emergence phenomenon

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14
Q

Etomidate

A

rapid onset
Dose- 0.3 mg/kg
haemodynamic stability
lowest incidence of hypersensitivity reaction

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15
Q

Unwanted side effects

A

Pain on injection
Spontaneous movements
Adreno-cortical suppression
High incidence PONV

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16
Q

Routes of anaesthesia

A

Total IV anaesthesia

Inhalational anaesthesia

17
Q

MAC

A

Concentration of the vapour

That prevents the reaction to a standard surgical stimulus in 50% of subjects

18
Q

Inhalational agents

A

sevoflurane
Desflurane
Isoflurane

19
Q

sevoflurane

A

sweet smelling

inhalational induction

20
Q

sevoflurane

A

Sweet smelling
inhalational induction
USE- Chubby child

21
Q

Isoflurane

A

Least effect on organ blood flow

22
Q

Isoflurane

A

Least effect on organ blood flow

Use- organ retrieval from a donor

23
Q

Non depolarising muscle relaxants

A

Block the nicotinic receptors
Examples- mivacurium (15-30mins), vecuronium, pancuronium (60 minutes)
Reversal with neostigmine and glycopyrrolate

24
Q

Depolarising muscle relaxants

A

Prevent breakdown of acetlycholinesterase

Example- suxamethonium (dose 1-1.5 mg/kg)

25
Q

To treat hypotension- Inotropes

A

Ephedrine- increases BP and HR
Phenylepherine- Increases BP and lowers HR
Metaraminol- Increases BP and lowers HR

26
Q

Anti emetics for PONV

A 
Ondansetron- most common- given half an hour before the end of operation
Cyclizine
Dexamethasone- given at induction
Prochlorperazine
Metoclopramide
27
Q

reversal

A

Stop anaesthetic vapours
Give oxygen
Perform throat suction
Reverse muscle relaxation with neostigmine and glycopyrrate (blocks nicotinic receptors in the heart so acetylcholine can only work in the muscles)

28
Q

Post anaesthetic care

A

Administer o2 during transfer
Handover the patient- brief history, any problems anticipated, intraoperative, analgesia and PONV prophylaxis
Prescribe- rescue analgesia, rescue antiemetics, fluids

29
Q

Aims of pre-operative assessment

A

Allay fear and anxiety
Identify potential anaesthetic difficulties and medical conditions
Improve safety by assessing and quantifying risk
Optimise and plan of the peri-operative care
Provide an opportunity for explanation and discussion (consent)

30
Q

Mallampati score

A 
To check for ease of intubation
Class I-IV- class 1 being the easiest
31
Q

ASA Grading

A

Physical status examination for assessing fitness for surgery
Grades 1-6
For emergency cases the suffix ā€˜Eā€™ is used

32
Q

ASA Grades

A

Grade 1- Fit and healthy
Grade 2- Mild systemic disease
Grade 3- Severe systemic disease with substantial functional limitations
Grade 4- severe systemic disease with a constant threat to life
Grade 5- Moribund patient who is not expected to survive with or without operation
Grade 6- Brain stem patient whose organs are being removed for donor purposes

33
Q

Grades of surgery

A

Minor- excision skin lesion
Intermediate- inguinal hernia
Major or complex- hysterectomy

34
Q

NCEPOD classification of surgery

A

Immediate- resus simultaneous with intervention within minutes
Urgent-time available for resus within hours
Expedited-patient requiring early treatment where the condition is not an immediate threat to life or limb within days
Elective- 18 weeks initiative

35
Q

Intralipid

A

reduces concentration of free local anaesthetic by absorbing it up from the blood

O&G (5 decks)

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