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PA20023 > General anaesthetics > Flashcards

General anaesthetics Flashcards

1
Q

What is the literal meaning of anaesthesia?

A

an - a lack of, aisthesis - feeling, perception, sensation.

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2
Q

What is required from anaesthetic?

A

Abolition of sensation, abolition of pain, “triad of general anesthesia”- unconsciousness, analgesia, muscle relaxation.

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3
Q

What are the characteristics of a general anaesthetic?

A

Stable, potent, non-toxic, controllable, they have to be rapid on and off, adjustable, minimal cardio-depressant, minimal respitatory depressant, non-irritant.

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4
Q

What are the stages of anaesthesia?

A

Analgesia, excitement, anaesthesia and medullary paralysis.

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5
Q

What is involved in the first stage of analgesia?

A

Analgesia - Conscious, drowsy, antinociception and amnesia.

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6
Q

What is involved in the second stage of anaesthesia?

A

Excitement - Loss of consciousness but delirium, irregular cardio-respiration, apnea, spasticity, gagging, vomiting.

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7
Q

What is involved in the third stage of anaesthesia?

A

Anaesthesia - Regular respiration, loss of reflex and muscle tone.

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8
Q

What is involved in the fourth stage of anaesthesia?

A

Medullary paralysis - Depression of cardio-respiration and death.

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9
Q

What are the two main classifications of general anaesthetics?

A

Inhalation and intravenous.

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10
Q

What are the two types of inhaled anaesthetics?

A

Gas and liquid.

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11
Q

What are the 4 types of intravenous anaesthetics?

A

Inducing agent, dissociative, analgesia and sedative relaxant.

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12
Q

What are the features of inhaled anaesthetics?

A

Inhaled anaesthetics are controllable and have rapid blood-gas exchange. They are usually halogenated ethers or hydrocarbons and are stable and potent.

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13
Q

What are the features of intravenous anaesthetics?

A

They are injected, they are rapid and short acting and cause induction or anaesthesia.

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14
Q

What are some of the combined approaches used in surgical anaesthesia?

A

Rapid unconsciousness with IV, maintaining unconsciousness using inhalation agents such as N2O, supplement analgesia such as fentanyl and paralysis such as a neuromuscular block such as succinylcholine.

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15
Q

What are some commonly used inhaled anaesthetics?

A

Ether, N2O, halothane, enflurane, isoflurane, desflurane and sevoflurane.

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16
Q

What are some commonly used intravenous anaesthetics?

A

Thiopental, etomidate, propofol, ketamine and midazolam and other benzodiaepines.

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17
Q

What is the lipid theory of anaesthetic action?

A

Potency is proportional to lipid solubility and narcosis commences when any chemically indifferent substance has attained a certain molar concentration in the lipids of the cell.

18
Q

How would the lipid theory work?

A

The idea that an anaesthetic molecule would enter an Na channel and cause it to close. There is increased membrane fluidity and expansion.

19
Q

Who made the protein theory of anaesthetic action?

A

Franks and Lieb - 1987.

20
Q

Who made the lipid theory of anaesthesia?

A

Overton and Meyer - 1901.

21
Q

What did the protein theory say?

A

That luciferase inhibition correlates with anaesthetic potency. It said that anaesthetics interact with membrane proteins.

22
Q

What proteins do anaesthetics target?

A

Transmitter receptors (ionotropic and GPCR), ion channels (Na+,K+), transporters and vesicular (release) proteins.

23
Q

What do general anaesthetics do to inhibitory GABAa receptors?

A

They potentiate them.

24
Q

What do general anaesthetics do to excitatory glutamate receptors?

A

They reduce them.

25
Q

What do general anaesthetics do to ion channels?

A

They alter stabilising and destabilising ion channels.

26
Q

What are some of the gas general anaesthetics?

A

Nitrous oxide, cyclopropane, xenon.

27
Q

What are some of the inducing agent anaesthetics?

A

Thiopentone, propofol, etomidate.

28
Q

What is a dissociative anaesthetic?

A

Ketamine.

29
Q

What is an analgesia anaesthetic?

A

Fentanyl.

30
Q

What is a sedative relaxant anaesthetic?

A

Benzodiazepines, droperidol.

31
Q

What are the features of N2O and when is it used?

A

It has rapid onset and low potency, it is used in combination with other anaesthetics.

32
Q

What are the features of halothane and when is it used?

A

It is used in vets and developing countries, it is hepatotoxic (damages liver cells) and has a hangover.

33
Q

What are the features of enflurane?

A

It fast on and off, it has lower toxicity and is epileptogenic (capable of causing an epileptic attack).

34
Q

What are the features of isoflurane?

A

It is non-epileptogenic but has cardio and respiratory effects.

35
Q

What are the features of desflurane and what is it used for?

A

It has fast on and off effects and is used in day surgery.

36
Q

What are the features of sevoflurane?

A

It is fast, potent but maybe hepatotoxic.

37
Q

What are the features of thiopental?

A

It is a barbiturate, it is very fast (20s) on and off (10-15 minutes). It is highly soluble, non-analgesic and causes respiratory depression.

38
Q

What are the features of etomidate?

A

It has a rapid metabolism, low cardio-respiratory effects and causes involuntary muscle jerks.

39
Q

What are the features of propofol?

A

It has a very rapid metabolism, it can be used for introduction and maintenance and is used in day surgery.

40
Q

What are the features of ketamine?

A

It has a slow onset, it is dissociative, analgesic, hallucinogenic, hypertensive and bradycardic.

41
Q

When are midazolam and other benzodiazepines used?

A

They are used pre-operation.

42
Q

What changes in neuronal pathways occur in anaesthesia?

A

There is more GABA inhibiton - the RAS is not activated, the hypothalamus is not activated so there is no excitation to the cerebral cortex.

PA20023 (17 decks)

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