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Pharm Y3S2 > General Anaesthetics > Flashcards

General Anaesthetics Flashcards

1
Q

Define anaesthesia.

A

Reversible loss of awareness of pain and sensation

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2
Q

What are the three main types of anaesthesia?

A

Local
Regional
General

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3
Q

What is stage 1 of anaesthesia?

A

Induction and administration of analgesia
Reduces response to pain
Conscious but drowsy

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4
Q

What is stage 2 of anaesthesia?

A

Excitement, loss of response to non painful stimuli

Coughing increased, gag reflex

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5
Q

What are the concerns of stage 2 anaesthesia?

A 
Choking
Breath holding
Talking
Vomiting
Movement
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6
Q

What is stage 3 of anaesthesia?

A

Desired phase for surgery
Regular respiration
Muscle tone preserved
Progressive shallow breathing

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7
Q

What is stage 4 of anaesthesia?

A

Anaesthetic overdose
Medullary paralysis
Respiration and vasomotor control ceases

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8
Q

Describe the ideal parameters of anaesthesia.

A

Rapid induction and recovery
Avoid stage 2 if possible
Ideally avoid side effects

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9
Q

Why are drugs commonly used in combination during anaesthesia? Give examples.

A

Stages of anaesthesia become less apparent

Different anaesthetics, analgesia, muscle relaxants, anxiolytics

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10
Q

What is used for rapid induction?

A

IV propofol

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11
Q

What is used to maintain unconsciousness?

A

Inhaled nitrous oxide/halothane

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12
Q

What can be given as supplementary IV analgesia?

A

Morphine

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13
Q

What is commonly given as a neuromuscular blocker in anaesthesia?

A

Atracurium

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14
Q

What are the benefits of induction and recovery?

A

Reduced stage 2
Homeostatic reflexes intact
Amnesia

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15
Q

What is the theory of lipid pertubation by anaesthetics?

A

Anaesthetics change the conformation of membrane proteins by changing the environment in which they are dissolved, some specifically affect certain proteins
Adding long carbon chains can reduce the potency

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16
Q

What is the protein theory of anaesthetic action?

A

GABA-A function potentiated, more Cl inions enter the neurone increasing inhibition in the CNS
NMDA receptor function inhibited by blocking glutamate binding
Two pore potassium channel function potentiated

17
Q

What are the most common inhalation anaesthetics?

A

Nitrous oxide

Isofluorane

18
Q

What are the disadvantages of ether anaesthetics? Where are they used?

A

Explosive, irritant and cause nausea

Used in 3rd world countries as very cheap

19
Q

What are the advantages of inhalation anaesthetics?

A

Easy to maintain degree of anaesthesia due to fast air-blood equilibration
Rapid emergence from anaesthesia

20
Q

What are the disadvantages of inhalation anaesthetics?

A

Cumbersome and expensive apparatus
Administered via mask
Atmospheric pollution by scavengers

21
Q

Discuss the problems with metabolism of inhalation anaesthetics.

A

Fluranes generate fluoride that causes renal toxicity
Halothane converted to bromide and TFA which is hepatotoxic
Scavenger systems required

22
Q

What is the minimum alveolar concentration?

A

Measures potency

Concentration required to produce anaesthesia in 50% of patients

23
Q

What is the relevance of blood-gas partition coefficient of inhalation anaesthetics?

A

Measure of how well the drug dissolves in the blood

Determines rate of induction and recovery

24
Q

What is the relevance of oil-gas partition coefficient of inhalation anaesthetics?

A

High oil-partition coefficient confers high potency

Lots of anaesthetic will dissolve in fat which is poorly vascularised, leading to slowly resolving ‘hangover’

25
Q

Describe the features of isoflurane.

A 
No metabolism
Little toxicity
Not pro-convulsive
Twice the cost of halothane
Negative inotrope, can cause hypotension
Coronary vasodilator
Potentially causes neurodegeneration
26
Q

Describe the features of sevoflurane.

A 
Described as the anaesthetic of choice
Rapid induction
Little metabolism
Five times cost of halothane
Recovery so fast that post-op pain relief is necessary
27
Q

Describe the features of nitrous oxide.

A

Low blood-gas partition coefficient
Analgesic at concentrations lower than those causing unconsciousness
Introduces more oxygen than pure oxygen would due to density
Rapidly leaves blood and tissue
Dilates oxygen in lungs for few minutes, transient hypoxia

28
Q

When is nitrous oxide contraindicated?

A

Pregnancy
Pernicious anaemia
Scuba diving

29
Q

Describe the formulation of nitrous oxide?

A

Entonox

50% nitrous oxide, 50% oxygen

30
Q

What are the advantages of IV anaesthetics?

A

Rapid induction
No stage 2
Simple apparatus
Pleasant induction

31
Q

What are the disadvantages of IV anaesthetics?

A

Level of anaesthesia difficult to control
Recovery can be slow
Finite duration
Vein damage

32
Q

Describe the use of thiopental.

A

Only normally used for induction
Very lipid soluble, crosses BBB quickly
Rapid redistribution to highly perfused tissues, slowly distributes into fat
Rapid awakening but prolonged hangover
Positive inotrope, hypotensioon in hypovolaemic patients
Respiratory depression (used in euthanasia)

33
Q

Describe the use of propofol.

A

Rapid metabolism and recovery compared to other IV
Can be continuously infused to maintain anaesthesia
Used for day surgery
Widely abused by medical personnel

34
Q

Describe the use of ketamine.

A 
Dissociative anaesthetic
Analgesia and amnesia but patient still partly conscious
Increases heart rate
Safe in emergency situations
High abuse potential
35
Q

What are Olney’s lesions?

A

Potential form of brain damage from ketamine

NMDA receptor antagonist neurotoxicity

36
Q

What is neuroleptic anaesthesia?

A

Combination of antipsychotic andopioid
Effects similar to ketamine
Not frequently used in humans

37
Q

What is immobilon?

A

Used in animals
Acepromazine and etorphine (neuroleptic anaesthetic)
Used in tranquiliser darts and supplied with antidote (revivon) due to potency

Pharm Y3S2 (29 decks)

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