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PR3136 > General anesthesia > Flashcards

General anesthesia Flashcards

1
Q

Role of GA

A

to produce unconsciousness and lack of responsiveness to noxious stimuli

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2
Q

What are the stages of GA

A 
Pre-assessment
Induction of anesthesia 
Airway management 
Maintenance of anesthesia 
Reversal
Post operative care
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3
Q

Properties of ideal anaesthetic drug?

A 
MUDBAMMA
Unconsciousness 
Analgesia
Muscle relaxation
Amnesia 
Brief and pleasant 
Depth of anesthesia can be raised/lowered with ease
Minimal adverse effects
Margin of safety is large
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4
Q

What is balanced anesthesia?

A

Must have unconsciousness, pain relief, inhibition of reflexes

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5
Q

What are the types of GA?

A

Inhalation and IV anesthetics

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6
Q

Types of inhalation anesthetics

A

Volatile liquids (halogenated hydrocarbons) and gases (NO)

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7
Q

What level of solubility would give a faster onset

A

Low solubility will lead to faster onset

High solubility → will stay in blood and doesn’t get to the brain

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8
Q

What are the proposed mechanisms of inhalant GA?

A

Enhance neurotransmission at inhibitory synapses via allosterically increasing GABA receptor sensitivity to GABA
Depressing neurotransmission at excitatory synapses via blocking glutamate neurotransmitter acting on NMDA receptor

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9
Q

What is MAC an index of?

A

Index of inhalation anesthetic potency
The lower the MAC, the more potent it is
It is defined as the minimum concentration of drug in alveolar air that will produce immobility in 50% of patients

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10
Q

How can MAC values be altered?

A

Age, condition, concomitant administration of other drugs

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11
Q

What are the factors affecting absorption of inhalant anesthetic?

A

Concentration of anesthetic in inspired air
Solubility of GA
Blood flow through lungs

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12
Q

How are inhalant anesthetics eliminated?

A

Almost entirely via the lungs

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13
Q

Which metabolites are nephrotoxic?

A

Isoflurane, enflurane, sevoflurane

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14
Q

Which metabolites are hepatotoxic?

A

Halothane

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15
Q

Which GA leads to bradycardia and arrythmia leading to hypotension?

A

Halothane (due to depression of CO)

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16
Q

Which GA leads to hypotension due to decrease in systemic vascular resistance?

A

Isoflurane

17
Q

Which GA have medium onset and recovery?

A

Isoflurane and halothane

18
Q

Which GA cannot be used with carbon dioxide absorbents in vaporiser machines?

A

Sevoflurane

19
Q

What is nitrous oxide used for?

A

Analgesia when don’t need unconsciousness

Adjunct for patient before going unconscious to reduce pain

20
Q

Side effects of nitrous oxide?

A

Post operative NV

21
Q

What is an induction agent?

A

A substance that induces unconsciousness, does not necessarily keep you unconscious for a long time

22
Q

Types of IV GA

A

Thiopentone, midazolam, propofol, ketamine

23
Q

What are the advantages of using inhaled + IV anesthetics

A

Permit dosage of inhalation agent to be reduced (high dose needed to induce anesthesia)
Produce effects that cannot be achieved with inhalation alone (such as analgesia, anxiolytic, fast)

24
Q

What type of IV GA is thiopental? Is tolerance and dependency a concern?

A

Short acting barbiturate

No, because it is used once only

25
Q

MOA of thiopental

A

Causes CNS depression by potentiating the action of GABA on GABA a receptors, leading to hyperpolarisation

26
Q

Which IV GA is used for day surgery?

A

Propofol - continuous low dose infusion

27
Q

Which IV GA has similar side effects as halothane?

A

Propofol (hypotension and bradycardia)

28
Q

What is the MOA of ketamine?

A

glutamate NMDA receptor antagonist

29
Q

Does ketamine produce full unconsciousness?

A

No, produces dissociative anesthesia

30
Q

Which IV GA has psychologic adverse reactions?

A

Ketamine - hallucination, delirium, distrubing dreams

Can be minimised using diazepam or midazolam premedication

31
Q

Which IV anesthetic has analgesic property?

A

Ketamine

32
Q

What do anesthetic adjuncts do?

A

Provide sedation, amnesia, analgesia

33
Q

Types of anesthetic adjuncts

A

Midazolam (anxiolysis, amnesia, sedation)
Dexmedetomidine (sedation and analgesic)
NSAIDs (analgesics)
Succinylcholine (relax muscles)

34
Q

What is succinycholine used for?

A

Administered during induction of anesthesia to relax muscles of jaw, neck and airway → facilitate laryngoscopy and endotracheal intubation

PR3136 (8 decks)

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