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Pain and Anxiety > Applied anatomy, physiology and pharmacology > Flashcards

Applied anatomy, physiology and pharmacology Flashcards

1
Q

Define sedation

A

A continuum which extends from normal alert consciousness to complete unresponsiveness

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2
Q

Minimal sedation responsiveness, airway, ventilation and cardiovascular effects?

A

Responsiveness - Normal response to verbal commands
Airway - Unaffected
Ventilation - Unaffected
Cardiovascular - Unaffected

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3
Q

Moderate sedation responsiveness, airway, ventilation and cardiovascular effects?

A

Responsiveness - Purposeful response to verbal or tactile stimulation
Airway - Maintained without intervention
Ventilation - Adequate
Cardiovascular - Usually maintained

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4
Q

Deep sedation responsiveness, airway, ventilation and cardiovascular effects?

A

Responsiveness - Purposeful response following repeated or painful stimulation
Airway - Intervention may be required
Ventilation - May be inadequate
Cardiovascular - Usually maintained

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5
Q

GA responsiveness, airway, ventilation and cardiovascular effects?

A

Responsiveness - Unrousable even with painful stimulation
Airway - Intervention often required
Ventilation - Frequently inadequate
Cardiovascular - May be impaired

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6
Q

Steps to respiration?

A
  1. Ventilation – moving of gas into and out of the lungs
  2. Diffusion – transfer of gases from the lungs into the blood
  3. Transport – the transport of oxygen by the blood to the cells and the transport away of carbon dioxide
  4. Diffusion – transfer of gases from the blood to the cells
  5. Oxidation – the use of oxygen to produce energy within the cell and the production of carbon dioxide
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7
Q

Inspiration features?

A 
Active process
Initiated by diaphragm
Supported by intercostals
Accessory muscles for more vigorous inhalation
Normal rate 10-18 per minute
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8
Q

Expiration features?

A

Passive process
Elastic recoil of lung
Forced expiration involves abdominal and intercostals

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9
Q

Where does pulmonary gas exchange occur?

A

Alveoli

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10
Q

Alveoli features?

A

Wall single layer thick
0.2 micrometers
Adjacent to pulmonary capillary wall
Gas diffuses down concentration gradients

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11
Q

How does delivery of O2 occur?

A 
O2 binds to haemoglobin
Each molecule can carry 4 O2 molecules 
Carried within RBC
CaO2= 1.34 x Hb x SpO2
Delivery =  CaO2 x Cardiac Output
Properties of haemoglobin means it releases O2 when it gets to the tissues

Hb - Lungs - Resp centre - Tissues

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12
Q

What does O2 delivery equal?

A

CaO2 x Cardiac Output

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13
Q

What makes up the Autonomic Nervous System?

A

Brainstem, medulla, pons

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14
Q

How to monitor the pt whilst sedated?

A

Resp rate 10-18 per minute
Depth of breathing
Pattern of breathing
Cyanosis

Advanced - pulse oximetry (mandatory), carbon dioxide monitoring (optional)

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15
Q

Venous blood O2 and CO2 levels compared to air? How does this impact diffusion?

A

Venous blood has less O2 compared to air - diffuses out alveoli
Venous blood has more CO2 compared to air - diffuses into alveoli

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16
Q

Cellular respiration?

A

Mitochondria uses O2 for metabolism

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17
Q

CV system basic function?

A

Deliver oxygenated blood to body organs and tissues for metabolism
“tissue perfusion”

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18
Q

What happens with inadequate perfusion?

A

Organs, tissues fail
Cardiac ischaemia - angina - myocardial infarct
Cerebral ischaemia - fain, collapse - stroke
Lung - hypoxia

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19
Q

What is the main determinant of organ perfusion?

A

Blood pressure

- Systolic, diastolic and mean (MAP) 12060 (80)

20
Q

How to calculate MAP?

A

Diastolic + 1/3 (systolic - diastolic)

21
Q

What is the normal MAP?

A

80mmHg

22
Q

What determines BP?

A

Cardiac output

Systemic vascular resistance

23
Q

What is cardiac output?

A

Amount of blood ejected by the heart per minute - average 5 litres/min
Determined by HR and stroke volume
HR between 50-180 have little effect

24
Q

How to reduce stroke volume?

A

Dehydration/blood loss
Ischaemic heart disease/heart failure
- Anaesthetic drugs

25
Q

Systemic vascular resistance?

A

Resistance produced by the vascular system to the flow of blood
Predominantly small arterioles throughout the body
Constriction increases SVR and BP
Dilation decreases SVR and BP

26
Q

How to decrease systemic vascular resistance?

A

Sedative drugs
Anaphylaxis
Sepsis/infec

27
Q

Acute control of BP?

A

Baroreceptors in aortic arch and internal carotids
Send signals to brainstem
Autonomic nervous system alters rate and strength of heart contraction and constriction of blood vessels

28
Q

Chronic control of BP?

A

Renin-angiotensin system
Aldosterone
Chronic regulation of blood sodium concentration and body fluid retention

29
Q

Drugs for moderate sedation?

A

Benzodiazepines - Midazolam
Opiates - fentanyl, remifentanil
Others - propofol, ketamine, dexomethomedine

30
Q

Midazolam mode of action?

A

–

31
Q

Midazolam features?

A 
Benzodiazepine
Given IV for moderate sedation
Onset 1-3 mins
Peak 5-7 mins
Duration 20-30 mins
Titrate dose to desired end point e.g. slurred speech
32
Q

Midazolam dosing? Cautions?

A

Initial dose 2.5mg given over 2 mins
Wait 2 mins for effect
Subsequent doses of 1mg
Usually no more than 5mg

Cautions - decrease initial dose to 1.5mg in the elderly
If used with a pre-med then reduce dose by 1/3

33
Q

Midazolam advantages?

A

Quick onset
Short action of duration
Minimal CV effects

34
Q

Midazolam disadvantages?

A

Resp depression

Airway obstruction

35
Q

Flumazentil features?

A

Reverse benzodiazepine effects quickly
Dose of 200mcg every 1-2 mins as required
Onset within 1-2 minutes, peak effect within 6-10 minutes

36
Q

Fentanyl features?

A 
Opiate
Provides analgesia and sedation
Onset 1-2 mins
Peak 10-15 mins
Duration 30-60 mins

Dosing 25mcg (0.5ml) bolus up to 200mcg max

37
Q

Fentanyl advantages?

A

Provides analgesia as well as sedation
Fast onset
Short duration of action

38
Q

Fentanyl adverse effects?

A

Hypotension and bradycardia
Respiratory depression
Nausea and vomiting

39
Q

Remifentanil features?

A

Ultra short acting opiate
V potent analgesic effect
Has to be administered by continuous infusion via syringe driver

40
Q

Remifentanil advantages?

A

Excellent analgesic properties

Extremely short duration of action (8 mins)

41
Q

Adverse effects of Remifentanil?

A

Hypotension
Bradycardia
Respiratory depression and apnoea

42
Q

Propofol features?

A

Intravenous anaesthetic induction agent
Onset: 30 seconds
Duration: 10 - 15 minutes

Dosage:
10 - 20mg (1 -2 mls) every 5 minutes
Or
By continuous infusion

43
Q

Propofol advantages?

A

Very potent sedative

Rapid onset

44
Q

Propofol adverse effects?

A

Only for use by trained sedationist or anaesthetic staff
Can rapidly progress to general anaesthesia
Significant cardiovascular and respiratory depression

45
Q

Tips for sedation?

A

Use single drug if possible - avoid ‘polypharmacy’
Give small incremental boluses to titrate effect in individual patient
Easier to give a bit more than to deal with effects of giving too much
Knowledge of time to onset and peak effect of the drug you are using

46
Q

Polypharmacy positives?

A

Use of more than one drug
Can have advantages
Different drugs give different effects
e.g. Opiate + Benzodiazepine gives both sedation and analgesia
Giving a second drug means you can use less of the first drug and so potentially reducing side effects

47
Q

Polypharmacy negatives?

A

Opens the door for greater risk of overdosing and over-sedating patients
Drugs with the same side effects will have synergistic action and make those side effects even more likely
Must be aware of time to peak effect of the drugs you are using…..

Midazolam 5 - 7 minutes
Fentanyl 10 - 15 minutes
Propofol 1 minute
Not waiting for full effect of first drug may lead to dosing of second drug peaking with first drug
Leads to significant over-sedation and side effects

Pain and Anxiety (6 decks)

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