Overview of anaesthesia

Question 1

Define general anaesthesia.

Answer 1

Pharmacologically induced reversible coma like state characterized by:

1. Loss of consciousness,
2. Loss of somatic and autonomic airway reflexes
3. Loss of recall.

Question 2

Is it possible for the patient to be breathing spontaneously while they are under general anaesthesia?

Answer 2

Yes. They may breathe spontaneously or they can be ventilated

Question 3

Describe three distinct periods of anaesthesia.

Answer 3

Preoperative visit: The patient is seen by the anaesthetist who obtains a thorough history and performs the exam to determine whether the patient needs optimization after which they create an anaesthetic plan

Intraoperative: From the administration of the induction to the recovery of the patient

Postoperative: The patient returns to full physiological functioning

Question 4

List three phases of anaesthesia

Answer 4

Induction
Maintenance
Emergence

Question 5

Is the patient unconscious when under regional anaesthesia? State why.

Answer 5

No, it targets or blocks a specific nerve or section rather than central nervous system receptor blockage,

Question 6

Does anaesthesia do good by itself?

Answer 6

Nope, you do it to facilitate the performance of another procedure such as a surgery or intubation.

Question 7

Name the high risk phase of anaesthesia and state why.

Answer 7

Induction, the risk occurs as a result of equipment or machine malfunction, failure to recognise airway problems and complications/reaction to administered drugs.

Question 8

List 4 important components of preinduction in anaesthesia.

Answer 8

Equipment and machine check

Identification of the presence of emergency equipment and drugs.

Drawing up drugs to be used
.
Preparation of the patient for anaesthesia: Establishing IV access, pre oxygenation, premedication and administering pre induction drugs,

Question 9

State three problems that may arise during the maintenance of anaesthesia.

Answer 9

Perioperative fluid shifts
Blood loss
Aggravation of pre existing medical or surgical conditions

Question 10

During the maintenance phase of anaesthesia the anaesthetist must pay careful attention to the patient and monitor the patient on: 3

Answer 10

Clinical grounds: Colour, temperature, auscultation and pulse volume

Non invasive and invasive monitoring devices

Point of care blood tests

Question 11

State three types of post operative placement that a patient can get after the surgery.

Answer 11

A recovery area or post anaesthesia care unit prior to returning to the ward or home

High care unit for more intense monitoring or pain/fluid management

Intensive care for further invasive monitoring and organ support

Question 12

The anaesthetic is complete when?

Answer 12

The patient is fully recovered from the effects of the anaesthetic drugs.

Question 13

Is pain management crucial during the postoperative period?

Answer 13

Yes, it relieves the patient from discomfort which can be either physical or psychological.

Question 14

Describe the triad of anaesthesia.

Answer 14

Hypnosis: Loss of consciousness after administration of either IV induction agents or inhalation agents

Analgesia: Most anaesthetic agents are not analgesic so the patient still experiences pain during the general anaesthesia which requires pain control

Muscle relaxation:(Immobility):

Question 15

List three indications of muscle relaxation

Answer 15

To facilitate tracheal intubation in people who cannot protect their airway(at a risk of aspiration)

To optimise surgical conditions for microsurgery (retina and brain), intrathoracic, intracranial and intra abdominal surgeries

To optimise ventilation in patients who require controlled ventilation

Question 16

Can deep general anaesthesia trigger muscle relaxation?

Answer 16

Yes to a certain degree but does not necessarily arrest respiration

Question 17

Name three ways in which analgesia is given during general anaesthesia.

Answer 17

1. Strong opioids such as fentanyl and opioids
2. Regional anaesthetics such as nerve blocks
3. Local anaesthetic at the site of insertion of general anaesthesia

Question 18

State why psychological hypnosis is not preferred over chemical hypnosis in anaesthesia.

Answer 18

It is time consuming
There are limited people who can provide it
It is unreliable: Only 10-30% can tolerate surgery

Question 19

State how the typical general anaesthesia is achieved,

Answer 19

Induce with an IV induction agent and maintain the anaesthesia with an inhalation agent

Question 20

Differentiate between sedation and general anaesthesia

Answer 20

Word.

Question 21

Can induction agents be used for sedation?

Answer 21

Only propofol in lower doses.

Question 22

Define neuroleptic anaesthesia.

Answer 22

Partial sedation whereby consciousness has been altered enough to lose comprehension and resistance to procedure.

Question 23

Name two agents used for neuroleptic anaesthesia

Answer 23

Ketamine
Or
Butyrophenones(Haloperidol or droperidol): Rarely used today

Question 24

Name 4 CNS depressants that can be used for sedation

Answer 24

Benzodiazepine
Alcohol
Phenothiazines
Barbiturates

Question 25

Why is deep general anaesthesia not the preferred choice for muscle relaxation?

Answer 25

Higher doses can lead to side effects

Question 26

List 4 ways in which muscle relaxation can be achieved during anaesthesia.

Answer 26

Restraining the patient Deep general anaesthesia Neuromuscular blockade(Preferred) Local anaesthetics

Question 27

State five different types of analgesia that can be given during anaesthesia(intraoperative or as premeds)

Answer 27

1. Simple analgesia such as paracetamol 2. NSAIDs 3. Opioids 4. Local anaesthetics 5. Serotonin and or norepinephrine agonists

Question 28

List 5 routes of administration of morphine.

Answer 28

Intramuscular, subcutaneous, transcutaneous, epidural or spinal, oral and inhalation

Question 29

Name the most commonly used pre-emptive analgesia.

Answer 29

Fentanyl

Question 30

Can intubation be performed without using neuromuscular blockers?

Answer 30

Nope

Question 31

Can the patient be extubated while still of deep sedation?

Answer 31

Yes, however the monitors should show adequate breathing in terms of sats, end tidal CO2

Question 32

Outline the Guedel stages of anaesthesia

Answer 32

1. Analgesia: From consciousness to unconsciousness 2. Excitatory: Hyperexcitable to external stimulus, delirium occurs, loss of airway protective reflexes and autonomic stability 3. Surgical anaesthesia: Marked by return of vital signs within normal range and autonomic stability. Divided into 4 planes(eyeballs are fixed and diaphragmatic respiration occurs) 4. Overdose: Respiratory depression marked by diaphragmatic paralysis

Question 33

Outline how reflexes are lost in order after general anaesthetic agents have been administered.

Answer 33

Eyelash reflex Lid reflex Swallowing, retching and vomiting Conjuctival reflex Muscular tone Corneal reflex Glottic reflexes and control of respiration Pupillary light reflex

Question 34

Is there an antidote for the reversal of general anaesthesia?

Answer 34

Nope, the patient regains consciousness when the agents are discontinued and they dissociate from the binding sites in the brain

Question 35

Name two drugs that are involved in the management of anaesthetic patients which should be monitored during the emergence of the patient from general anaesthesia.

Answer 35

Opioids: They can cause sedation and respiratory suppression which can affect the emergence of the patient Neuromuscular blockers: The patient might be awake but unable to move due to their effect which needs to be reversed

Question 36

Is anaesthesia curative?

Answer 36

Nope, it is just performed to allow another doctor to perform a curative procedure such as a surgeon

Question 37

When was general anaesthesia first used?

Answer 37

1846

Question 38

When was local anesthesia first used?

Answer 38

1884 for eye surgery

Question 39

When was intensive care added to anesthesia?

Answer 39

In the 1952-54 during the polio pandemic when an anaesthetist used an endotracheal tube and bag ventilation to save a respiratory polio victim

Question 40

List instances when pain management is used by anaesthetists.

Answer 40

During the postoperative period, in the trauma room and drying acute or chronic pain services