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control > L31 - general anaesthetics > Flashcards

L31 - general anaesthetics Flashcards

1
Q

triad of balanced general anaesthesia

A

amnesia
analgesia
akinesis

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2
Q

amnesia

A

lack of response and recall to noxious stimuli - unconsciousness

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3
Q

analgesia

A

pain relief

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4
Q

akinesis

A

muscle relaxation / paralysis

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5
Q

general anaesthesia

A

total loss of sensation

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6
Q

brain arm circulation time

A

time it takes for drug to travel from site of injection to brain
10-20s

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7
Q

how many brain arm circulation times induce loss of consciousness

A

2

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8
Q

IV agents for amnesia drugs

A
  • quick onset

- short duration (terminates due to redistribution from muscle to fat)

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9
Q

Cp50

A

the concentration of the agent in the blood that prevents movement after a skin incision in 50% of patients

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10
Q

timeline of events

A
  • monitoring
  • IV access to give anaesthetic agents
  • start the process
  • maintain the process
  • reverse the process
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11
Q

what do IV GAs do

A
  • hyperpolarise nerve cells, preventing conduction of action potentials alone neurones
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12
Q

action of GAs on inhibitory and excitatory neurones

A
  • excite inhibitory neurones

- inhibit excitatory neurones

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13
Q

ideal properties of IV induction agents

A
  • Simple preparation
  • Compatible with other agents and IV fluids
  • Painless on administration
  • High potency and efficacy
  • Predictable action within one circulation time
  • Minimal cardiovascular effects or other toxicity
  • Depression of airway reflexes for intubation
  • Rapid and predictable offset of effect
  • Rapid metabolism for minimal hangover
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14
Q

most common IV induction agent

A

propofol

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15
Q

propofol

A
  • lipid based
  • excellent suppression of airway reflexes (prevents gag reflex or vomiting when equipment inserted into mouth)
  • decreases incidence of post-op nausea and vomiting (PONV)
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16
Q

unwanted effects of propofol

A
  • marked drop in HR and BO
  • pain on injection
  • involuntary movements
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17
Q

thiopentone

A
  • barbiturate (anti-epileptic properties)
  • faster than propofol
  • used for rapid sequence induction
  • protects brain
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18
Q

unwanted effects of thiopentone

A
  • drops BP and increases HR
  • rash / bronchospasm
  • intra-arterial injection (thrombosis and gangrene as travels up arteries and blocks blood flow)
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19
Q

best drug for minor procedures

A

ketamine

muscle relaxation not required

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20
Q

ketamine

A
  • dissociative anaesthesia
  • slow onset (90s)
  • rise in HR/BP
  • bronchodilation
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21
Q

unwanted effects of ketamine

A
  • nausea and vomiting

- emergence phenomenon

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22
Q

dose of propofol used

A

1.5-2.5mg/kg

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23
Q

dose of thiopentone used

A

4-5mg/kg

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24
Q

dose of ketamine used

A

1-1.5mg/kg

25
Q

drug with the quickest onset

A

etomidate

26
Q

dose of etomidate

A

0.3mg/kg

27
Q

lowest incidence of hypersensitivity reaction

A

etomidate since it is steroid based

28
Q

unwanted effects of etomidate

A
  • pain on injection
  • spontaneous movements
  • adrenal-cortical suppression
  • high incidence of PONV
29
Q

how to maintain amnesia

A
  • propofol induction (total IV anaesthesia)

- inhalation agents (inhalation anaesthesia)

30
Q

how long do amnesia induction agents last without maintaining them

A

4-10mins

31
Q

when to give amnesia agents (Vapours)

A

immediately after induction

32
Q

how are amnesia agents administered

A

vaporisers

breathing circuits

33
Q

physical properties of the ideal inhalation agent for amnesia

A
  • non-flammable
  • stable
  • long shelf life
  • environmentally friendly
  • cheap and easy to manufacture
34
Q

biological properties for the idea inhalation agent for amnesia

A
  • pleasant to inhale
  • non-irritant
  • fast onset
  • high potency
  • minimal effect on other systems
  • no biotransformation
  • non-toxic to theatre personnel
35
Q

neurological effects of anaesthetics

A

amnesia
hypnosis
immobility

36
Q

agents of amnesia

A

isoflurane
sevoflurane
desflurane

37
Q

MAC

A

concentration of the vapour which prevents the reaction to the standard surgical stimulus in 50% of patients

38
Q

what does a low solubility of a GA mean

A

fast equilibrium = fast recovery

39
Q

what does a highly fat soluble GA mean

A

GA given for a long time accumulates in far = hangover effect for hours

40
Q

sevoflurane

A
  • sweet smelling

- inhalation induction

41
Q

desflurane

A
  • low lipid solubility
  • rapid onset and offset
  • long operations
42
Q

isoflurane

A
  • least effect on organ blood flow
43
Q

adverse effects on amnesic agents

A
  • vasodilation
  • decrease cardiac contractility
  • can affect organ perfusion
  • malignant hyperthermia
  • hepatotoxicity
44
Q

preferred inhalation amnesic agent for a long surgery

A

desflurane

45
Q

preferred inhalation amnesic agent for a chubby child with no IV access

A

sevoflurane

46
Q

preferred inhalation amnesic agent for an organ retrieval from a donor

A

isoflurane

47
Q

what is analgesia required for

A
  • insertion of airway
  • laryngeal mask airway
  • intubaiton
  • intra-op pain relief
  • post-op pain relief
48
Q

akinesis

A

muscle relaxant required for intubation and surgery

49
Q

depolarising akinesia agent

A

suxamethonium

50
Q

non-depolarising akinesia agent

A

short acting: mivacurium
intermediate acting: vecoronium
long acting: pancoronium

51
Q

assessing unconsciousness

A
  • lineal signs
  • measure MAC
  • BIS monitor
  • isolated forearm
  • Evoked potentials
52
Q

BIS monitor

A

A bispectral index (BIS) monitor is commonly utilized to assess depth of sedation when administering sedative, hypnotic, or anesthetic agents during surgical and medical procedures. The depth of sedation is calculated by measuring cerebral electric activity via an electroencephalogram (EEG).

53
Q

most commonly used opioid induction agent

A

Fentanyl

54
Q

Best Induction agent for a patient with a history of heart failure requires a general anaesthetic

A

Etomidate

as causes least harm-dynamic changes

55
Q

best induction agent for a burn change

A

ketamine

56
Q

Best Induction agent for a patient undergoing arm operation under GA with an laryngeal mask airway (LMA).

A

propofol

as it causes suppression of airway reflexes

57
Q

what does MAC stand for

A

Minimum alveolar concentration

58
Q

Most commonly used non-opiod analgesic agent in anaesthesia is

A

paracetamol

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