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Week 2&3 FCP > Induction and Maintenance of Anaesthesia > Flashcards

Induction and Maintenance of Anaesthesia Flashcards

1
Q

Name the 5 routes of drug administration/delivery

A

IM
IV
SC
Inhaled
Across mucous membranes

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2
Q

Name the 3 things that general anaesthesia includes

A
  1. Amnesia
  2. Loss of consciousness (hypnosis)
  3. Immobility, often associated with analgesia and suppression of autonomic reflexes
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3
Q

Name the main pharmacokinetic properties of propofol (absorption, solubility, distribution, metabolism, elimination)

A

Absorption - minimal oral bioavailability therefore inject IV
Solubility - Minimally soluble in water therefore injected as an emulsion
Distribution - 98% protein bound
Metabolism - liver, process of glucuronidation
Elimination - renal

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4
Q

Name the main pharmacodynamic properties of propofol

A

Anaesthesia in 5-8 mins
Respiratory and cardiovascular depression
Decreased cerebral metabolic rate of oxygen (CMRO2)
Haemodynamic effects due to sympathetic depression
- Decreased HR, MAP, SVR and CVP
- Stable cardiac output

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5
Q

Why do we need to intubate ASAP when using propofol

A

Apnoea is common

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6
Q

Name the main pharmacokinetic properties of alfaxalone (absorption, solubility, distribution, metabolism, elimination)

A

Absorption - good bioavailability
Solubility - soluble in water - can give IM or IV
Distribution - 30-50% protein bound
Metabolism - liver, rapid (also lungs and kidney)
Elimination - renal (small % bile)

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7
Q

Name the main pharmacodynamic properties of alfaxalone

A

Anaesthesia
Decreased cerebral metabolic rate of oxygen (CMRO2)
Haemodynamic effects minimal
- Stable cardiac output
- Stable HR, MAP, SVR, CVP

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8
Q

How should you administer alfaxalone and propofol

A

Titrate to effect - over 60 seconds

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9
Q

What are the haemodynamic effects of ketamine

A

Minimal
Stable cardiac output
Increased HR, MAP, SVR, CVP

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10
Q

What effects does ketamine have on the cardiovascular system, and what patients is it contraindicated in

A

Increases arterial pressure, HR and cardiac output - due to stimulation of SNS
Increases pulmonary arterial pressure
Contraindicated in patients with coronary artery disease and poorly controlled hypertension

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11
Q

What effects does ketamine have on the respiratory system

A

Minimal effect on ventilatory drive
Bronchodilator - preserves upper airway reflexes
Patients with an increased risk of aspiration may require airway protection

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12
Q

What effects does ketamine have on the cerebral system

A

Increased cerebral blood flow, intracranial pressure and cerebral oxygen requirements
Dissociative anaesthesia - patent may appear conscious e.g. eye-opening, swallowing
Analgesia and opioid sparing

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13
Q

Which drug can you use to minimise the unpleasant dream/hallucinations following administration of ketamine

A

Benzodiazepines

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14
Q

Name the main pharmacokinetic properties of ketamine (availability, solubility, distribution, metabolism, elimination)

A

Availability - Good bioavailability - IV, IM, squirted into mouth
Solubility - soluble in water
Distribution - 12% protein bound
Metabolism - liver => norketamine
Elimination - renal, small % bile

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15
Q

Name the 2 main volatile agents used in maintenance of anaesthesia

A

Isofluorane
Sevofluorane

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16
Q

Name the main pharmacodynamic properties of volatile agents

A

Anaesthesia
Cardiopulmonary depression
- Reduced cardiac output, HR, MAP, SVR, CVP

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17
Q

Name the main pharmacokinetic properties of the volatile agents (absorption, solubility, distribution, metabolism, elimination)

A

Absorption - lungs
Solubility - in tissues/blood varies
Distribution - Via blood to brain
Metabolism - minimal
Elimination - lungs

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18
Q

How is the speed of induction with volatile agents related to cardiac output and why

A

Speed of induction is inversely proportional to cardiac output
Due to negative effects of cardiac output on alveolar partial pressure

19
Q

Name 3 ways anaesthesia can be maintained

A
  1. Inhalational anaesthesia
  2. Total intravenous anaesthesia (TIVA)
  3. Mix of the two - Partial intravenous anaesthesia (PIVA)
20
Q

Are volatile/inhalational agents vapours or gasses

A

Vapours

21
Q

Which gasses can be used to carry volatile agents to the patient

A

Oxygen - most common
Medical air?
May include NO

22
Q

How do inhalational agents work (cause anaesthesia)

A

Fresh gas + volatile agent are inhaled => alveoli
The agent is soluble in blood, plasma conc. increases
Agent => brain

23
Q

What factors does the rate of plasma increase of volatile agents depend on and how

A

The concentration of the agent
- Increase in conc => quicker increase of plasma conc.
Patient’s ventilation
- Increased ventilation => faster increase in plasma conc.
Cardiac output
- Increased CO => slower increase
Solubility of the agent in the blood
- increased solubility => slower increase
- Poorly soluble agents diffuse out of blood to tissues more quickly

24
Q

What 3 receptors do we think volatile agents act on

A
  1. GABA
  2. NMDA
  3. Ach
25
Q

Name the different types of anaesthetic scavenging

A

Passive scavenging - can use charcoal to absorb
Active scavenging

26
Q

Define the minimum alveolar concentration (MAC)

A

The concentration of a vapour in the alveoli of the lungs that is needed to prevent movement in 50% of subjects in response to surgical stimulus.

27
Q

Name 3 factors which affect MAC

A
  1. Individual variation
  2. Body temperature, age, etc.
  3. Drugs given premed or intraoperatively (MAC sparing often)
28
Q

Out of isoflurane and sevoflurane, which has a higher MAC across all species

A

Sevoflurane

29
Q

Which species are isoflurane and sevoflurane licensed in

A

Iso - dogs, cats, horses
Sevo - Dogs and cats

30
Q

What are the advantages and disadvantages of sevoflurane

A

Higher MAC and lower blood gas solubility => diffuses into the brain quicker than iso => quicker change in anaesthetic depth
More expensive than iso
Higher MAC - use more of it
More suitable for mask induction - doesn’t taste/smell and quicker to effect

31
Q

What are the main disadvantages of inhalational anaesthetic agents

A

Profound dose-dependant cardiovascular and respiratory depression
Cardiovascular depression leads to:
- Peripheral vasodilation
- Decrease in vascular reactivity
- Reduction in BP and cardiac output
Respiratory depression due to:
- Depressed response to CO2
- Depressed hypoxic pulmonary vasoconstriction
- Almost complete suppression of ventilatory response to hypoxia
- Bronchodilation => increased dead space

32
Q

What are the negatives of nitrous oxide (N2O)

A

Persists in atmosphere for 100 years
Ozone-depleting
Very high MAC - can’t use on its own
Poor solubility In blood - can lead to diffusion hypoxia

33
Q

What are the positives of Nitrous oxide (N2O)

A

MAC sparing
Can spare the cardiovascular effects of iso or sevo
Anaesthetic and analgesia due to NMDA receptor antagonism

34
Q

What are the main contraindications of Nitrous oxide

A

N2O quickly diffuses into gas-filled spaces - any condition with a gas filled space = bad
GDV
Pneumothorax
Horses and rabbits
Endoscopy - inflate areas with air
ocular procedures where there is a risk of bubbles forming in the eye

35
Q

Why are there environmental concerns regarding anaesthetic inhalation agents

A

Considered greenhouse gasses
Some of which, e.g. N2O, are ozone depleting

36
Q

What controls are anaesthetic inhalation agents subject to and why

A

COSHH (control of substances hazardous to health)
They are volatile and not metabolised by the patient => potential for personnel exposure

37
Q

How is exposure to inhalation anaesthetic agents measured

A

Dosimeter

38
Q

What is TIVA and what does it stand for

A

TIVA = total intravenous anaesthesia
Where anaesthesia is induced and maintained by IV administration of drugs
Simply - no inhaled agents are used

39
Q

Which drugs are licensed for TIVA in small animals

A

Propofol
Alfaxalone
(can also use repeated boluses of ketamine)

40
Q

Why should you be careful if using propofol for TIVA in cats

A

Potential for oxidative damage and Heinz body formation if propofol is used repeatedly or over a long period of time

41
Q

Which 3 drugs are in the ‘triple drip’ used for TIVA in horses

A

Detomidine (or Xylazine)
Ketamine
Guafenesin

42
Q

What is PIVA and what does it stand for

A

PIVA = partial intravenous anaesthesia
Combination of IV and inhalational anaesthesia
The rationale is that using IV drugs reduces the amount of inhalation agent used

43
Q

Give 2 examples of drugs which improve cardiovascular stability under anaesthesia

A

Ketamine
Lidocaine

Week 2&3 FCP (20 decks)

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