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Finals > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

name some antiemetics and what neurotransmitters they target?

A

Ondasteron (serotonin)
Cyclizine (Histamine)
Domperidone/Metoclopromide (Dopamine)

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2
Q

what do you include in a Anaesthetics history?

A
  • about previous anaesthetics/family history
  • conditions: malignant hyperpyrexia and suxamethonium apnoea
  • airway problems
  • any previous PONV
  • allergies to anaesthetic/analgesic/ABx/latex/eggs
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3
Q

how do you treat malignant hyperpyrexia?

A

reverse with Dantralene

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4
Q

What is suxamethonium apnoea?

A

patient doesn’t have the enzyme to break down propofol

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5
Q

Name some drugs which should be stopped 24 hours before the operation?

A

ACEi/ARB

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6
Q

What do you include in a pre-operative assessment?

A

CVS - HTN/IHD/pacemaker/PVD

RESP - COPD/asthma - can they take NSAIDS/OSA/exercise tolerance

other - reflux, DM, thyroid problems, previous VTE, rheumatoid, smoking, alcohol, drugs]

O/E - heart and lungs, teeth, neck flexibility airway assessment

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7
Q

name some causes of a difficult airway

A 
down's syndrome
rheumatoid arthritis
ankylosing spondylitis
obesity
dental abscesses
smally mouth and chin
expensive dental work
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8
Q

name some predictive airway tests

A

mallampati - how much of the oropharynx is visible
extension of the upper c spine
thyromental test - distance from tip of thyroid to tip of mandible at extension (<6 = difficult)

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9
Q

what is the triad of anaesthetic drugs?

A

anaesthesia
analgesia
muscle relaxant

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10
Q

what is anaesthesia?

A

pharmacologically induced and reversible state of sleep characterised by lack of pain/awareness/memory of events

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11
Q

what are the stages of anaesthesia?

A
  1. INDUCTION - normally IV (sevofluorane), secure airway to give O2.
  2. MAINTENANCE - volatile N2O/O2.
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12
Q

when do you need to ventilate?

A

if muscle relaxants given

GCS <8

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13
Q

name some simple manouvres for airway control?

A

head tilt
chin lift
jaw thrust

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14
Q

name some complex airways used for airway control?

A

oropharyngeal
nasopharyngeal
supraglottic
ET tube

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15
Q

how can you determine the correct placement of the ET tube?

A

chest movement
misting mask
trace on capnography

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16
Q

how does local anaesthetic act?

A

blocks Na channel

17
Q

name some different types of LA (where theyre placed)

A

nerve block
plexus block
epidural block
spinal block

18
Q

name some benefits of LA

A 
avoids GA
can stay awake
no airway problems
reduced N&V
better pain control peri-op
19
Q

what are the differences between onset and duration of lidocaine and bupivacaine

A

LIDOCAINE - immediate onset, lasts 15 mins, used in small procedures

BUPIVOCAINE - 10 minute onset, lasts 2 hours, regional blocks use

20
Q

what is a spinal block?

A

needle goes through ligament and dura

LA bolus which lasts 2 hours

21
Q

what is an epidural?

A

needle between ligament and dura

LA administered via catheter as a confusion

22
Q

why do we need to use muscle relaxants during surgery?

A

relax the glottis
relax muscles for surgery
so patient doesn’t resist ventilator

23
Q

name the two types of muscle relaxants

A

polarising and depolarising

24
Q

name a depolarising muscle relaxant and explain how it works

A

Suxamethonium - 2ACh molecules bidn to both sites simultaneously - causes contraction and then flaccid paralysis

25
Q

name a non-depolarising muscle relaxant and explain how it works

A

Rocuronium - competitively inhibits ACh by blocking binding site

26
Q

how can you reverse a muscle relaxant?

A

Neostigmine - blocks ACh, causes build up of ACh, creates competition with muscle relaxant for binding site.

27
Q

Name 2 drugs you can give if the HR is too slow during surgery

A

ATROPINE - inhibits vagus

DOBUTAMINE - stimulates B adrenoreceptors in myocardium

28
Q

how can you manage the BP being too low in surgery

A

stimulate the A adrenoreceptors - causes vasoconstriction

29
Q

name some SE of NSAIDS?

A

peptic ulcers, AKI, thins blood

30
Q

name some SE of paracetamol?

A

liver failure, cachexia

31
Q

what is crystalloid solution?

A

ions and small molecules dissolved in water

32
Q

what are colloids?

A

large insoluble molecules which are retained within plasma for longer e.g. blood/albumin/starch/gelitin

33
Q

what do you check before prescribing fluids?

A 
haemodynamic status
ongoing losses
can patient drink orally
weight
renal function
UEs
34
Q

What is T1RF? name some causes and which ventilation would you use

A

low O2 and normal CO2
causes: pneumonia, COVID, LVF
Use CPAP - maintains the alveolus open and forces fluid from the lungs

35
Q

what is T2RF? name some causes and which ventilation would you use

A

low O2 and high CO2
causes: COPD, muscular dystrophy, MND, MS
use BiPAP - helps with CO2 removal

36
Q

name some complications of IV

A

VAP, VILI, sedation and muscle relaxants, immobility, stockings, O2 toxicity

37
Q

name some ET tube indcations

A

protect airway, UA obstructed, NM paralysis, improve oxygenation

Finals (21 decks)

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