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Block 3: Pathophysiology and pharmacology > Introduction to anaesthesia > Flashcards

Introduction to anaesthesia Flashcards

1
Q

What 3 A’s make up the normal state of consciousness?

A

Alertness
Awareness
Attention

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2
Q

What is the most common scale used to measure consciousness clinically?

A

Glasgow Coma Scale (GCS)

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3
Q

What is the difference between anaesthesia and sedation?

A

Anaesthesia = drug-induced, predictably reversible form of coma characterised by a lack of feeling

Sedation = state that allows patients to tolerate unpleasant diagnostic or surgical procedures an to relieve anxiety and discomfort, during which verbal contact can be maintained

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4
Q

What is the difference between anaesthesia and sedation?

A

Anaesthesia = drug-induced, predictably reversible form of coma characterised by a lack of feeling

Sedation = state that allows patients to tolerate unpleasant diagnostic or surgical procedures an to relieve anxiety and discomfort, during which verbal contact can be maintained

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5
Q

What are the 3 main scales used to assess levels of sedation?

A

Ramsey scale
Richmond Agitation Sedation Scale (RASS)
Riker Sedation Agitation Scale (SAS)

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6
Q

What are the most commonly used drugs for sedation?

A 
Benzodiazepines 
Opiates
Entonox (NO/ O2) 
Anaesthetics 
Dexmedetomidine (alpha2 antagonist)
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7
Q

Name the common benzodiazepines used for sedation

A

Lorazepam
Midazolam
Diazepam
Temazapam

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8
Q

Name 3 common anaesthetics

A

Ketamine
Propofol
Sevoflurane

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9
Q

What is the mechanism of action of Benzodiazepines?

A

Benzodiazepines are allosteric positive modulators
Work near GABA receptor sites to increase chloride entry into the cell - leads to hypopolarisation thus decreasing neuronal firing

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10
Q

What conditions are Benzodiazepines commonly used for?

A

Anxiety
Insomnia
Epilepsy

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11
Q

Why should Benzodiazepines only be used short term?

A

Long term use can lead to tolerance and dependence

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12
Q

What opioids are commonly used for sedation

A

Alfentanil
Fentanyl
Remifentanil

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13
Q

What is the principal opioid receptor that short acting opioids (such as fentanyl) bind to?

A

Mu-opioid receptors

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14
Q

What are the 3 cardinal signs of opioid overdose?

A

Hypoventilation
Coma
Miosis (pinpoint pupils)

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15
Q

What are the main receptors upregulated by opioid receptor activation?

A

Upregulation of voltage sensitive K+ channel increases movement of K+ out of cell (causing hyperpolarisation of cell thus making it harder for the cell to fire afterwards)

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16
Q

What are the main receptors downregulated by opioid receptor activation?

A

Downregulation of Ca2+ channels reduces vesicular release from the presynaptic terminal and plasticity on the post-synaptic terminal

17
Q

What is Entonox?

A

50:50 mixture of Nitrous Oxide and Oxygen
Inhaled
Used for light sedation and as an analgesic

18
Q

What is Dexmedetomidine?

A

Selective alpha2-adrenoceptor agonist

19
Q

Where is Dexmedetomidine most commonly used?

A

Intensive Care

Used when patient needs to maintain verbal responsiveness

20
Q

Where are alpha2-adrenoceptor mainly located?

A

Pre-synaptic terminals of neurons in the brain and ANS.

Also found on pancreatic islets, platelets and fat cells.

21
Q

What is the mechanism of action of Dexmedatomidine?

A

Binds to presynaptic alpha2-adrenoceptors in the brain
Inhibits release of noradrenaline
Terminates propagation of pain signals

22
Q

What are the 3 key elements making up the triangle of balanced anaesthesia?

A

Analgesia
Anaesthesia (hypnosis)
Muscle relaxation

23
Q

What are the common local anaesthetics?

A

Bupivacaine
Levobupivacaine
Lidocaine

[All amino amides]

24
Q

What are the common general anaesthetics?

A

Ketamine
Propofol
Nitrous Oxide
Isofluorane

25
Q

What are the two main routes of administration for general anaesthetics?

A

IV

Inhalation

26
Q

What properties of nerves can affect speed/effectiveness of block from local anaesthetic?

A

Myelination (work more easily on un- or light-myelinated axons)
Length of axon (work more easily on shorter neurons)

27
Q

What is the mechanism of action of local anaesthetics?

A
  1. Enter cell in an unionised form
  2. Become ionised in intracellular space
  3. Blocks Na+ channel from inside
28
Q

Why do local anaesthetics not work as well on inflammed tissue?

A

pH-dependent and inflammatory soup in damaged soup is generally acidic.
Local anaesthetics ionise in acidic pH which reduces ability to cross the neuronal membrane to attach to the Na+ channel.

29
Q

What are the 2 groups of local anaesthetics?

A 
Amino esters (metabolised in the plasma) 
Amino amides (metabolised in the liver)
30
Q

What is the ideal score for each sedation scale?

A 
Richmond = 0 
Ramsey = 2 
Riker = 4

Block 3: Pathophysiology and pharmacology (16 decks)

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