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anaesthesia > Anesthestic Drugs > Flashcards

Anesthestic Drugs Flashcards

1
Q

Groups of anaest drugs

A

Induction agent
- Inhalation -> Volatile agent & Gas: Volatile agent: sevoflurane, desflurane, isoflurane, halothane, enflurane
Gas: nitrous oxide

  • Intravenous drugs: propofol, ketamine, thiopentone

Local anest: lignocaine, bupivacaine, cocaine

Muscle relaxant: suxamethonium, rocuronium, atracurium

Analgesic: fentanyl, morphine, nsaid, paracetamol

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2
Q

Indication of volatile agent/gas

A
  • children (uncooperative, needle phobia)
  • no IV access
  • airway compromised
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3
Q

Factors affecting uptake of anaes into the tissue

A
  1. solubility (blood to gas partition coefficient): high blood to gas partition coefficient, high uptake of gas into blood
  2. tissue blood flow: the greater the blood flow, the faster the uptake
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4
Q

What is minimum alveolar concentration (MAC) and acceptable range

A

Minimum gas concentration needed to anaesthetized 50% of patient

  • high MAC, low potency
  • acceptable range: around 0.8
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5
Q

Factors affecting MAC

A

Higher MAC needed in
- hyperthermia
- chronic opioid use (tolerance)
- chronic alcohol intake (tolerance)
- steroid usage

Lower MAC needed in
- neonate
- acute alcohol and opioid intake
- hypothermia
- pregnancy
- anemia/hypotension
- hypothyroidism

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6
Q

Common volatile agents

A
  • nitrous oxide
  • sevoflurane
  • desflurane
  • isoflurane
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7
Q

Nitrous oxide
- Indication
- S/E
- MAC
- describe/criteria

A

Indication: use as analgesic ONLY (ethonox in O&G), use as adjuvant to lower the MAC of volatile agent

S/E: respiratory depression, mild teratogen esp used in pregnancy during organogenesis, PONV

Describe/criteria:
- colourless, odourless, non explosive
- potent analgesic but weak anaesthetic

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8
Q

Sevoflurane
- indication
- s/e
- mac
- describe/criteria

A

Indication: for rapid induction and maintenance, and rapid recovery

Rapid S/E: mild effect on bp/hr, respiratory depression (decrease tidal volume, increase RR), bronchodilation

Mac: 2.0

Describe: sweet smell (can be used in paeds and adult)

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9
Q

Desflurane
- indication
- s/e
- mac
- describe/criteria

A

Indication: for maintenance (rapid onset and rapid recovery) & use in daycare surgery

S/e: same with sevoflurane for respiratory s/e, however on CVS has effect of tachycardia with rapid response to concentration

MAC: 6.0

Describe: has pungent smell (irritate the airway and can cause laryngospasm, coughing and secretions)

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10
Q

IV induction is divided into

A
  • barbiturate: sodium thiopentone (STP)
  • non barbiturate: propofol, ketamine, midazolam, etomidate
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11
Q

Criteria for ideal IV anaes agents

A
  • rapid, smooth and safe
  • limited CVS and respiratory effects
  • should possess analgesic activity
  • rapid return of consciousness
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12
Q

MOA of induction agents

A

All except ketamine potentiate GABA receptor

Ketamine: NMDA receptor

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13
Q

Propofol
- indication
- onset
- s/e
- CI

A

Indication (SIMS)
- sedation
- induction (+ TIVA)
- maintenance
- sedation in status epilepticus

Onset: fast onset (40-50sec)

S/e:
CVS: hypotension, brady (cardiovascular depressant)
Respi: resp depression, temporary apnea
Reduce PONV

CI: allergy to eggs, hypotension, known hypersensitivity to propofol

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14
Q

Thiopentone
- indication
- onset
- s/e
- CI

A

Pale yellow powder

Indication
- induction (potent anaest)
- tx status epilepticus
- induce coma (NOT used as maintenance agent)

Onset: 30-40s (short onset)

S/e:
CVS: hypotension with tachycardia
Respi: respiratory depression and bronchospasm
Anticonvulsant, anti analgesic (poor)

CI
- severe asthma & COPD (bronchoconstriction)
- porphyria, allergy to barbiturates

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15
Q

Ketamine
- indication
- onset
- s/e
- CI

A

Indication
- hypnotic
- analgesic (mass casualties, burn dressing)
- induction in pt risk of hypotension and bronchial asthma
- mx for severe bronchospasm and hypotensive pt

Onset: 1 min

S/e:
CVS: increase BP and HR
GIT: PONV
LA properties: emergence delirium, vivid dreams, hallucinations, increase catecholamine secretions

CI
- increase ICP
- hypertension
- glaucoma
- heart failure

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16
Q

Midazolam
- indication
- onset
- s/e
- CI

A

Indication
- premed sedation
- premed amnesia
- premed anxiolysis

*commonly use together with fentanyl as part of induction agent

Onset: 5 min (rapid onset)

S/e: resp depress, drowsiness, confusion, anterograde amnesia

CI: elderly/ ill patients with marked respiratory depression

Antidote: flumazenil

17
Q

Etomidate (imidazole)
Indication:
Benefit:
S/e:

A

Indication: IV induction ONLY
Benefit: CVS stable (can be used in compromised CVS pt)
S/e: adrenal insufficiency

18
Q

Types of muscle relaxant

A

Depolarizing agent: suxamethonium

Non depolarizing agent: atracurium, rocuronium

19
Q

Suxamethonium/ succinylcholine
-MOA
-Onset & duration
-Reversal agent
-Indication
-S/e or complication
-Contraindication

A

MOA: bind to ACh receptor -> desensitized the receptor -> muscle relaxant effect

Onset: rapid onset (30-60sec) and short duration

Reversal agent: NO reversal agent. Hydrolyse by plasma cholinesterase

Indication: muscle relaxant in RSI, short procedures

S/E:
-muscle pain
- bradycardia
- hyperkalemia
- apnea
- malignant hyperthermia
- increase IOP, ICP, intragastric pressure

CI:
- known hypersensitivity/allergy
- positive history of malignant hyperthermia
- high risk of hyperkalemic response
- myotonia (muscular dystrophy)

20
Q

Atracurium
-MOA
- Metabolism
-Onset & duration
-Reversal agent
-Indication
-S/e or complication
-Contraindication

A

MOA: compete with acetylcholine

Metabolism: spontaneous degradation by Hoffman elimination and ester hydrolysis

Onset: fast onset 3min and intermediate acting (20-35 min)

Reversal agent: neostigmine, sugamadex

Indication: muscle relaxant

S/e: hypotension, reflex tachycardia

CI: hypersensitivity, NMJ ds

21
Q

Rocuronium
-Onset & duration
-Reversal agent
-Indication
-S/e or complication
-Contraindication

A

Onset: fast (1-2 min) and intermediate acting (20-35 min)

Reversal agent: same with atracurium
Indication: muscle relaxant, RSI (alternative for Suxa), tracheal intubation

S/e: large dose cause tachycardia. Minimal CVS effect and very low potential for histamine release

Contraindication: hypersensitivity, NMJ ds

22
Q

S/e of neostigmine and given together with

A

Bradycardia
Cardiac arrest
PONV
Slow HR

Given together with anti cholinergic (atropine) or glycopyrulate

23
Q

CI for sugamadex

A

Impaired renal fx cs excreted by kidney

24
Q

CI in atropine

A

Worsen in CVS or hyperthyroid pt

25
Q

Types of analgesia

A

Opioid
- strong opioid: fentanyl, morphine, pethidine
- weak opioid: tramadol, dihydrocodeine

Non opioid
- simple analgesic: PCM
- non selective NSAID: ibuprofen, diclofenac, mefenamic acid, ketorolac
- selective COX2 inhibitors: celecoxib (celebrex), parecoxib

26
Q

Indication for opioid

A

Chronic and severe pain

27
Q

CI in morphine

A

Caution in renal insufficiency and elderly

28
Q

CI for NSAIDs

A

Asthma
Gastric ulcer/bleeding
Kidney impairment
Platelet dysfuntion

29
Q

Indication for PCA

A
  • cancer pt
  • severe pain
  • post op
  • delivery
30
Q

CI in PCA

A
  • terminally ill pt
  • dementia
  • not for chronic pain (except cancer)
31
Q

What needs to be monitored in PCA

A
  • vomiting
  • sedation level
  • HR, BP
  • pain score (acceptable less than 3)
32
Q

What is PONV

A

Any nausea, retching, vomiting occur during first 24 to 48 hrs after anaesthesia

33
Q

Factors increase risk of PONV

A

Female
Obesity
History of PONV and motion sickness
Ocular
ENT
laparoscopic and gynae procedure

34
Q

Types of antiemetic

A

Butyrophenon: droperidol (dopamine antagonist)

Benzamides: metoclopramide (maxolon)

Serotonin antagonist (5HT3): ondansetron, granisetron

Phenothiazine: chlorpromazine

Antihistamine: promethiazine

anaesthesia (5 decks)

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