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DEN 2026 - Pharmacology > General Anaesthesia > Flashcards

General Anaesthesia Flashcards

1
Q

What is anaesthesia?

A

The absence of sensation

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2
Q

What is analgesia?

A

The absence of pain

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3
Q

What is the intention of regional anaesthetics?

A

Ensure the patient remains conscious and ventilating with haemodynamic stability yet cannot feel pain in a certain part of the body

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4
Q

What is an antipyretic?

A

Anti-temperature agent

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5
Q

Give an example of an antipyretic agent

A

Intravenous paracetamol

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6
Q

What is amnesia?

A

Inability to recall information

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7
Q

What is anxiolysis?

A

Elimination of anxiety

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8
Q

What is an antiemetic?

A

An agent used to reduce nausea and vomiting

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9
Q

What are 2 clinical scoring systems used to grade level of consciousness?

A
  1. AVPU

2. Glasgow Coma Score (GCS)

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10
Q

What are the 4 components of the AVPU consciousness grading system?

A
  1. Alert
  2. Verbal
  3. Pain
  4. Unresponsive
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11
Q

What are the 3 components of the GCS consciousness grading system?

A
  1. Best verbal response
  2. Best motor response
  3. Best eye contact
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12
Q

What is “A Conscious Decision”?

A

A review of the use of general anaesthesia and conscious sedation in primary dental care

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13
Q

What were the 2 main points taken from “A Conscious Decision”?

A
  1. Confinement of general anaesthesia for dentistry within a hospital setting where there was immediate availability of a critical care facility
  2. General anaesthesia should be undertaken only when absolutely necessary
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14
Q

Name 3 alternatives to general anaesthesia

A
  1. Behaviour management with or without conscious sedation
  2. Inhalation sedation
  3. Intravenous sedation
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15
Q

What is conscious sedation?

A

A technique where drugs produce state of depression of CNS, but during which verbal contact with the patient is maintained

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16
Q

What is the major aim of conscious sedation?

A

Reduce anxiety of patient and enable procedures to be longer without the need for general anaesthetics

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17
Q

Name 3 safety measures which must be taken if a dental professional is providing conscious sedation

A
  1. Operating chairs must be capable of being placed in head down tilt position
  2. Equipment for resuscitation from respiratory and cardiac arrest must be available
  3. Patients must be escorted home
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18
Q

Name 4 types of anaesthesia

A
  1. General anaesthetics
  2. Sedation
  3. Regional anaesthesia
  4. Local anaesthetics
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19
Q

What is the major complication with sedation?

A

Patient can lose consciousness and become apnoeic or go into a state of cardiac arrest

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20
Q

What is regional anaesthesia?

A

Use of local anaesthetics to block specific regions of the peripheral nervous system

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21
Q

What is local anaesthesia?

A

Infiltration of local anaesthetics into the subcutaneous tissues to block innervation of the skin

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22
Q

How is epidural anaesthesia delivered?

A

Via a catheter to allow anaesthetic to be topped up

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23
Q

What are 2 ways a nerve can be identified before being anaesthetised?

A
  1. Landmark techniques

2. Ultrasound guidance

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24
Q

What are 3 major components of pre-assessment for anaesthesia?

A
  1. History
  2. Examination
  3. Investigations
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25
Q

Name 4 parts of a patient’s history to be checked during pre-assessment for anaesthesia?

A
  1. Co-morbidities
  2. Previous anaesthesia
  3. Allergies
  4. Chronic pain medication
26
Q

What are co-morbidities?

A

Diseases co-occurring with primary problem

27
Q

Why is it important to establish if a patient has previously been anaesthetised?

A

Their previous reaction can indicate suitability for anaesthesia

28
Q

Name 4 examinations which should be undertaken during the pre-assessment for anaesthesia?

A
  1. BMI
  2. Syndromic features
  3. Urea biomarkers
  4. Creatinine biomarkers
29
Q

Why is BMI important to examine before anaesthesia?

A

It can have dramatic effect of respiratory system, where a patient can quickly become apnoeic, develop an airway obstruction or go into respiratory arrest

30
Q

Name a possible syndromic feature which could prevent anaesthesia

A

Treacher Collins syndrome

31
Q

How can urea and creatinine biomarkers be tested?

A

Renal function tetss

32
Q

Why must kidney function be tested before anaesthesia?

A

Under preforming kidneys may be unable to deal with massive clearance of the anaesthetic

33
Q

Name 2 investigations which should be taken before anaesthesia

A
  1. ECG

2. Blood glasses rumere

34
Q

Why is it important to take an ECG before a patient undergoes general anaesthesia?

A

It tests a patient’s anaerobic threshold and can help predict who may need critical care post operation

35
Q

Describe the 7 degrees of anaesthesia

A
  1. Loss of sensation
  2. Loss of consciousness
    3, Loss of spinal reflex function
  3. Loss of ANS function
  4. Loss of central homeostatic control
  5. Brain stem dysfunction
  6. Death
36
Q

What are the 4 stages of anaesthesia (Guedel)?

A
  1. Analgesia and disorientation
  2. Excitement and delirium
  3. Start of surgical anaesthesia
  4. From stoppage of respiration until death
37
Q

Between what 2 events does stage 1 of anaesthesia occur?

A

Beginning of induction to loss of consciousness

38
Q

Between what 2 events does stage 2 of anaesthesia occur?

A

Loss of consciousness to onset of automatic breathing

39
Q

Between what 2 events does stage 3 of anaesthesia occur?

A

Onset of automatic breathing to respiratory paralysis

40
Q

Between what 2 events does stage 4 of anaesthesia occur?

A

Respiratory paralysis to death

41
Q

What are the 2 methods of inducing anaesthesia?

A
  1. Used at low dose continuously via syringe driver

2. Anaesthetic machine can deliver specific concentration agent

42
Q

When is pre-medication usually used during the induction of anaesthesia?

A

Paediatrics

43
Q

Name 3 drugs which can be used as pre-medication during the induction of anaesthesia

A
  1. Oral form of midazolam
  2. Nasal spray of fentanyl
  3. Oral clonidine
44
Q

What are 3 advantages of pre-medication?

A
  1. Improved induction of anaesthesia
  2. Reduced parasympathetic system activity
  3. Lower maintenance dose of anaesthesia
45
Q

Name 3 types of inhaled anaesthetic agents

A
  1. Halogenated hydrocarbons
  2. Nitrous oxide
  3. Xenon
46
Q

What are 3 types of halogenated hydrocarbons?

A
  1. Sevoflurane
  2. Isoflurane
  3. Desflurane
47
Q

How is nitrous oxide commonly used?

A

In combination with intravenous midazolam

48
Q

What 4 factors can affect the onset of action of inhaled anaesthetic agents?

A
  1. Solubility of agent in the blood (poor solubility - faster onset)
  2. Inhaled concentration of agent (high concentration - faster onset)
  3. Lipid solubility of agent
  4. Cardiac output of patient (low output - faster onset)
49
Q

Name 5 side effects of inhaled anaesthetic agents

A
  1. Slow onset of action when used as induction agent
  2. Effects on respiratory system
  3. Halogenated agents reduce mean arterial pressure and cardiac output
  4. Reduce hepatic blood flow
  5. Can induce nausea and vomiting
50
Q

What is malignant hyperpyrexia?

A

A condition triggered by drugs used for general anaesthesia which causes drastic increase in oxidative metabolism in skeletal muscle which leads to circulatory collapse and death if untreated

51
Q

Name 2 advantages of intravenous anaesthetics

A
  1. Rapid onset and offset of agent

2. More predictable response if titrated

52
Q

Name 5 intravenous anaesthetics

A
  1. Thiopentone
  2. Propofol
  3. Midazolam
  4. Etomidate
  5. Ketamine
53
Q

Describe midazolam as an intravenous anaesthetic agent

A
  • Used for minor procedures
  • It is a benzodiazepine so modulates effects of GABA at GABA-A receptors
  • Flumazenil is a competitive antagonist so can reverse its effects
54
Q

Describe fentanyl as an intravenous anaesthetic agent

A
  • Synthetic phenylpiperidine derivative

- μ receptor agonist

55
Q

Describe propofol as an intravenous anaesthetic agent

A
  • Phenolic derivative which is highly lipid soluble
  • Dose dependent reduction in cardiac output and systemic vascular resistance which can cause profound drop in blood pressure
  • Involuntary muscle action common
  • Pain at site of injection
56
Q

Describe ketamine as an intravenous anaesthetic agent

A
  • Antagonises the excitatory neurotransmitter glutamate at the NMDA receptors within CNS
  • Increases blood pressure so stable induction of anaesthesia during emergencies
  • Cause post operative psychotic symptoms
57
Q

What are 2 main types of neuromuscular blocking agents?

A
  1. Non-depolarising neuromuscular blockers

2. Depolarising neuromuscular blockers

58
Q

Name 2 examples of non-depolarising neuromuscular blockers

A
  1. Aminosteroids and bisbenzylisoquinoliniums

2. Rocuronium and Atracurium

59
Q

Name an example of a depolarising neuromuscular blocker

A

Suxamethonium

60
Q

What is the function of neuromuscular blocking agents?

A

Used to allow the incubation of the trachea

DEN 2026 - Pharmacology (22 decks)

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