Anaesthetics Flashcards
when is an RSI done?
high aspiration risk
what are the three aspects of an anesthetic?
analgesia
hypnosis
muscle relaxant
what happens in an RSI?
5 mins of preoxygenation
pressure on cricoid cartilage (prevent aspiration)
induction + muscle relaxant
intubated
what are the components of an RSI?
analgesia - fentanyl
anaesthetic/induction - propofol
muscle relaxant - suxamethonium
in a GA, what is given to make sure patient can ventilate themselves?
volatile agents
e.g NO
where does the spinal cord run to?
L1 (adults)
L3 (kids)
what level is the iliac crest?
L4/5
where does epidural go?
to epidural space (between dura and spinal cord)
where does spinal go?
subarachnoid space (CSF flows out)
what does an epidural pass through?
skin subcut tissue supraspinous lig inerspinous lig lig flavum epidural space
who should be intubated?
GCS <8 obese pregnant reflux non fasted length DM trauma laparoscopic surgery acutely unwell
what are the short vs long acting locals?
short = lidocaine long = bupivacaine
who and where should adrenaline not be given?
fingers/ears/toes
those on MAOis/TCAs
who is at higher risk of local anaesthetic toxicity? what does it cause?
liver problems/low protein
CNS overactivity/depression/arrythmias
what does propofol work on?
works on GABA
anaesthetic
side effects of propfol?
hurts to inject
stops upper airway reflex
myocardial depression
what is atracurium? do you get fasciculations?
long acting muscle relaxant
NO
what is suxamethonium? do you get fasciculations?
short acting muscle relaxant (depolarising agent)
YES
how long should warfarin be withheld for pre op?
5 days (check INR)
what is the INR aim for surgery?
≤1.5
what is the warfarin reversal agent?
vit K
when can warfarin be given post op?
same day
when should heparin be stopped pre op?
6 hours unfrac
24 hours LMWH
who should not have anticoagulants stopped?
VTE <3mnths
mechanical valves
AF/valve disease with Hx thrombosis
when should clopidogrel be stopped pre op?
7 days
what cardiac drugs should be withheld on the day of surgery? why?
ACE
AKI and hypotension risk
how should T1DM be managed pre op?
fasted and first on list
take long acting but not short
give post op once eaten
how should T2DM be managed pre op?
fasted and first on list
withold oral hypo on day
give metformin after once renal function is checked
difference between HDU and ICU?
HDU = single organ failing ICU = multiple
difference between CPAP and BIPAP?
CPAP - pressure doesn’t change
BIPAP - less pressure when breathing out/more breathing in
where are CVC usually inserted?
IJV
subclavian
femoral
what do inotropes do vs chronotrope?
inotropic - increase contractility
chronotrope - rate
examples of inotropic drugs?
adrenaline
dobutamine
how does adrenaline work?
attaches to B1 receptors
increases force and rate of contraction
examples of vasopressors? what do these do?
NA
adrenaline
make blood vessels contract to try increase BP
what is classified as chronic pain?
> 3 months
pain ladder?
non opiod + adjuvant
opiod + non + adjuvant
opiod + non + adjuvant
what are the mid vs stronger opiods?
mid = codeine, tramadol, oxy
strong = morphine, oxy, methadone, fentanyl
what can be used as pain adjuvants? what drug class are these?
amitryptilline (TCA)
duloxetine (SNRI)
anticonvulsants
what is the pain rating scale?
0 = no pain at rest or movement 1 = no pain at rest, slight on movement 2 = intermittent at rest, moderate on movement 3 = continuous at rest, severe on movement
what is a normal paracetamol dose?
1g 6 hourly
what is a fast onset opiod?
oxycodone
what is a less addictive opiod?
tramadol
what is a normal PCA dose?
morphine
1mg with 5 min lockout (12mg per hour)
e.g of a depolarising and non depolarising muscle relaxant?
depolarising - suxamethonium
non depol - rocuronium
how do histamine antagonists work?
block H1 receptors in the CNS
cause sedation
e.g cyclizine
how do dopamine antagonists work?
binds to D2 receptors and relaxes the gut (promotility)
how do 5HT3 antagonists work?
antagonise 5HT3 receptors in the CNS/GI tract
what type of drug is hyoscine bromide?
anti muscarinic (anti emetic)
how long should the COCP be stopped before surgery?
2 weeks
if on warfarin pre op, what can this be changed to?
heparin
if on insulin, what should be done with this pre op?
stop on day
give a glucose, K, and insulin infusion
what anaesthetics are more likely to make people sick?
opiods
NOS
ketamine
how to check if patient is intubated and not in oesophagus?
chest air entry
chest movement
capnography (flat - no CO2 detected)
no steam on mask
what happens in local anaesthetic toxicity?
peri oral tingling numb anxiety lightheaded collapse
what layers does an epidural pass through?
skin subcut tissue supraspinous interspinous ligamentum flavum epidural space
what layers does a spinal pass through?
skin subcut tissue supraspinous interspinous ligamentum flavum dura into subarachnoid space
layers of the spinal cord?
dura
arachnoid
pia
e.g of a dopamine antagonist 5HT3 antagonist H1 antagonist anti muscarinic ?
dopamine = metaclopramide
5HT3 = ondansetrone
H1 = cyclizine
anti muscarinic = hyoscine bromide
e.g of drowsy and non drowsy anti histamines?
drowsy = chlorampenicol
non drowsy = cetirizine
