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Neurology - Sem 3 > Case 10 - General Anaesthesia > Flashcards

Case 10 - General Anaesthesia Flashcards

1
Q
  1. What are the purposes of anaesthesia?
A
  1. Analgesia
  2. Amnesia
  3. Immobility
  4. Unconsciousness
  5. Skeletal muscle relaxation
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2
Q

1. Define the following:

  • Analgesia
  • Amnesia
  • Immobility
A
  • Loss of response to pain
  • Loss of memory
  • Loss of consciousness
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3
Q
  1. What are the 3 stages of anaesthesia?
  2. Which has a quicker onset, IV or inhalation?
A
  1. Induction, Maintenance, and Reversal
  2. IV injection
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4
Q
  1. Why is the maintenance phase required?
  2. What form of anaesthesia is used for this?
A
  1. The induction phase is short lived and so drugs are required to prolong the anaesthesia
  2. Inhalation agents
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5
Q
  1. When does recovery of consciousness happen?
  2. What is used to induce paralysis?
A
  1. When the concentration of anaesthetic in the brain drops below a certain level
  2. Neuromuscular blocker to provide temporary muscle relaxation
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6
Q
  1. What procedure are muscle relaxants necessary for?
  2. What NT do muscle relaxants inhibit?
A
  1. Endotracheal intubation
  2. ACh
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7
Q
  1. What class of drugs are these?

(Muscle relaxants, Inhalation agent, IV agent)

  • Atacurium
  • Suxamethonium
  • Curare
  • Propofol
  • Etiomidate
  • Ketamine
  • Sodium thiopentone
  • Isoflurane
A
  1. Muscle relaxants (Atacurium, Suxamethonium, Curare)
  2. Inhalation agent (Propofol, Isoflurane)
  3. IV agent (Propofol, Ketamine, Etiomidate)
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8
Q
  1. Why is artificial respiration required?
  2. Why is an endotracheal tube required?
A
  1. Because muscle relaxants cause paralysis of muscles of respiration, meaning artificial respiration is required
  2. Because the muscles of the larynx are paralysed so the airway needs to be kept open
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9
Q
  1. What drugs are used to reverse muscle relaxant drugs?
  2. What is the final stage of anaesthesia?
A
  1. Acetylcholinesterase drugs
  2. Reversal
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10
Q
  1. What would respiratory depression lead to?
  2. What would happen if the patient respired on room air?
A
  1. Increase in CO2 levels - Hypercapnia
  2. They would become hypoxic
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11
Q
  1. What is the effect of high lipid solubility?
  2. Why does this happen?
A
  1. Accumulate in body fat and can produce a prolonged hangover
  2. Due to low blood flow to adipose tissue, so can take hours for the drug to enter and leave the fat
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12
Q
  1. What is the difference between sleep and unconsciousness?
  2. What causes the change from sleep to wakefulness?
A
  1. You can wake up from sleep voluntarily
  2. Reticular activating system
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13
Q
  1. What causes the change from wakefulness to sleep?
  2. What determines the circadian rhythm?
A
  1. Inhibition of arousal, through blockage of the thalamus and upper brainstem
  2. Detection of decreases in light levels as night approaches
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14
Q
  1. What do the ganglion cells responsible contain?
  2. Which tract is responsible for circadian control?
A
  1. Melanopsin which depolarises to light
  2. Retino-hypothalamic tract
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15
Q
  1. What cycle is the majority of time spent in during sleep?
  2. What induces non-REM sleep?
A
  1. Non-REM sleep
  2. Non-REM ON GABA neurons in the hypothalamus & Serotonin in the raphe nuclei
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16
Q
  1. What is shown on an EEG during non-REM sleep?
  2. What happens to muscles during non-REM sleep
A
  1. Brainstem noradrenergic neurons show decreased activity
  2. Skeletal muscles relax but maintain tone
17
Q
  1. What is a concussion?
  2. What is a coma?
A
  1. Reversible state of unconsciousness that lasts for a brief amount of time. Without pathological alteration
  2. Profound state of unconsciousness associated with depressed cerebral activity
18
Q
  1. What is a generalised seizure?
  2. What is a partial seizure?
A
  1. Overactivity in the brain which is across the entire cerebral cortex of both hemispheres
  2. Overactivity which involves only a limited area of the cortex
19
Q
  1. What is epilepsy?
A
  1. When a person has repeated seizures
20
Q
  1. What do anticonvulsants do?
A
  1. Potentiate GABA channels therefore hyperpolarising neurons
21
Q
  1. What is the preferred treatment for elevated ICP?
A
  1. Intubation, hyperventilation leading to vasoconstriction caused by the lack of O2 and a reduction in cerebral blood volume
22
Q
  1. What is a craniotomy?
  2. What is a craniostomy?
A
  1. Surgical removal of part of the cranium to relieve intracranial pressure
  2. Where a Burr hole is drilled at several locations to relieve pressure
23
Q
  1. What is the GCS?
  2. What are the components?
  3. What do the following scores show?
  • Less than 8
  • 9-12
  • Greater than 13
A
  1. Used to assess consciousness
  2. Test E (4) V (5) M (6)
  3.  Severe- GCS≤8

 Moderate - GCS 9 - 12

 Minor - GCS ≥ 13.

24
Q
  1. What are coup v Contracoup lesions?
A
  1. Contusions and deeper hemorrhages result from mechanical forces that displace and compress the hemispheres forcefully and by deceleration of the brain against the inner skull, either under a point of impact (coup lesion) or, as the brain swings back, in the antipolar area (contrecoup lesion)
25
Q
  1. What is the normal pH?
A
  1. 7.35 - 7.45
26
Q
  1. What is the normal pCO2 level? (In KPa and mmHg)
A
  1. 4.7 - 6 KPa or 35-45mmHg
27
Q
  1. What is the normal pO2 level?
A
  1. 9.3-13.3 kPa / 80-100 mmHg
28
Q
  1. What is HCO3-?
  2. What is the normal HCO3- level?
A
  1. Bicarbonate
  2. 22-28 mmol/L
29
Q
  1. What is the normal O2 saturation?
A
  1. 92-98% saturation

Neurology - Sem 3 (15 decks)

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