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ACC > Introduction to Anaesthetics - Lecture > Flashcards

Introduction to Anaesthetics - Lecture Flashcards

1
Q

What are the 3 types of anaesthesia and what do they do?

A
  1. General anaesthesia = total loss of sensation.
  2. Regional anaesthesia = loss of sensation to a region or part of body.
  3. Local anaesthesia = topical.
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2
Q

Define:

  1. Amnesia
  2. Analgesia
  3. Akinesis
A
  1. Lack of response and recall to noxious stimuli - unconsciousness.
  2. Pain relief.
  3. Immobilisation / paralysis.
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3
Q

What do you need for general anaesthesia?

A
  1. Monitoring
  2. IV access
  3. Start the process - induction of anaesthesia + start analgesia and muscle relaxation.
  4. Maintain the process - maintenance agents + replace fluid loss blood loss.
  5. Reverse muscle relaxation.
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4
Q

What is the best induction agent for:

  1. Burn dressing change?
  2. Arm operation under GA with an LMA?
  3. Hx of HF + requires GA?
  4. Intestinal obstruction + requires emergency laparotomy?
  5. Porphyria + needs inguinal hernia repair?
A
  1. Ketamine - short procedure.
  2. Propofol - commonly used.
  3. Etomidate - haemodynamic stability (steady blood flow).
  4. Thiopentone - RSI.
  5. Porphyria - NOT thiopentone.
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5
Q
  1. What are the positives of using propofol.

2. What dose is used?

A
  1. Excellent suppression of airway reflexes + decreases incidence of PONV.
  2. Dose = 1.5 - 2.5 mg/kg
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6
Q

What are the unwanted effects of propofol?

A
  1. Marked drop in HR and BP.
  2. Pain on injection.
  3. Causes involuntary movements.
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7
Q
  1. What are positives of using thiopentone?

2. What dose is used?

A
  1. Faster than propofol - used for rapid sequence induction.
  2. Antiepileptic properties + protects brain.
  3. Dose = 4 - 5 mg/kg
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8
Q

What are the unwanted effects of thiopentone?

A
  1. Drops BP but raises HR.
  2. Rash
  3. Bronchospasm
  4. Intra-arterial injection = can cause thrombosis and gangrene.
  5. Contraindicated in porphyria.
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9
Q
  1. When is ketamine used and what are the positives?
  2. What is the dose?
  3. How long does it take to act?
A
  1. Sole anaesthetic for short procedures.
  2. Raise HR/BP
  3. Bronchodilation
  4. Dose = 1 - 1.5 mg/kg
  5. Slow = 90 seconds.
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10
Q

What are the unwanted effects of ketamine?

A
  1. N&V

2. Emergence phenomenon.

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11
Q

What is emergence phenomenon?

A

Hallucinations, vivid dreams, illusions - basically, px trips out when coming around from anaesthesia.

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12
Q

What are the positives of etomidate and what is the dose?

A
  1. Rapid onset
  2. Haemodynamic stability - good for HF px
  3. Lowest incidence of hypersensitivity reaction.
  4. Dose = 0.3 mg/kg
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13
Q

What are the unwanted effects of etomidate?

A
  1. Pain on injection.
  2. Spontaneous movements.
  3. Adreno-cortical suppression.
  4. High incidence of PONV.
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14
Q

How long do induction agents last for?

A

4 - 10 minutes

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15
Q

What can be used to maintain amnesia?

A
  1. Propofol infusion - total intravenous anaesthesia.

2. Inhalation agents = sevoflurane, desflurane, isoflurane, enflurane.

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16
Q

What is MAC?

A

Minimum alveolar concentration - the concentration of vapour required, to prevent the reaction to a surgical stimulus, in 50% of px.

17
Q

What are the MAC values for:

  1. Nitrous oxide
  2. Sevoflurane
  3. Desflurane
  4. Isoflurane
  5. Enflurane
A
  1. 104%
  2. 2%
  3. 6%
  4. 1.15%
  5. 1.6%
18
Q

Best inhalation agent for:

  1. Long, 8 hour, finger re-implantation.
  2. Chubby child with no IV access.
  3. Organ retrieval from a donor.
A
  1. Desflurane - low lipid solubility + used for long operations.
  2. Sevoflurane
  3. Isoflurane - least effect on organ blood flow.
19
Q

What are analgesics required for?

A

Intubation, insertion of LMA, intra-operative pain relief and postoperative pain relief.

20
Q
  1. What short-acting opioids are used?

2. What long-acting opioids are used?

A
  1. Fentanyl, alfentanil, remifentanil.

2. Morphine, oxycodone

21
Q

What other analgesics are used?

A
  • Paracetamol IV

- NSAIDS = Diclofenac, Parecoxib, Ketorolac

22
Q

Most commonly used analgesic?

A

Paracetamol

23
Q

Most commonly used oral opioid in adults?

A

Codeine

24
Q

IV NSAIDS?

A

Ketorlac, Parecoxib

25
Q

Name the only depolarising muscle relxant and what is its dose?

A

Suxamethonium - RSI

Dose = 1 -1.5 mg/kg

26
Q

What are the adverse effects of suxamethonium?

A

Muscle pains, fasciculations, hyperkalemia, malignant hyperthermia, rise in IOP/ICP

27
Q

How do non-depolarising muscle relaxants work?

A

Compete with acetylcholine for nicotinic receptors.

28
Q

What is the difference between suxamethonium and non-depolarising muscle relaxants?

A

Sux = rapid onset and rapid offset (RSI) + lots of side effects.

Non = slow onset and variable duration + less side effects.

29
Q

What can be used to reverse the effects of atracurium?

A

Neostigmine or Glycopyrrolate.

30
Q

What drugs are commonly used to treat hypotension whilst px is undergoing surgery?

A
  1. Ephedrine
  2. Phenylephrine
  3. Metaraminol

(Vaso-active drugs)

31
Q

How does ephedrine work?

A

Acts directly and indirectly on alpha and beta receptors (adrenergic receptors) - causing vasoconstriction.

Increasing HR and contractility = rise in BP.

32
Q

How does phenylephrine / meteraminol work?

A

Causes vasoconstriction - direct action on alpha receptors.

Drops HR.

33
Q

Best vaso-active agent for:

  1. Low BP, low HR
  2. Low BP, high HR
  3. ICU / severe sepsis
A
  1. Ephedrine
  2. Phenylephrine / Metaraminol
  3. Noradrenaline / Adrenaline
34
Q

What % of px get PONV after GA?

A

20-30%

35
Q

Name the commonly used anti-emetic agents and what class of drug?

A
  1. 5HT3 blocker = Ondansetron
  2. Anti-histamine = Cyclizine
  3. Steroid = Dexamethasone
  4. Phenothiazine = Prochlorperazine (Stemetil)
  5. Anti-dopaminergic = Metoclopramide
36
Q

What are the 4 steps to reversal of GA?

A
  1. Stop anaesthetic vapours
  2. Give o2
  3. Perform throat suction
  4. Give reversal muscle relaxant
37
Q

How does neostigmine work?

A

Anti-cholinesterase = prevents breakdown of acetylcholine

ACC (10 decks)

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