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MD4001 Pharmacology > General Anaesthesia > Flashcards

General Anaesthesia Flashcards

1
Q

What are the 3 commonly used IV induction agents?

A
  • Propofol (most common)
  • Thiopentone
  • Etomidate
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2
Q

Name 4 inhalational agents

A
  • Nitrous oxide
  • Isoflurane
  • Sevoflurane
  • Desflurane
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3
Q

What is general anaesthesia?

A

Reversible, drug induced loss of consciousness, usually to allow a surgical procedure to be performed

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4
Q

What are other reasons other than surgery to give general anaesthetics?

A
  • ECT (severe depression)
  • Impaired understanding (e.g infants, dementia, learning difficulties) need general anaesthesia for more simple procedures like imaging, dental fillings
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5
Q

What is the most common general anaesthetic?

A

Propofol

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6
Q

When are general anaesthetics given via inhalation?

A
  • Induce anaesthesia in children

- More commonly to maintain anaesthesia

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7
Q

What is entonox?

A
  • 50:50 nitrous oxide : oxygen
  • French blue with quartered shoulders
  • Analgesic
  • Labour
  • Trauma
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8
Q

What are the different molecular structures of anaesthetic drugs?

A
  • Propofol - phenol derivative
  • Sevoflurane, isoflurane - Haloginated hydrocarbons
  • Thiopentone - Barbiturate
  • Etomodate - immidasol ring
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9
Q

A greater lipid solubility leads to what?

A

A greater potency of drug and lower MAC

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10
Q

A higher MAC (atomsopheres) leads to what?

A

The lower the potency

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11
Q

A more blood soluble inhalational agent leads to what?

A

A slower onset of drug

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12
Q

Isoflurane is a structural isomer of what drug?

A

Enflurane (same solubility, different potencies)

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13
Q

Etomidate exists as what?

A

2 stereoisomers (only R isomer is active)

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14
Q

Ketamine exists as what?

A

2 different isomers (both have activity but different potnecy)

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15
Q

Inhibition of luciferase enzyme leads to what?

A

Anesthetic potency

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16
Q

How are general anaesthetics though to affect ion channels?

A

Potnetiate inhibitory neurotransmitters (GABA primarily, change configuration of GABA receptor) and inhibit excitatory neurotransmitters (glutamate)

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17
Q

What is the structure of a GABA(A) receptor?

A
  • Pentameric arrangement (2x alpha 2x Beta 1xGamma)
  • Central ion channel pore
  • 18 possible sub units
  • Approx 30 forms of receptor
  • Some subunits location specific
  • Anaesthetics allosterically activate the receptor
18
Q

What part of the GABA(A) receptor are the IV anaesthetics thought to bind to?

A

Beta sub unit

19
Q

What part of the GABA(A) receptor are the inhalational anaesthetics thought to bind to?

A

Somewhere between alpha and Beta sub unit

20
Q

What drugs act on GABA(A) receptors?

A
  • Propofol
  • Etomidate
  • Barbiturates
    Block neuronal excitibility
21
Q

What does Ketamine inhibit?

A

Excitatory NMDA receptors where glutamate act

22
Q

What are the advantages of ketamine?

A
  • Maintain own airway
  • CV stable not so much of a BP drop
  • Used in field surgery
23
Q

What class of drug is ketamine?

A

Class C

24
Q

What organ can Ketamine affect?

A

The bladder “stone bladder” - cannot expand or contract

25
Q

What part(s) of the brain do general anaesthetics act on?

A
  • Thalamus
  • Cerebral cortex
  • Brain stem
  • Reticular formation
  • Spinal cord
26
Q

How do general anaesthetics generally affect the heart?

A
  • Negative ionotropic effect
  • Reduce systemic vascualr resistance
  • Therefore decrease BP
27
Q

What anaesthetic does not cause a negative ionotrpic affect on heart and does not reduce vascular resistance?

A

Ketamine (may cause tachycardia)

28
Q

What did Michael Jackson die of?

A

Propofol

29
Q

What kind of anaesthetic affects the tidal volume more; inhalatory or IV anaesthetic?

A

Inhalatory (IV more a drop in respiratory rate)

30
Q

What are the properties of an ideal anaesthetic agent?

A
  • Act rapidly
  • Pleasant
  • Cheap
  • Stable
  • Analgesic effect
  • Amnesic effort
  • Minimal ‘hangover’
  • Does not irritate veins or airways
  • Not an emetic
  • Minimal effects on respiratory and cardiovascualr systems
  • Does not produce toxic metabolites
  • Does not cause histamine release / anaphylaxis
31
Q

Why is soda lime a component of some anaesthetics?

A

Absorbs Co2 making it stable

32
Q

What is desflurane?

A

Inhalational agent which is growing in popularity as it has a very rapid onset and offset - very irritable, so no t used initially, causes coughing, works well to wake up

33
Q

Why is Nitrous oxide not used as much as it used to be?

A

Effects on bone marrow

34
Q

What anaesthetic agent is best to use on someone with low BP e.g septic shock?

A

Etomidate - cardiovascularly stable, decreases respiratory rate

35
Q

What general anaesthetics are painful on injection?

A
  • Propofol

- Etomidate

36
Q

What are some advantages of thiopentone?

A
  • Marginally quicker than propofol
  • Rapid sequence induction patient may have full stomach and at risk of aspiration
  • Not painful on injection
37
Q

What is the most effective inhalatory anaesthetic?

A

Sevoflurane (less irritable than desflurane and isoflurane)

38
Q

What inhaled anaesthetic do patients wake up quickly from?

A

Desflurane - useful maintenance agent, also preferred in some obese patients

39
Q

What is balanced anaesthesia?

A
  • Selection of different drugs and anaesthetic agents
  • Used to minimise patient risk and maximise patient safety and comfort
    Bearing in mind:
  • Health and requests of the patient
  • Properties of the drugs
  • Requirements of surgery
40
Q

When a surgeon needs access to the abdomen what drug is useful to add in balanced anaesthesia?

A

A muscle relaxant

MD4001 Pharmacology (8 decks)

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