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ACC Lectures > Introduction to Anaesthestics > Flashcards

Introduction to Anaesthestics Flashcards

1
Q

Three As of Anaesthesia

A

Amnesia, analgesia, akinesis

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2
Q

Minimum Monitoring Standards

A

ECG, Sp02, NIBP, airway gases (02, carbon and vapour), airway pressure, nerve stimulator, temp monitoring if indicated

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3
Q

Four Induction Agents

A

Propofol, thiopentone, ketamine, etomidate

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4
Q

Propofol

A
  • Most common
  • Lipid based (white emulsion)
  • Excellent suppression of airway reflexes
  • Decrease incidence of PONV
  • Unwanted effects; marked drop in HR and BP, pain on injection, involuntary movements
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5
Q

Thiopentone

A
  • Barbiturate
  • Faster than propofol
  • Rapid sequence induction
  • Antiepileptic properties and protects brain
  • Unwanted effects; drops BP but rise in HR, rash/bronchopasm, intraarterial injection:thrombosis and gangrene, contraindicated in porphyria
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6
Q

Ketamine

A
  • Dissociative (anterograde amnesia and profound analgesia)
  • Sole anaesthetic for short procedures
  • Slow onset
  • Rise in HR/BP, bronchodilation
  • Unwanted effects; N/V, emergence phenomenon
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7
Q

Etomidate

A
  • Rapid onset
  • Haemodynamic stability
  • Lowest incidence of hypersensitivity reaction
  • Unwanted effects; pain on injection, spontaneous movements, adreno-cortical suppression, high incidence PONV
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8
Q

Amnesia Vapours

A

To maintain; inhalation agents, started after induction

  • Administered via; vaporisers, breathing circuits
  • Isoflurane, sevoflurane, desflurane, enflurane
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9
Q

MAC

A
  • Minimum alveolar concentration

- At 1MAC, 100% will be amnesic, 50% will have analgesia as well

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10
Q

MAC of

  • Nitrous oxide
  • Sevoflurane
  • Isoflurane
  • Desflurane
  • Enflurane
A

MAC of

  • Nitrous oxide 104%
  • Sevoflurane 2%
  • Isoflurane 1.5%
  • Desflurane 6%
  • Enflurane 1.6%
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11
Q

Sevoflurane

A
  • Sweet smelling
  • Amnesia after 8 breaths
  • Used when IV access is not possible
  • e.g. chubby child
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12
Q

Desflurane

A
  • Low lipid solubility; less well absorbed into muscle and fat, so will leave faster
  • Rapid onset and offset
  • Long operations
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13
Q

Isoflurane

A
  • Least effect on organ blood flow

- Good for e.g. organ retrieval

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14
Q

Analgesia - Opioids

A

Short acting
-Intra-op analgesia, suppress response to laryngoscopy, surgical pain
-Rapid onset, high potency; fentanyl
Long acting
-Intra-op and post-op; morphine, oxycodone

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15
Q

Two IV NSAIDS?

A

Parecoxib, Keterolac

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16
Q

Which drug can you use with morphine?

A

Tramadol

17
Q

Two types of muscle relaxant?

A

Depolarising
-Two ACh bound together, resistant to Acetylcholinesterase
-Bind to nicotinic receptors leading to persistent depolarisation
-Muscle fasciculations, PO myalgia
Non-depolarising
-Bind to ACh receptors but do not produce an action potential
-Prevent ACh binding so action potential not produced

18
Q

Depolarising Muscle Relaxant?

A
  • Suxamethonium
  • Rapid sequence induction (rapid onset, rapid offset)
  • Adverse effects; muscle pains, fasciculations, hyperkalaemia, malignant hyperthermia, rise in ICP, IOP and gastric pressure
19
Q

Non-Depolarising Muscle Relaxants?

A
  • Slow onset and variable duration, less side effects,
  • Short acting; mivacurium
  • Intermediate acting; atracurium, rocuronium, vecuronium
  • Long acting; pancuronium
  • Atracurium and rocuronium most commonly used
  • Reversal with Neostigmine and Glycopyrrolate
20
Q

Vaso-Active Drugs

A

-Maintain BP
-Commonest problem is raised BP; not enough anaesthesia
-Ephedrine BP↑ HR↑ (a+b receptors)
-Phenylephrine BP↑ HR↓ (a receptors)
-Metaraminol BP↑ HR↓ (a receptors)
If severe hypotension (ICU)
-Noradrenaline, adrenaline, dobutamine

21
Q

Anaesthesia Anti-Emetics

A

Odansetron, cyclizine, dexamethasone

22
Q

Typical Anaesthetic Order? (Minus inhalational)

A

Antibiotic, alfentanyl, propofol, rocuronium, ephidrine/phenylephrine, odansetron, dexamethasone

23
Q

Four Steps to Reversal

A

Stop vapours, give oxygen, perform throat suction, reverse muscle relaxation

24
Q

Neostigmine

A
  • Reversal
  • Inhibits acetylcholinesterase
  • Works on non-depolarising
  • Prevents breakdown of ACh
  • Muscarinic effects of acetylcholine (bradycardia, urination…)
  • Usually combined with antimuscarinic eg, glycopyrrolate (blocks receptors in heart so Neostigmine can only work on skeletal muscle)
  • SEs N/V
25
Q

Post Anaesthesia Care

A
  • Administer 02
  • Handover
  • Prescribe; rescue analgesia, rescue antiemetics, fluids, other indicated medications
26
Q

Steps of GA (LMA)

A

Oxygenation, opioid, induction, volatile agent, bag valve mask ventilation, LMA insertion

27
Q

Steps of GA (Intubation)

A

Oxygenation, opioid, induction, volatile agent, bag valve mask ventilation, muscle relaxant, endotracheal intubation

ACC Lectures (5 decks)

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