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Semester 3 > Case 10 - anaesthesia notes > Flashcards

Case 10 - anaesthesia notes Flashcards

1
Q

what is the diagram showing the scale from fully alert and conscious to brainstem death

A
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2
Q

what are the different parts of the reticular activating system

A

midbrain reticular formation
mesencephalic nucleus in midbrain
thalamic intralaminar nucelus
dorsal hypothalamus
tegmentum

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3
Q

reticular activating system diagram

A
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4
Q

what are the phases of surgery and anaesthesia

A

preparation
induction
maintenance
early recovery
delayed recovery

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5
Q

what is the monitoring of an anaesthetised patient

A

heart rate and ST segments
pulse oximetry - oxygen saturations
arterial wave form - cannula into radial artery to monitor BP and cardiac output
CO2 and ventilation perimeters
isoflurane also
temperature (hypothermic)

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6
Q

how do we optimise preparation for elective surgery - physiologically

A

stop smoking, loose weight, improve exercise tolerance

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7
Q

how do we optimise preparation for elective surgery - pharmacologically

A

awareness, information, anticipation and mindset

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8
Q

why do people with a high BMI need more of a drug

A

because they have a lot more lipid to dissolve the drug

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9
Q

what is the BIS and which range means a patient is anaesthetised

A

is the bispectral index and a number between 40 and 60 means the patient is anaesthetised

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10
Q

what is local anaesthesia

A

consciousness is not impaired

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11
Q

types of local anaesthesia:

A

topical
field
regional: spinal, epidural

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12
Q

what is an essential feature of general anaesthetic

A

hypnosis

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13
Q

what is combined anaesthesia

A

general anaesthesia combined with some regional technique

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14
Q

why is anaesthesia further down the back less risky than one further up

A

because it is much easier to hit the spinal cord and do damage if anaesthesia needs to be placed higher up the back e.g epidural

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15
Q

when is regional anaesthesia given

A

peripheral limbs
Lower abdomen
Supplied by a distinct set of nerves
Topical
Local infiltration
Field block
Ring blocks
plexus blocks: ultra sound guided

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16
Q

what are the three components of general anaesthesia

A

hypnosis
analgesia
muscle relaxation

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17
Q

what agents are used for hypnosis

A

intravenous agents: propofol, barbiturates (thiopentone), benzodiazepines

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18
Q

what agents are used for analgesia

A

optiates: synthtic or natural
non-opiates

19
Q

what agents are used for muscle relaxation

A

depolarising agents
non-depolarising agents

20
Q

what is remifentanyl used for

A

to perform brain surgery when the patient is aware during it

21
Q

what do more soluble inhalation anaesthetic agents have

A

a higher coefficient

22
Q

what do agents with a lower coefficient have

A

faster onset and faster emergence

23
Q

what is the potency of anaesthetic agents measured and related to

A

measured by oil-gas partition coefficient and related to lipid solubility

24
Q

what is potency not related to

A

the blood gas solubility coefficient

25
Q

what drug has low potency

A

N2O

26
Q

what is the inverse indicator of potency

A

MAC

27
Q

what are the mode of actions these drugs can have

A

disruption of synaptic transmission
Pre synaptic membrane
Altering reuptake
Alter binding
Alter activation / ionic conductance of the post-synaptic membrane

Direct action on the neuronal plasma membrane

28
Q

what is the Meyer Overton Theory

A

lipid solubility and anaesthetic potency

29
Q

what are the adverse effects

A

PONV
Cardiovascular depression
Negatively inotropic
Variable action on heart rate
arrhythmogenesis
Hypotension: vasodilation
Loss of airway tone: airway obstruction
Malignant hyperthermia
Bronchial muscle relaxation
Agitation and confusion… particularly in elderly
Nephrotoxicity
Hepatotoxicity: halothane hepatitis

30
Q

pain pathway diagram

A

X

31
Q

what are natural opiates

A

morphine
dihydro-morphine
codeine

32
Q

what are opiate analogues

A

tramadol

33
Q

what are synthetic or semisynthetic agents

A

pethidine
fentanyl
alfentanyl
remifentanyl

34
Q

what is mediated via the mu1 receptor

A

analgesia

35
Q

what is mediated via the mu2 receptor

A

respiratory depression

36
Q

what is mediated via the mu3 receptor

A

vasodilation

37
Q

where do must muscle relaxants work

A

the motor end plate

38
Q

what is a depolarising blocker

A

suxamethonium

39
Q

what are non-depolarising blockers

A

curare, atracurium

40
Q

what are the adverse effects of suxamethonium

A

muscle pain
Hyperkalaemia
Malignant hyperthermia
Anaphylaxis
Suxamethonium apnoea
Increased IOP and ICP

41
Q

what are adverse effects of non-depolarising blockers

A

hypotension
Histamine release
Wheeze
Tachycardia or bradycardia
Anaphylaxis
Incomplete reversal

42
Q

what drugs are involved in recovery

A

neostigmine and glycopyrolate

43
Q

what is involved in long term recovery

A

early mobilisation
Physiotherapy: prevention of pulmonary complications
Prevention of thromboembolic disorders
Early enteral nutrition

44
Q

why are patients given 100% oxygen

A

to wash out and replace the anaesthesia gas

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