Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anaesthetics > Induction and Maintenance > Flashcards

Induction and Maintenance Flashcards

1
Q

What are examples of intravenous anaesthetics?

A
  • Propofol
  • Thiopental sodium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are adverse reactions to intravenous anaesthetics?

A
  • Rapid onset of upper airway obstruction due to loss of muscle tone
  • Respiratory depression and apnoea
  • Bradycardia (propofol)
  • Hypotension
  • Propofol infusion syndrome (<16 years)
  • Anaesthetic hangover - long period of drowsiness post anaesthetic
  • Nausea, vomiting, headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are examples of inhaled anaesthetics?

A
  • Isoflurane
  • Sevoflurane
  • Desflurane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is an important contraindication to inhaled anaesthetic use?

A

Susceptibility to malignant hypertermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are adverse reactions to inhaled anaesthetics?

A
  • Respiratory depression
  • Hypotension
  • Arrhythmias
  • Mucous membrane irritation leading to cough, breath-holding and laryngospasm (Isoflurane/Desflurane)
  • Increased intracranial pressure - cerebral vasodilatation
  • Uterine hypotonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are examples of non-depolarising neuromuscular blocking drugs?

A
  • Atracurium
  • Mivacurium
  • Rocuronium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is an example of a depolarising neuromuscular drug?

A

Suxamethonium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When are non-depolarising neuromuscular blocks contraindicated for use?

A

Allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When are depolarising neuromuscular blocks contraindicated for use?

A
  • Family history of malignant hyperthermia
  • Severe burns
  • Numerous neuromuscular contraindications including spinal cord injury and dystrophia myotonica
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do non-depolarising NM blocks work?

A

Act as competitive antagonists of the acetycholine channels of the motor end plate. The drugs bind the channel and stop ACh from binding and opening the channel to Na+, preventing action potentials in the muscle fibres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do depolarising NM blocks work?

A

Act as acetylcholine agonists on the ACh channels of the motor end-plate. Their binding results in the continuous production of action potentials until exhaustion of the cell’s ability to repolarise occurs, causing neuromuscular paralysis

Suxamethonium is rapidly broken down by plasma cholinesterase, once this has happened repolarisation again becomes possible and neuromuscular function returns.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are adverse reactions to non-depolarising NM blocks?

A
  • Histamine release (atracurium / mivacurium)
  • Allergy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are adverse reactions to suxamethonium?

A
  • Hyperkalaemia
  • Malignant hyperthermia
  • Prolonged paralysis (cholinesterase deficiency)
  • Post-operative muscle pains
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the general levels of sedation?

A
  • Minimal sedation
  • Moderate sedation
  • Deep sedation
  • General anaesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does minimal sedation mean?

A

Drug-induced state where the patient is still able to respond to speech. Cognitive function and coordination are impaired but ABC are unaffected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does moderate sedation mean?

A

Conscious sedation

Drug-induced reduction of consciousness during which the patient is able to make a purposeful response to voice or light touch. At this level of sedation, no airway adjuncts are required, and B and CVS function should be adequate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does deep sedation mean?

A

Drug-induced reduction in consciousness to a point where the paitent cannot be easily roused but does respond purposefully to painful stimuli. At this level, airway intervention may be required, with spontaneous ventilation becoming inadequate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does general anaesthesia mean?

A

Drug-induced LOC during which pateitns are not able to be roused, even by painful stimuli. Airway typically needs intervention, spontaneous ventilation is frequently inadequate, and CVS function may be impaired

19
Q

What steps would you take for intravenous induction of anaesthesia?

A
  • Establish IV access
  • Pre-oxygenate
  • Give co-induction agents - fentanyl, midazolam
  • Give sleep inducing dose - propofol
20
Q

What steps are involved in gaseous induction of anaesthesia?

A
  • Either
    • Sevoflurane in oxygen
    • Nitrous oxide + sevoflurane
  • Establish IV access as soon as asleep
21
Q

What are indications for gaseous induction of anaesthesia?

A
  • Patient request
  • Difficult IV access
  • Children
  • Patients with partially obstructed airway - awake fibre optic intubation often needed
22
Q

When is intrubation in anaesthesia often needed?

A
  • Increased vomiting risk/aspiration
  • Difficult airway
  • Inaccessible/shared airway - head and neck surgery
  • Paralysis indicated in surgery - e.g. abdominal surgery
23
Q

What options are available for maintianing anaesthesia?

A
  • Volatile agent
  • IV infusion - propofol +/- opiates
  • High dose opiates with mechanical ventilation
24
Q

How would you gauge the depth of general anaesthesia?

A
  • HP
  • BP
  • Signs of sympathetic stimulation
25
Q

What signs may indicate a lack of appropriate anaesthesia?

A
  • HR increase
  • BP increase
  • Lacrimation
  • Dilated pupils
  • Movement or laryngospasm
26
Q

What monitoring is normally conducted when somoene is under GA?

A
  • Respiration - depth and RR
  • BP
  • Temperature
  • Pulse oximetry
  • ECG
  • CVP
  • Capnogrophy
  • Inspired O2 concentration
  • Urine output
  • Ventilator pressures
  • Neuromuscular status
27
Q

Why is capnogrophy essential in surgery?

A

A low end tidal CO2 can indicate a displaced ET tube, emboli and more

28
Q

What are features which indicate intubation could be difficult?

A
  • Obese
  • Short neck
  • Limited neck movement
  • Receding chin/mandible
  • Protruding Teeth
  • Limited mouth opening
29
Q

What classification system is used to assess difficulty of intubation?

A

Mallampati classification

30
Q

What mallampati classification is the following?

A

Class I - soft palate and uvula visible

31
Q

What mallampati classification is the following?

A

Class II - Uvula tip masked by base of tongue

32
Q

What mallampati classification is the following?

A

Class III - Only soft palate visible

33
Q

What mallampati classifcation is the following?

A

Class IV - Soft palate not visible

34
Q

How would you subjectively assess if someone might have a difficult airway?

A
  • Mallampati classification
  • Thyromental and sternomental distances
35
Q

What are the main anaesthetic complications that can occur in surgery?

A
  • Failure to intubate
  • Atelectasis and penumonia
  • Awareness
  • Bronchospasm
  • Laryngospasm
  • Malignant hypertemia
  • Teeth damage
  • Suxamethonium apnoea
  • Shivering
  • Aspiration
36
Q

How would you manage someone with laryngospasm?

A
  • 100 % oxygen
  • Deepen anaesthesia + attempt to ventilate
  • May be necessary to paralyse and intubate
37
Q

How is malignant hyperthermia inherited?

A

Autosomal dominant

38
Q

How is malignant hyperthermia triggered?

A

Exposure to suxamethonium or other volatile agents

39
Q

What are features of malignant hyperthermia?

A
  • Increased O2 consumption
  • Hypercapnia
  • Tachycardia
  • Raised temperature - late sign
40
Q

How would you manage someone with Malignant hyperthermia?

A
  • Hyperventilate with 100%
  • Maintain anaesthesia with IV agent
  • Abandon surgery
  • Non-depolarising muscle block
  • Give dantrolene IV
  • Check for hyperkalaemia, arrythmias, acidosis, myoglobinaemia, coagulopathy
41
Q

What is sux apnoea?

A

Abnormal cholinesterase leads to prolonged drug effect lasting 2-24 hrs.

42
Q

What is rapid sequence induction?

A

Method of ET intubation used in emergency setting of an acutely unwell patient and suspected risk of aspiration is high

43
Q

What is the sequence of steps the occur in RSI?

A
  • Pre-oxygenate with 100% O2 for 3 minutes
  • Apply cricoid pressure and give induction agent (propofol) + muscle relaxant (sux)
  • Wait 60 seconds for relaxant to work
  • Intubate the trachea and release cricoid pressure
  • Add volatile agent to mainatin anaesthesia
44
Q

Why is suxamethonium used in RSI?

A

Fast acting muscle relaxant

Anaesthetics (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions