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CPT > Lecture 25 - Anaesthetics > Flashcards

Lecture 25 - Anaesthetics Flashcards

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1
Q

What are the 2 main methods that anaesthetics act?

A

General
Local

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2
Q

What are the 2 ways by which general anaesthesia can be administered?

A

Inhaled or volatile

Intravenous

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3
Q

What are the ways by which local anaesthesia is given?

A

Regionally so injection

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4
Q

What is conscious sedation?

A

When a small amount of anaesthetic or benzodiazepines to produce a sleepy-like state

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5
Q

What type of drug is give as a premedication (to help calm a patient down before surgery) for anaesthesia?

A

Hypnotic-benzodiazepine

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6
Q

How can you induce anaesthesia?

A

IV
Inhalational

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7
Q

What type of drug is often given as an Intra operative analgesic?

A

Opioid like fentanyl

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8
Q

What type of drug needs to be given to allow for intubation?

A

Muscle relaxant

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9
Q

What drugs need to be given to a patient after surgery?

A

Reverse muscle relaxants so can breathe again
Post op analgesia
Anti-emetic

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10
Q

How does inhaational volatile general anaesthesia work?

A

Liquid containing anaesthetic gets vaporised into a gas and so gets delivered to lungs via an agent specific vaporiser

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11
Q

What is the most common anaesthetic delivered intravenously to induce anaesthesia?

A

Propofol
Barbiturates
Etomidate
Ketamine

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12
Q

What are some gases/volatiles that can be delivered to induce anaesthetics?

A

Xenon
Fluorxene
Halothane
Nitrous oxide (N2O)
Chloroform
Desflurane

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13
Q

What are the 3 main features that are observed as a patient goes under anaesthesia?

A

Muscle tone
Breathing
Eye movement

Guedels signs

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14
Q

What are the 4 stages of anaesthesia? (Guedels signs)

A

1 = analgesia and consciousness (muscle normal and slight eye movement)
2 = uncosncosius, erratic breathing, delirium (moderate eye movment and increased muscle tone)
3 = surgical anaesthesia muscles become increasingly relaxed and eye movment. Becomes zero
4 = flaccid muscles, respiratory paralysis

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15
Q

What is achieved in anaesthesia?

A

Analgesia
Hypnosis (loss of consciousness)
Depression of spinal reflexes
Muscle relaxes

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16
Q

As anaesthetic concentration increases, what repsonse are lost first to last?

A

First:
Memory
Consciousness
Movement
Cardiovascualr response
Last

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17
Q

How do you measure potentcy of a volatile aneasthetic?

A

MAC
Minimum Alveolar Concentration

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18
Q

What is Minimum Alveolar Concentration (MAC)?

A

The alveolar concentration of a volatile anaesthetic at which 50% of patients fail to move to a surgical stimulus

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19
Q

How is the concentration of volatile anaesthetic in the alveoli at equilibrium related to the conc at the spinal cord?

A

They are equal

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20
Q

What is the anatomical site/substrate for MAC (Minimum ALveolar Concentrtation)?

A

Spinal cord

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21
Q

What values determine how fast induction and recovery will be?

A

BLood:Gas partition coefficient (measure of solubility/how it partitions into the blood)

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22
Q

What partition coefficient determines the potentcy of an anaesthetic?

A

Oil:Gas partition
(How it partitions into fat)

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23
Q

What are some factors affecting Minimum Alveolar Concentration of a volatile anaesthetic?

A

Age (high in infants, low in elderly)
Hyperthermia (inc)
Hypothermia (dec)
Pregancy (inc)
Alcoholism (inc)
Central stimulants (inc)
Other anaesthetics and sedatives (dec)
Opioids (dec)

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24
Q

Why is Nitrous Oxide often added to other volatile anaesthetics?

A

To reduce the required dosing/ MAC

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25
Q

What determines the potency of an anaesthetic?

A

Lipid solubility

26
Q

How are potency and lipid solubility related?

A

Higher lipid solubility = higher potency

27
Q

What receptor do most anaesthetics interact with to provide effects?

A

GABA(a)

28
Q

What is the major method of action of most anaesthetics causing anaesthesia?

A

Anaesthetics bind to and potentiate GABA(a) receptors leading to enhanced Cl- influx leading to hyperpolarisation. Of neurones

29
Q

What is the effect of most anaesthetics potentiating GABA activity?

A

Anxiolytics
Sedation
Anaesthesia

30
Q

Which anaesthetics dont potentiate GABA activity?

A

Xenon
Argon
N2O
Ketamine

31
Q

What receptor do Xe, Argon, N2O and ketamine act on?

What neurotransmitter is involved?

A

NMDA receptors
Glutamate

32
Q

The balance of activity of what 2 receptors determines the aneasthetic status?

A

NMDA glutamate receptor excitation
GABA(a) receptor inhibition

33
Q

What is the function of the reticular system?

What is the affect of depressing its connectivity to the cortex in anaesthesia?

A

The activating system which increases arousal keeping a person awake

Person loses consciousness

34
Q

What is the purpose of suppressing the connections from the thalamus to the cortex in anaesthesia?

A

Thalamus transmits and modifies sensory information so if depressed loss of sensation

35
Q

What is the purpose of suppressing the connections from the hippocampus to the cortex in anaesthesia?

A

Loss of memory

36
Q

What part of the body is depressed leading to analgesia?

A

Spinal cord-depression in dorsal horn

(Maybe periaqueductal grey too)

37
Q

What are the main IV anaesthetics?

A

Propofol (rapid)
Barbiturates (rapid)
Ketamine (slower)

38
Q

What is it called when IV anaesthetic is the sole method of anaesthesias?

A

TIVA
Total IntraVenous Anaesthesia

39
Q

How do we describe IV anaesthesia potency?

A

Plasma conc to a acheive a specific end point like loss of eyelash reflex or a certain BIS value (Bispectral index) 0= brain inactivity 100 = full brain function

40
Q

What is the process of induction in mixed anaesthesia?

A

IV bolus to end point then switch to the volatile

41
Q

What are some scenarios where local and regional aneasthetic issued?

A

Dentistry
Obstetrics
Regional surgery (patient awake)
Post-op (wound pain)
Chronic pain management

42
Q

What are some local anaesthetics?

A

Lidocaine
Bupivacaine
Ropivacaine
Procaine

43
Q

How is pKa (dissociation constant) related to the time of onset of local anaesthetic?

A

Lower pKa the faster the onset since theres more unionised drug which is present to access the site

44
Q

What leads to a local anaesthetic having a longer duration?

A

Higher protein binding

45
Q

What are the 2 types of chemical link which change how long anaesthetics last?

A

Ester link

Amide link

46
Q

Which chemical link takes longer to break down leading to the aneasthetic lasting longer, ester link or amide link?

A

Amide link

Most cells have esterases so ester links are gonna get broken down so dont last as long

47
Q

Are anaesthetics going to prefer blocking highly active neurones or inactive neurones?

A

Highly active

48
Q

What do local anaesthetics block to causes anaesthetic affect?

A

Voltage gated sodium channels

49
Q

What are the 2 pathways by which voltage gated sodium channels become blocked by local anaesthetics?

A

Hydrophobic pathway
Hydrophilic pathway

50
Q

What is the hydrophilic pathway of local anaesthesia?

A

Charged local aneasthetic directly goes in and blocks the channel of a open sodium voltage gated ion channel

51
Q

What is the hydrophobic pathway of local anaesthesia?

A

Uncharged local anaesthetic passes through plasma membrane into the cell
Becomes charged within the cell
Then goes into and blocks the open voltage gated Na+ channel

52
Q

What is the benefit of administering both local anaesthetic like lidocaine with adrenaline?

A

The adrenaline helps prolong the duration which the local anaesthetic is able to act at its intended site
Since adrenaline causes vasoconstriction

53
Q

What does a high value of pKa indicate?

A

Slow speed of onset of action

54
Q

How does bupivacaine differ in terms of potency and duration of action compared to procaine?

A

Bupivacaine is more potent and longer duration of action

55
Q

What is regional aneasthesia?

A

Selectively anaesthetising a part of the body causing a block of a nerve

56
Q

What types of drugs are used for regional anaesthesia?

A

Local anaesthetic
Opioid

57
Q

What is the point in the neck you can inject local anaesthetic to cause nerve block in. The upper limb?

A

Interscalene triangle (Erbs point)

58
Q

Where can local anaesthetic be injected to cause nerve block in the lower limb?

A

Femoral nerve
Sciatic nerve
Popliteal nerve
Spahenous nerve

59
Q

What side effects do opioids typically cause in anaesthesia?

A

Nausea and vomiting

60
Q

What are some side effects of general anaesthesia?

A

Post op nausea and vomiting (opioids)
CVS (HYPOTENSION)
Post op Congnitive dysfunction
Chest infection

61
Q

What are some side effects of local and regional anaesthetic?

A

Depends on agent use and usually occurs due to systemic spread

Locals that block Na+ VGC are cardiovascular toxic

62
Q

What type of hyeprsensitivty can occur due to anaesthesia?

A

Type I allergic reactions (Anaphylaxis)

CPT (30 decks)

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