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Pharm > General Anaesthetics > Flashcards

General Anaesthetics Flashcards

1
Q

General anaesthetics

A

Cns depression (monitor for respiratory depression)
Loss of consciousness
Insensitivity to pain
Combine drugs to minimize adverse reactions

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2
Q

Mechanism of action

A

Increase threshold firing
Facilitate GABA
Decrease duration of nicotinic channels opening

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3
Q

Stages

A

Analgesia to sedation to anaesthesia

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4
Q

Stage I analgesia

A

Reduced pain sensation
Conscious
End of stage marked by loss of consciousness

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5
Q

Stage II: delirium or excitement

A

Loss of consciousness
Involuntary movement
Irregular respiration
Tachycardia, hypertension

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6
Q

Stage III surgical anaesthesia

A

4 planes (eye movement, depths of respiration, muscle relaxation)

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7
Q

Onset stage III (planes I and II)

A

Regular respiratory movement
Muscle relaxation
Normal heart and pulse rate

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8
Q

Beginning plan III into IV

A

Intercostal muscle paralysis (diaphragm breathing remains)
Absence of reflexes
Extreme muscle flaccidity

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9
Q

Plane IV

A 
Cessation of respiration
Pupils Max dilation
Blood pressure falls rapidly
If not reversed immediately patient will die
Respiration artificially maintained
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10
Q

Minimal Alveolar Concentration

A

Compared potency
Minimum concentration required to prevent 50% of patients responding to stimulus
Lower MAC=more potent anaesthetic

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11
Q

Nitrous oxide

A 
Colours less, odorless
Low potency
Light sedation and relaxation
Anxiety relief
Reduces concentration of other agents needed to obtain desired depth of anaesthesia
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12
Q

Nitrous oxide technique

A

100% oxygen for 2-3 minutes
Gradually add 5-10% nitrous oxide (number varies, average=35%)
100% oxygen for 5 minutes at end to avoid diffusion hypoxia

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13
Q

Diffusion hypoxia

A

Caused by rapid outflow of nitrous oxide, carbon dioxide, oxygen
Loss of carbon dioxide=decreases ventilation
Severe headache, nausea, vomiting

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14
Q

Nitrous oxide advantages

A 
Rapid onset
Easy administration
Close control
Rapid recovery
Acceptable for children
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15
Q

Nitrous oxide pharmacological effects

A

Cns sedation (most commonly used in pediatric dentistry)

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16
Q

Adverse Effects

A

Misuse or faulty installation
Automatically limited concentration
Nausea and vomiting (light meal before, avoid large meal 3 hours after)
Reduces the activity of methionine synthetase (vitamin b12 functioning)

17
Q

Nitrous oxide contraindications and dental issues

A 
Respiratory obstruction 
COPD
Emotional instability
Pregnancy considerations
Abuse
18
Q

IV anaesthetics advantages

A 
Rapid onset
Titrate doses 
Gag reflex diminished
Nausea/vomiting minimized
Greater bioavailability 
Good for seizure prone patients
19
Q

IV anaesthetics disadvantages

A 
Venipuncture necessary
Complications at venipuncture site
Intensive patient monitoring
Some IV drugs cannot be reversed by drunk antagonists 
Patients escorted home after treatment
20
Q

IV Anaesthetics Contraindications

A 
Pregnancy
Hepatic dysfunction 
Thyroid dysfunction
Adrenal insufficiency
Maios or tcas within previous 14 days (opioids)
21
Q

IV anaesthetics

A 
Benzodiazepines
Opioids
Short acting barbiturates
Ketamine
Propofol
22
Q

Benzodiazepines

A

Mostly commonly used
Include diazepam and midazolam (midazolam preferred-short action, better anxiety control, antegrade amnesia)
Avoid in elderly, children under 18 and pregnant patients

23
Q

Iv opioids

A

Disadvantage=prolonged respiratory depression
Fentanyl is preferred
Morphine can be used for appts longer than 2 hours

24
Q

Fentanyl

A 
Rapid onset
Action=30-60 minutes 
Cardiovascular stability
No histamine release
Contraindications (pregnancy, liver/kidney failure, COPD, Maois in last 14 days)
25
Q

Iv short acting barbiturates

A

Thiopental
(Onset 20-30 seconds, action =15-30 minutes)
Contraindications (porphyria, previous allergy, asthmatics)

26
Q

IV ketamine

A 
Sedation without loss of consciousness 
Onset less than 1 minute
Action=10 minutes 
caution with elderly and cv disease 
Contraindications (high blood pressure, epilepsy, heart disease, cv accident)
27
Q

Iv propofol

A 
Onset:30 seconds
Less than 10 minutes action 
Rapid recovery
Can cause hypotension 
Egg allergies contraindication
Caution with elderly
28
Q

Balanced general anaesthesia

A

Good control, relaxation, pain relief

Patient passes from stage I to III skipping signs of stage II

Pharm (9 decks)

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