Misc

Question 1

Features of Propofol

Answer 1

Rapid onset of anaesthesia
Pain on IV injection
Rapidly metabolised with little accumulation of metabolites
Proven anti emetic properties
Moderate myocardial depression
Widely used especially for maintaining sedation on ITU, total IV anaesthesia and for daycase surgery

Question 2

Sodium thiopentone

Answer 2

Extremely rapid onset of action making it the agent of choice for rapid sequence of induction
Marked myocardial depression may occur
Metabolites build up quickly
Unsuitable for maintenance infusion
Little analgesic effects

Question 3

Ketamine

Answer 3

May be used for induction of anaesthesia
Has moderate to strong analgesic properties
Produces little myocardial depression making it a suitable agent for anaesthesia in those who are haemodynamically unstable
May induce state of dissociative anaesthesia resulting in nightmares

Question 4

Etomidate

Answer 4

Has favorable cardiac safety profile with very little haemodynamic instability
No analgesic properties
Unsuitable for maintaining sedation as prolonged (and even brief) use may result in adrenal suppression
Post operative vomiting is common

Question 5

ASA

Answer 5

1 No organic physiological, biochemical or psychiatric disturbance. The surgical pathology is localised and has not invoked systemic disturbance
2 Mild or moderate systemic disruption caused either by the surgical disease process or though underlying pre-existing disease
3 Severe systemic disruption caused either by the surgical pathology or pre-existing disease
4 Patient has severe systemic disease that is a constant threat to life

Question 6

TPN key features

Answer 6

Commonly used in nutritionally compromised surgical patients.
Bags contain combinations of glucose, lipids and essential electrolytes, the exact composition is determined by the patients nutritional requirements.
Although it may be infused peripherally, this may result in thrombophlebitis.
Longer term infusions should be administered into a central vein (preferably via a PICC line).
Complications are related to sepsis, re-feeding syndromes and hepatic dysfunction.

Question 7

Acute dystonic reaction

Answer 7

abnormal and involuntary facial and bodily movements, such as spasmodic torticollis, oculogyric crisis and oromandibular dystonia.

hronic cases are generally only encountered in psychiatric units. In surgical practice the administration of the anti dopaminergic drug metoclopramide may be sufficient to precipitate an attack.

Treatment may be required -> benzhexol and procyclidine are two drugs which may be used.

Question 8

features of muscle relaxants
Suxamethonium