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Anaesthetics, ED and Plastics > Conduct + Principles of Anaesthesia > Flashcards

Conduct + Principles of Anaesthesia Flashcards

1
Q

What is the triad of anaesthesia and what types can you get

  • General
  • Regional - epidural / spinal
  • Local
A

Analgesia
Relaxation
Hypnosis

Balanced anaesthesia has contribution from all 3 but doesn’t require all 3
Allows flexibility
Can titrate doses so more accurate
Avoid overdosage

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2
Q

What provides analgesia

A

LA
Regional block
Opiates

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3
Q

What provides relaxation

A

LA
Muscle relaxants
General anaesthetics

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4
Q

Why is relaxation needed

A

Provide immobility for procedures and allow ventilation

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5
Q

What provides hypnosis / unconsciousness

A

GA

Opiates - small affect (lessen pain so less GA needeD)

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6
Q

What is always needed with a GA

A

Hyponosis

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7
Q

What is a GA

A

Central acting drugs which cause whole body unconsciousness except ketamine

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8
Q

What is regional anaesthesia

A

Insensbility in an area or region
Applied to nerves supplying area
Nerve and plexus block including spinal and epidural

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9
Q

What is a LA

A

Insensibility in relevant part of body

Applied directly to tissues

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10
Q

How can GA be given

A

Inhaled or IV

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11
Q

What does GA lead too

A

Hypnosis
Small degree of relaxation
Neglible analgesia except for ketamine

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12
Q

What does GA require

A

Airway management

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13
Q

How does GA work

A

Hyperpolarise neuronal ion channels
Less likely to fire
More complex processes lost first e.g. cerebral function and reflexes relatively spared

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14
Q

What is halothane and what are SE

A

Inhaled GA
Hepatotoxity - NO LONGER USED DUE TO THIS
Myocardial depression
Malignant hyperthermia

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15
Q

What is thiopental and what are SE

A 
IV GA
Cause laryngospasm
Rapid onset 
Quickly affects brain
Use if short procedure or risk of ICP
Reduces CO so not in truama/. hypovolaemia
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16
Q

What is propofol used for

A 
Rapid onset 
Rapid loss of reflexes
No obvious planes of GA 
Widely used to maintain sedation / total IV anaesthesia and day case 
Radidly metabolised 
Anti-emetic
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17
Q

SE

A

Pain on IV injection so use with LA

Moderate myocardial and resp depression

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18
Q

What is agent of choice for rapid induction

A

Sodium thiopentone

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19
Q

SE / disadvantages

A

Metaoblites build up quick
Little analgesia
Marked myocardial depression

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20
Q

What is used in young children and why

A

Sevoflurane gas
Slow
More obvious planes of anaesthesia

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21
Q

When is ketamine useful for

A

Can be used for induction
Little myocardial depression and does not cause hypo so better if haemodynaimcally unstable / polytrauma
Also has mod-strong analgesic properties
Can increase BP so avoid in HTN or ICP

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22
Q

What has most favourable cardiac safety

A

Etomidate

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23
Q

What is it unsuitable for

A

Maintaining sedation as risk of adrenal suppression

Also high post-op vomiting

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24
Q

What is the sequence of GA

A 
Pre-op
- Premeds 
- Pre-oxygen 
Preparation
Induction
Maintenance
Emergencies 
Recovery
Post op care and pain management
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25
Q

What is IV induction

A

Rapid onset with rapid recovery

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26
Q

What is inhalation induction

WHAT IS MAC

A

Slow and prolonged duration
Minimum alveolar conc = minimum drug to produce anaesthesia
Low MAC = very potent

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27
Q

What is most common

A

IV induction with inhalation maintenance

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28
Q

What are planes of anaesthesia

A

Analgesia
Excitation
Anaesthesia - light then deep
Overdose

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29
Q

What is needed during GA

A 
Careful monitoring of conscious
- Loss of verbral
- Movement
- RR
- EEG
- Planes 
Airway maintenance
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30
Q

What is minimum monitoring with GA

A 
SpO2, FiO2, ETCO2
NIBP - non-invasive BP 
ECG
Temp / UO / NMG
Invasive venous / arterial
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31
Q

What happens when awakening

A 
Change inspired gas to 100% O2 only 
Discontinue anaesthetic 
Use nerve stimulator to check some reversal has occurs
Muscle relaxation wears of
Anaesthetic wears of 
Can give anti-cholinesterase to reverse 
Return of airway reflex
Remove ET once breathing spontaneous 
Adminster O2 via facemask
Transfer to recovery
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32
Q

What happens in recovery

A

Dedicated area
Many may still be unconscious or requiring airway control
Pain control
- Pain ladder
- Have naloxone written up PRN incase of opiate overdose
N+V management

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33
Q

What is the physiology of GA

A

Depress CVS

  • Reduced sympathetic
  • -ve inotrope
  • Vasdilaton so decreased resistance
  • Ventilation so decreased return and CO
  • Decreased MAP

Depress Resp

  • Reduced hypoxic and hypercarbic drive
  • Reduced TV and increased RR (opiates opposite)
  • Decreased FRC
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34
Q

What can be prolonged after GA

A

Decreased FRC
Lower lung volume / V/Q mismatch
May need post op O2

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35
Q

How do muscle relaxants work

A

Paralyse skeletal muscle by blocking NMJ

Affects resp and airway muscles

36
Q

What are indications for muscle relaxant

A

Ventilation and intubation
Microscopic surgery
Neurosurgery
Body cavity surgery

37
Q

What are problems with relaxant

A

Awaerness
Incomplete reversal leading to obstrcution
Apnoea so need airway support

38
Q

What is used to reverse muscle relaxant

A

Neostigmine if non-depolarisation

39
Q

What are types of muscle relaxant

A

Depolarizing

Non-depolarizing

40
Q

Example of depolarising

A

Suxamethonium

41
Q

How do they work

A

Bind to Ach receptors and first activates
Cause fasciculation then paralysis
Deactivated by acetylcholinesterase
Rapid onset and short acting

42
Q

What happens if cholinesterase deficiency / myasthenia graves Rx

A

Prolonged action leading to resp arrest

Keep ventilated whilst drug degrades

43
Q

What are SE

A

Malignant hyperthermia

Hyperkalaemia

44
Q

What is muscle relaxant of choice for rapid

A

Suxamethonium

45
Q

What are CI to suxamethonium

A

Penetrating eye injury
Acute narrow angle glaucoma as increased pressure
Causes a transient rise in IOP
FH suxamethonium apnoea

46
Q

What are examples of non-depolarising

A

Tubcurarine
Vecuronium
Pancuronium

47
Q

How do they work and what is used to reverse

A

Antagonise Ach receptor
Neostigmine
Longer onest and longer lasting
No fasciculation

48
Q

AE

A

Hypotension

49
Q

Why is intraoperative analgesia used

A

Prevent arousal
Suppress reflex responses to painful stimuli e.g. tachy and hypertension
Opiates can contribute to hypnosis of GA

50
Q

Why are regional good

A

Less GA needed as eliminates pan

Has no sedative effects itself

51
Q

Physiology of local and regional anaesthetic

A 
Retain awareness and consciousness
Affects CVS proportional to size of area
Veno and vasodilation 
Decreased FRC
Increased V/Q mismatch
52
Q

How does lidocaine work

A

Blocks Na channels so no AP is sent
Hepatic metabolism
Protein bound
Renal excretion

53
Q

What does lidocaine interact with

A

BB
Ciprofloxacin
Phenytoin

54
Q

What is it useful for

A

Local wounds
Fast acting
Doesn’t last long

55
Q

What may be added to LA and what does it do

A

Adrenaline
Prolongs duration of action
Permits uses of higher doses as limits systemic absorption as vasoconstriction

56
Q

When is adrenaline CI

A

MAOI
TCA
Procedures where risk of digital ishaemia

57
Q

Max safe dose of lidocaine

A

3mg / kg

7mg / kg if 1% or 2% adrenaline 1 in200,000

58
Q

Max safe dose of bupivacaine

A

2mg / kg

59
Q

Max sae dose of prilocaine

A

6mg / kg

60
Q

What is buivacaine good for

A

Topical wound infiltration at end of surgery as longer duration

61
Q

When is it CI

A

Regional as cardiotoxic so if tourniquet fails will affect heart

62
Q

What is 1st line in regional

A

Prilocaine as less cardiotoic

63
Q

How is cocaine applied

A

Paste in conc of 4% + 10%
Causes vasoconstriction
Lipophillic and cross BBB causing arrhythmia / tachy

64
Q

When is cocaine used

A

ENT
Nasal mucosa
Otherwise not used

65
Q

What must you do if injecting LA

A

Aspirate to make sure not in blood vessel as would constrict the heart

66
Q

Calculations = important for exam

A

1% lidocaine = 10mg in 1 ml
If max dose worked out as 180mg then this is 18ml (move decimal point)

If 2% = 20mg in 1ml
If given 20ml = 40mg of drug

If 20ml of 2% lidocaine given what is the mg
= 400mg
2g in 100ml
20ml = 400mg

67
Q

What are signs of lidocaine toxicity

A 
Tingling
Light head
Tinnitus
Visual disturbance
Muscle twitching
Confusion
Agitation
Drowsy 
CVS depression
Seizure
Collapse
Abnormal ECG
68
Q

What increases risk of toxicity

A

Liver issue

Low protein

69
Q

How do you monitor

A

ABCDE
Help - ICU / anaethestist
IV intra-lipid
Benzo - midalazam to prevent seizure

70
Q

What level of care does LA require

A

Same
IV access
Anaesthesist

71
Q

If need more than LA what can you do

A

Regional nerve block

Epidural or spinal

72
Q

What are indications for spinal

A

Avoid a GA
Severe respiratory disease / cardio
Allergy to GA

73
Q

What are CI

A 
Fixed CO due to stenosis
Infection
Bleeding
Anti-caog
Technical difficulties
Spinal problem
74
Q

What is a TIVA

A

Total IV anaesthesia

75
Q

What is malignant hyperthermia

A

AD condition following administration of anaesthetic

Often FH

76
Q

What happens

A 
Excessive release of Ca2 from SER of skeletal muscle
Sudden increase in O2 requirement 
Hyperpyrexia - can be a late sign 
Muscle rigdity 
Tachycardia 
CK raised
77
Q

What causes

A

Halothane
Suzemthonium
Anti-psychotics= NMS

78
Q

How do you Rx

A

Stop offending agent
Hyperventilate
Dantrole - prevents Ca2 release
Take to ITU

79
Q

Why is analgesia used in maintenance

A

Body still response to pain i.e. BP and HR increase

80
Q

What should you always have written up with opiates

A

Naloxone PRN incase of overdose

81
Q

What are complications of GA

A 
Anaphylaxis
Oesophageal intubation / airway management 
Temp control 
Loss o protective reflexes 
VTE 
Atelectasis
Awareness 
- Careul monitoring of sedation
Bronchospasm 
Laryngospasm
Malignant hyperthermia
Suxamethonium apnoea
Unable to consent
82
Q

What do you do for bronchospasm

A 
100% O2 
Salbutamol
Steroid 
Mg 
Same as asthma
83
Q

What causes laryngospasm

A

Irritation with vapour

Make sure patient paralysed fully

84
Q

What is suxamethonium apnoea

A

Pseudo-cholinesterase definceicny

AD

85
Q

What happens

A

Prolonged muscle relaxation
Lasts 24 hours
Have to keep in ITU ventilated till it wears of as nothing to reverse

86
Q

What are signs of anaphylaxis if under GA

A

Hypotension + tachycardia = 1st signs
Desaturation = later sign
Rash + angioedema = late sign
Won’t have cough or resp distress as under GA

87
Q

What are signs of oesophageal intubation instead of tracheal

A

Desaturation
CO2 trace diminishes
Unable to hear air entry despite being able to hand ventilate

Anaesthetics, ED and Plastics (14 decks)

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