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Specialties > Anesthetics > Flashcards

Anesthetics Flashcards

1
Q

What are the 3 main components of Anesthesia?

A

Analgesia
Hypnosis
Relaxation

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2
Q

How do anesthetic agents work ?

A

Suppressing neuronal activity in a dose dependent fashion.

Interfere with neuronal ion channels.

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3
Q

Which type of anesthesia works rapidly and causes unconsciousness as soon as they reach the brain ?

A

IV Agents such as propofol

They also have rapid recovery.

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4
Q

Which pump system is used to allow accurate infusions to achieve specific blood and brain concentrations of agents ?

A

Target Controlled Infusion (TCI) pump

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5
Q

What is the anesthetic which is inhaled for GA ?

A

Halogenated Hydrocarbons

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6
Q

How do inhaled GA agents get into the patients blood stream ?

A

Cross the alveolar basement membrane into the circulation.

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7
Q

What is MAC ?

A

Minimum Alveolar Concentration.

The concentration of the drug required in the alveoli to produce anesthesia with any inhaled agent.

Low number = High Potency

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8
Q

What is the main role of inhaled anesthetic agents ?

A

Extension and continuation of anesthesia.

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9
Q

How does anesthesia work centrally on the CVS ?

A

Depresses cardiovascular centers in the brain-stem.

Reduces sympathetic outflow.
Negative inotropic/chronotropic effect on the heart.
Vasodilates = Reduction in SVR.

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10
Q

What happens to the cardiac output during anesthesia ?

A

Due to the vaso and venodilation there is decreased venous return and therefore decreased cardiac output

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11
Q

Which anesthetic drug is not a depressant of the CVS ?

A

Ketamine

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12
Q

How do anesthetic agents effect the respiratory system ?

A

All GA agents are respiratory depressants.

They reduce tidal volume an increase resp. rate (Opiates have the opposite effect).

They reduce hypoxic and hypercarbic drive via the depression of the brainstem resp. centres.

Lung volume is greatly reduced - hence the need for oxygen post-op.

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13
Q

What are the indications for muscle relaxants ?

A

Ventilation and intubation.
When immobility is essential.
Body cavity surgery.

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14
Q

What problems do muscle relaxants hold ?

A

Awareness - The seperation of unconciousness and hypnosis.

Incomplete reversal - Airway obstruction.

Maintaining and protecting the airway and providing ventilation to the lungs for as long as the muscle relaxants are working.

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15
Q

Why use analgesia during GA ?

A

Prevention of arousal
Opiates contribute to the hypnotic effect.
Suppression of reflex responses to painful stimuli i.e. tachycardia and hypertension.

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16
Q

Why use local/regional analgesia ?

A

Retain awareness/consciousness.

Lack of global effects of GA.

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17
Q

What is the process of anesthesia ?

A 
Pre-op assessment
Preparation
Induction 
Maintenance
Emergence 
Recovery
Post-op care and pain management.
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18
Q

What is the triple airway manoevre performed by anesthetics ?

A

Head tilt
Chin lift
Jaw thrust

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19
Q

A laryngeal mask airway does what to the airway ?

A

Maintains but does not protect

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20
Q

What does an I-gel not protect you from ?

A

Aspiration

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21
Q

How does an obstruction happen ?

A

Ineffective triple airway manoevre.
Airway device malposition or kinking.
Laryngeal spasm.

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22
Q

What occurs in Laryngeal spasm ?

A

Forced reflex adduction of the vocal cords.
May result in complete airway obstruction.
Caused by airway stimulation in light planes of anesthesia.

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23
Q

When is the airway maintained and when is it protected ?

A

Maintained: Open and unobstructed.

Protected: Only a cuffed tube in the trachea protects the airway from contamination.

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24
Q

What is endotracheal intubation ?

A

Placement of a cuffed tube in the trachea - oral route.

Laryngeal reflexes must be abolished.

25
Q

Why intubate a patient ?

A

Protect airway from gastric contents.
Need for artificial ventilation i.e. muscle relaxants.
Need for tight control of blood gases.
Restricted access to airways.

26
Q

What are the risks to an unconscious patient ?

A 
Airway
Temp.
Loss of protective reflexes.
Venous thromboembolism.
Consent and ID.
Pressure areas.
27
Q

What are the 2 types of respiratory failure ?

A

Type 1: Oxygenation Failure

Type 2: Oxygenation and ventilation failure

28
Q

What are the 5 types of shock ?

A 
Distributive (Septic)
Hypovolaemic
Anaphylactic
Neurogenic
Cardiogenic
29
Q

What are 2 types of vasopressors used in cardiovascular failure ?

A

Metaraminol

Noradrenaline

30
Q

What are 2 types of Inotropes used in cardiovascular failure ?

A

Adrenaline

Dobutamine

31
Q

What grading system is used by anesthetists as a pre-op assessment ?

A

ASA Grading (1-6)

32
Q

What is nociceptive pain ?

A

Obvious tissue injury or illness.
Also called physiological or inflammatory pain.

Has a protective function.

33
Q

How is nociceptive pain described ?

A

Sharp and dull

Well localized

34
Q

What is neuropathic pain ?

A

Nervous system damage or abnormality - tissue injury may not be obvious.

Does not have a protective function.

35
Q

How is neuropathic pain described ?

A

Buring, shooting, pins and needles.

Not well localized

36
Q

What are the 4 steps of physiologcial pain ?

A

Periphery
Spinal cord
Brain
Modulation

37
Q

What occurs in the periphery when pain occurs ?

A

Tissue injury

Release of chemicals

Stimulation of pain receptors (nociceptors)

Signal travels in Ad or C nerve to spinal cord.

38
Q

What occurs in the spinal cord when pain occurs ?

A

Dorsal horn is the first relay station.

Ad or C nerve synapses with 2nd nerve.

Second nerve travels up opposite side of the spinal cord.

39
Q

What occurs in the brain when pain occurs ?

A

Thalamus is the 2nd relay station.

Connections to many parts of the brain (Cortex, limbic system and brainstem)

Pain perception occurs in the cortex.

40
Q

What occurs during modulation in the pain pathway ?

A

Descending pathway from brain to dorsal horn.

Usually decreases pain signal.

41
Q

What is the gate theory of pain ?

A

The gate control theory of pain asserts that non-painful input closes the nerve “gates” to painful input, which prevents pain sensation from traveling to the central nervous system.

42
Q

What are some examples of simple analgesics ?

A

Paracetamol

NSAIDs (Dicofenac and Ibuprofen)

43
Q

What are some examples of mild opioids ?

A

Codeine, Dihydrocodiene

44
Q

What are some examples of string opioids ?

A

Morphine, Oxycodone and Fentanyl

45
Q

How do you treat pain in the periphery ?

A

Rest, Ice, compression or elevation.

NSAIDs

Local anaesthetics

46
Q

How do you treat pain in the spinal cord ?

A

Local anaesthetics
Opioids
Ketamine

47
Q

What are some treatments that target the brain during pain responses ?

A

Paracetamol
Opioids
Amitriptyline
Clonidine

48
Q

What is the mechanism of action of Tramadol ?

A

Weak opioid effect plus inhibitor of serotonin and noradrenaline reuptake

49
Q

Give 3 examples of anticonvulsant drugs

A

Carbamazepine
Sodium valproate
Gabapentin

50
Q

When is the WHO pain ladder used ?

A

Nociceptive pain

51
Q

What is the RAT approach to pain management ?

A

Recognise
Assess
Treat

52
Q

How can you assess pain, give 6 examples

A 
Verbal rating score
Numerical rating score
Visual analogue scale 
Smiling faces
Abbey pain scale (for confused patients)
Functional pain
53
Q

What is the non-pharmacological treatment, RICE ?

A

Rest
Ice
Compression
Elevation

54
Q

How does the WHO pain ladder suggest you treat someone who has mild nociceptive pain ?

A

Paracetamol +/- NSAIDs

55
Q

How does the WHO pain ladder suggest you treat someone who has moderate nociceptive pain ?

A

Paracetamol +/- NSAIDs + codeine

56
Q

How does the WHO pain ladder suggest you treat someone who has severe nociceptive pain ?

A

Paracetamol +/- NSAIDs + Morphine

57
Q

When is the WHO pain ladder not applicable ?

A

In neuropathic pain

58
Q

What drug therapies are useful in neuropathic pain ?

A

Amitryptaline
Gabapentin
Duloxetine

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