Anaesthetics Flashcards by Ashkun Zolfaghari

what are the three principles of anaesthetics

Amnesia
analgesia
akinesis

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what are induction agents

act quickly ( 10-20s)
last a short period of time
make patient go unconscious

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what is used to maintain amnesia

inhalational agents

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what are the 4 induction agents

propofol
thiopentone
ketamine
etomidate

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tell me about propofol

most common
lipid base
SUPPRESSES AIRWAY WELL
low PONV

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what are the side effects of propofol

drop in BP + HR
pain on injection
involuntary movements

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tell me about thiopentone

barbituate –> antiepileptic
used for rapid sequence induction
faster than propofol

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what are the side effects of thiopentone

drop in BP but rise in HR
rash/ bronchospasm
thrombosis / gangrene with intra-arterial injection
contraindicated in porphyria

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tell me about ketamine

dissociative anaesthesa
profound analgsia
slow onset

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what are the side effects of ketamine

rise in HR / BP

emergence phenomenon –> vivid dreams + hallucinations

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tell me about etomidate

rapid onset
causes haemodynamic stability
lowest incidence of hypersensitivity reaction

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what are the side effects of etomidate

pain on injection
spontaneous movements
adreno-cortical suppression
high incidence of PONV

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what does continous etomidate lead to

cortisol suppression up to 72hrs

DO NOT USE IN SEPTIC SHOCK

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what are the 4 main inhalational agents

isoflurane
sevoflurane
desflurane
enflurane

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tell me about sevoflurane

sweet smelling

inhalational induction

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tell me about desflurane

low lipid solubility
rapid onset + offset
long operations

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tell me about isoflurane

least effect on organ blood flow

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what is MAC and what are the concentrations for different drugs

minimum concentration needed to work
114% NO2
1.15% isoflurane
2% sevoflurane
desflurane 6%

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what are the two IV NSAIDs

ketorolac

parecoxib

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what are depolarising muscle relaxants like?

act on receptor
cause muscle contraction then fatique and then relaxation
used for rapid induction sequence

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what are non-depolarising muscle relaxants like

block nicotinic receptors

slow onset

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what is suxamethonium

depolarising muscle relaxant
used for rapid sequence induction
adverse effects
-muscle pain / fasiculations / hyperkalaemia / malignant hyperthermia

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tell me about different types of non-depolarising muscle relaxants

short acting = atracurium / mivacurium
intermediate = vecuronium / rocuronium
long acting = pancuronium

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what is used for reversal of non-depolarsing agents

neostigmine + glycopyrrolate

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why is glycopyrrolate used for reversal with neostigmine

neostigmine can cause severe bradycardia

what the types of anti-emetics used in anaesthesia

``` 5HT3 blockers = ondansetron anti-histamine = cyclizine steroids = dexamethasone phenothiazine = prochlorperazine anti-dopaminergic = metoclopramide ```

what can PONV lead to ?

increased hospital stay increased bleeding incisional hernias aspiration pneumonia

what are vaso-active drugs used for

treating hypotension

what vaso-active drugs are commonly used

ephedrine | metaraminol

what vaso-active drugs are used in ICU / severe hypotension

noradrenaline adrenaline dobutamine

what is the process for pain management

RAT

what are the three classifications of pain

duration cause mechanism

what are the two causes of pain

cancer | non-cancer

what are two mechanisms of pain

nociceptive | neuropathic

describe nociceptive pain

physiological / inflammatory has a protective purpose sharp/ dull well localised

describe neuropathic pain

nervous system damage / abnormality not a protective function burning / shooting / numbness / pins + needles not very well localised

where do local anesthetics work

nodes of ranvier block transmission of nerve impulse blocks sensory information

what suffixes denote local anesthetics

-caine

what is the max dose of Lignocaine w/wo adrenaline

``` w/o = 3mg/kg w = 7mg/kg ```

what is the max dose of bupivacaine/levobuviacaine w/wo adrenaline

2mg/kg

what is the max dose for prilocaine

6mg/kg

how do you calculate safe doses of local anaesthetics

multiple solution% x 10 to get content of local anaesthetic multiple max dose by weight divide step 2 /step 1

what are the symptoms of local anaesthetic overdose

tingling sensation ringing in ears tonic clonic seizure

how to manage local anaesthetic overdose

``` ABC 100% oxygen call for help tell surgeon to stop send for crash trolley with intralipid start IV fluids ```

what are the three layers of the spinal cord

pia mater arachnoid mater dura

where is CSF

between PIA and arachnoid

where is epidural space

between dura and vertebral canal

where does spinal cord end

lower border of L1

where does subarachnoid space end?

where can you put spinal block

below L2 to S2 lowesy possible level

where is epidural block done

below L1 | same level as spinal during pregnancy

tell me about the pros and cons of spinal

``` single shot rapid onset ( 5-10min) predictable + reliable dense block lasts for 2-3 hours ```

tell me about epidural

slow onset 15-30min effect dependent on cathether position less of a motor block can be titrated for 72hours

what are indications for spinal/ epidural

anaesthesia for lower body obstretics / caesarean / haemorrhage repair / orthopaedics / urology intra-operative analgesia

benefits of spinal / epidural over opioids

can be used on patients with respiratory disease | patients where IV analgesia is not very effective --> obstructive sleep apnoea / PONV

what is included in an preoperative assessment

thorough history + exam | approopritate investigations

what are the key CVS hx + ex

``` chest pain HTN PND orthopnoea excercise tolerance ```

what are the key resp question in pre-op

asthma chest infection cough smoking

what are the key airway hx + exam to ask

teeth dentures neck movements mouth opening

what to ask in previous anaesthetic history

problems with PONV pain relief FHx of anesthetic problems

what hx + ex for GI in pre-op history

GORD | last meal time

what PMHx is important in pre-op

``` diabetes epilepsy renal disease thyroid problems TIA / stroke ```

what air way examination score is given

mallampati score

what are the classes for the mallampati

``` 1 = Uvula / fauces / soft palate / pillars 2= uvula / soft palate / fauces 3= base of uvula / soft palate 4 = only hard palate ```

what are ASA grades

physical status classification 1= healthy 6= brainstem death E = emergency

what are the grades of surgery

minor --> drain/ excision intermediate --> hernia / tonsillectomy major/complex -> big boy tings

what investigations are done for a minor surgery with ASA 1/2/3/4

1/2= none | 3/4 --> kidney function in patients at risk of AKI / consider ECG if none availible from last 12 months