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Gwen - Anaesthetics > Induction and Maintenance > Flashcards

Induction and Maintenance Flashcards

(52 cards)

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1
Q

What is the triad of anaesthesia?

A
  • Hypnosis- unconsciousness (necessary component of GA)
  • Analgesia- pain relief (removal of perception of unpleasant stimulus)
  • Relaxation- muscle relaxation (provides immobility during surgery)

General anaesthetics (hypnotic, relaxant and analgesic)

Muscle relaxant (relaxants)

Analgesia (local, opiates)

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2
Q

What is a balanced anaesthesia?

A

Allows a great degree of control over the individual components of the triad of anaesthesia.

Various componentes: awake, analgesia, muscle relaxation, airway management

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3
Q

Why should ACEi be stopeped prior to surgery

A

Can cause severe hypotension after induction of GA

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4
Q

What are examples of intravenous anaesthetics?

A
  • Propofol
  • Thiopental sodium
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5
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
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6
Q

What are examples of inhaled anaesthetics?

A
  • Isoflurane
  • Sevoflurane
  • Desflurane
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7
Q

What is an important contraindication to inhaled anaesthetic use?

A

Susceptibility to malignant hypertermia

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8
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
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9
Q

What are examples of non-depolarising neuromuscular blocking drugs?

A
  • Atracurium
  • Mivacurium
  • Rocuronium
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10
Q

What is an example of a depolarising neuromuscular drug?

A

Suxamethonium

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11
Q

When are non-depolarising neuromuscular blocks contraindicated for use?

A

Allergy

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12
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
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13
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

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14
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.

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15
Q

What are adverse reactions to non-depolarising NM blocks?

A
  • Histamine release (atracurium / mivacurium)
  • Allergy
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16
Q

What are adverse reactions to suxamethonium?

A
  • Hyperkalaemia
  • Malignant hyperthermia
  • Prolonged paralysis (cholinesterase deficiency)
  • Post-operative muscle pains
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17
Q

What are the general levels of sedation?

A
  • Minimal sedation
  • Moderate sedation
  • Deep sedation
  • General anaesthesia
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18
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

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19
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

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20
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

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21
Q

What does general anaesthesia mean?

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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.

They provide: hypnosis, muscle relaxation (small degree), analgesia (to different extents)

22
Q

What steps would you take for intravenous induction of anaesthesia?

Study These Flashcards
A
  • Establish IV access
  • Pre-oxygenate
  • Give co-induction agents - fentanyl, midazolam
  • Give sleep inducing dose - propofol
23
Q

What steps are involved in gaseous induction of anaesthesia?

Study These Flashcards
A
  • Either
    • Sevoflurane in oxygen
    • Nitrous oxide + sevoflurane
  • Establish IV access as soon as asleep
24
Q

What are indications for gaseous induction of anaesthesia?

Study These Flashcards
A
  • Patient request
  • Difficult IV access
  • Children
  • Patients with partially obstructed airway - awake fibre optic intubation often needed
25
When is intrubation in anaesthesia often needed?
* **Increased vomiting risk/aspiration** * **Difficult airway** * **Inaccessible/shared airway** - head and neck surgery * **Paralysis indicated in surgery** - e.g. abdominal surgery
26
What options are available for maintianing anaesthesia?
* **Volatile agent** * **IV infusion** - propofol +/- opiates * **High dose opiates with mechanical ventilation**
27
How would you gauge the depth of general anaesthesia?
* **HP** * **BP** * **Signs of sympathetic stimulation**
28
What signs may indicate a lack of appropriate anaesthesia?
* **HR increase** * **BP increase** * **Lacrimation** * **Dilated pupils** * **Movement or laryngospasm**
29
What monitoring is normally conducted when somoene is under GA?
* **Respiration** - depth and RR * **BP** * **Temperature** * **Pulse oximetry** * **ECG** * **CVP** - helps differentiate between hypovolaemi and decreased cardiac function so if large blood loss anticipated helps guid fluid replacement * **Capnogrophy** * **Inspired O2 concentration** * **Urine output** * **Ventilator pressures** * **Neuromuscular status**
30
Why is capnogrophy essential in surgery?
A low end tidal CO2 can indicate a displaced ET tube, emboli and more
31
What are features which indicate intubation could be difficult?
* **Obese** * **Short neck** * **Limited neck movement** * **Receding chin/mandible** * **Protruding Teeth** * **Limited mouth opening**
32
What classification system is used to assess difficulty of intubation?
Mallampati classification
33
What mallampati classification is the following?
Class I - soft palate and uvula visible
34
What mallampati classification is the following?
Class II - Uvula tip masked by base of tongue
35
What mallampati classification is the following?
Class III - Only soft palate visible
36
What mallampati classifcation is the following?
Class IV - Soft palate not visible
37
How would you subjectively assess if someone might have a difficult airway?
* **Mallampati classification** * **Thyromental and sternomental distances**
38
What are the main anaesthetic complications that can occur in surgery?
* **Failure to intubate** * **Atelectasis and penumonia** * **Awareness** * **Bronchospasm** * **Laryngospasm** * **Malignant hypertemia** * **Teeth damage** * **Suxamethonium apnoea** * **Shivering** * **Aspiration**
39
How would you manage someone with laryngospasm?
* **100 % oxygen** * **Deepen anaesthesia + attempt to ventilate** * **May be necessary to paralyse and intubate**
40
What is malignant hyperthermia?
Causes a fast rise in body temperature and severe muscle contractions when someone with the MH gets general anesthesia.
41
How is malignant hyperthermia inherited?
Autosomal dominant
42
How is malignant hyperthermia triggered?
Exposure to suxamethonium or other volatile agents
43
What are features of malignant hyperthermia?
* I**ncreased O2 consumption** * **Hypercapnia** * **Tachycardia** * **Metabolic acidosis** * **Raised temperature** - late sign (\>1 degree every 30 minutes) **_Masseter spasm may be an early sign_**
44
How would you manage someone with Malignant hyperthermia?
* **Hyperventilate with 100%** * **Maintain anaesthesia with IV agent** * **Abandon surgery** * **Non-depolarising muscle block** * **Give _dantrolene IV_** (muscle relaxant) * Active cooling * **Check for hyperkalaemia, arrythmias, acidosis, myoglobinaemia, coagulopathy**
45
What is sux apnoea?
Abnormal cholinesterase leads to prolonged drug effect lasting 2-24 hrs.
46
What is rapid sequence induction?
Method of ET intubation used in emergency setting of an acutely unwell patient and suspected risk of aspiration is high
47
What is the sequence of steps the occur in RSI?
* **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**
48
Why is suxamethonium used in RSI?
Fast acting muscle relaxant
49
How is airway maintained?
* Triple airway manoeuvre * Simple apparatus * Face mask * Oropharyngeal (Guedel) airway * Nasopharyngeal airway * Advanced apparatus * Laryngeal mask airway (LMA) - cuffed tube with "mask
50
Why would you intubate?
* Requires muscle relaxation with a depolarising/non depolarasing NABs * Protects airway from gastric contents * Shared airways with risk of blood contamination (tonsillectom in ENT surgery) * Need for tight control of blood gases * Restricted aaccess to airway (Max-Fax surgery)
51
Complications of airway maintenance
* Obstruction - usually caused by loss of airway tone * Laryngospasm - forced reflex adduction of the vocal cords * Aspiration - foreign material in the lower airway (gastric content or blood)
52
How can a patient be woken in an emergency?
* Anaesthetic agents off an change inspired gases to 100% O2 * Discontinue any anaesthetic agent and reverse muscle aparlysis * Put patient in recovery position once patient is spontaneously breathing.

Gwen - Anaesthetics (16 decks)

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