General Anaesthesia And Post Op Care Flashcards
What do we do in the induction phase?
Iv and inhalational induction. Also mask vent and endotracheal intubation to secure the airway
In the induction phase we monitor spO2, what’s the normal value
Above 95%
In the induction phase we monitor End-Tidal CO2, what’s the normal range?
35-45mmHg
What’s the use of monitoring EtCo2?
To ensure adequate ventilation and that the endotracheal tube was placed properly
We monitor urine output, what’s the range?
0.5mL/Kg/hr is considered adequate
We also monitor the BIS, what is it and what’s the range
Details the patients level of consciousness/anesthesia. Range is 40-60
What is Total Intravenous anesthesia and who do we give it to?
TIVA is the infusion of propofol or remifentanil in patients for whom inhalational agents are contraindicated
In the Emergence phase, how do we reverse the muscle relaxation?
Via neostigmine with glycopyrrolate.
In the Post-Anesthesia care unit (PACU) how we do manage the pain?
We use long acting analgesics like Morphine or Oxycodone
The IV Anesthetic propofol has a big con, and when should it be discarded?
It’s prime to bacterial contamination, hence must be discarded after 6 hours
Explain Propofol’s mechanism of action
Enhances the inhibitory neurotransmitter GABA-A , which leads to sedation
Propofol onset and duration
Rapid onset and short acting
Propofol side effects
Hypotension, apnea, pain on injection but minimized by co-admin of lidocaine
Thiopental is provided in the form of what?
A powder, which is then added to saline or sterile water
Thiopental mechanism of action?
Enhances GABA-A activity
When do we prefer Thiopental to Propofol?
In neurosurgery for its neuroprotective properties
What is the difference in metabolization between Thiopental and Propofol?
Thio is hepatically metabolized, while propofol is metabolized in the liver. Both however, are excreted by the kidneys
Thiopental side effects?
Mostly same as Propofol. But with Hangover effect.
What is Thiopental’s Hangover Effect?
Prolonged sedation and recovery due to lipid solubility and redistribution
How can Ketamine he admined?
IV, IM, or Orally
Ketamine mechanism of action?
Non-competitive NMDA receptor antagonist.
When do we use Ketamine?
For patients with risk of hypotension or those of trauma. Also adjunct in TIVA
Ketamine metabolism?
Liver, by CYP450 enzyme.
Ketamine side effect?
Delirium, hallucinations and such. Mainly Psychomimetic stuff
IV anesthetic of longest duration?
Midazolam
Fastest acting IV anesthetic?
Ketamine
Why do we use opioids with IV anesthesia?
Due to them providing analgesia
Hepatic enzyme CYP3A4 metabolizes which Opioids?
Fentanyl and Alfentanil.
There is only one opioid which is metabolized by Plasma Esterases, what is it?
Remifentanil
MAC value reflects the potency of an inhalational agent, explain its values
The lower the value, the more potent the anesthetic
What does the blood gas partition mean?
Reflects the solubility of the agent, in the blood, a high number means it’s soluble and hence slower in induction and recovery.
What is NO used for? (nitrous oxide)
Smaller procedures like labor or dental things
Which inhaled anesthetic is used for children and why?
Halthane, as it has a sweet odor
Halothane has been replaced with two newer agents used a lot more, what are they?
Sevoflurane and Desflurane
How do we treat Malignant hyperthermia,
Immediately discontinue the triggering agents, and apply Dantrolene.
What is the most and least potent Inhalational agent
Halothane and NO
What is the fastest onset inhalational agent
Desflurane
Why would we use a neuromuscular blockade sometimes?
In cases where we want to do a tracheal intubation
Succinylcholine is a rapid neuromuscular block, when do we use it?
Emergency intubations or shorter procedures
Succinycholine however, has a big side effect, what is it?
Sometimes Malignant Hyperthermia, or succinylcholine apnea.
