Peri-operative pharmacology

Question 1

satges of ASA (american sosciety anaesthesiologists)

Answer 1

1 = normal health pt
2 = pt with mild systemic disease
3 = pt with severe systemic disease
4 = severe systemic disease constant threat to life
5 = moribund pt not expect to survive over 24 hr with/without surgery
6 = brain dead, organ retrieval

Question 2

preop rx

Answer 2

o2
fluids
analgesia
sedatives
antiemetics
antacids (preg women or if undx acid reflux)
-normal meds (NB some are stopped!_

Question 3

drugs omitted preop

Answer 3

ACEi (24-72 hrs)
ARBs (24-72 hr)
anti TNF (2 weeks)
aspirin, clopidogrel

Question 4

when can NSAIDs not be used

Answer 4

GI ulceration/bleeding
-increased risk of intraop bleeding (increase bleeding time)
-aspirin sensitive asthma (20% asthmatics)
renal impairment
other reasons due to the affect on kidneys: hyperkal, hypovol, circ failure, severe liver dysfunction, eclampsia

Question 5

why can NSAIDs cause AKI

Answer 5

prostaglandins usually released when renal blood flow low causing vasodilation
NSAIDs inhibit this

Question 6

groups of drugs given intraoperatively

Answer 6

o2
fluids
blood/blood products
antibiotics
anaesthesia
analgesia
muscle relaxation

Question 7

what is anaesthesia

Answer 7

from greek and means without feeling -

state of controlled, temporary loss of sensation or awarenes

Question 8

inhaled anaesthetics

Answer 8

isoflurane
sevoflurane
desflurane

Question 9

iv anaesthetic

Answer 9

propofol

Question 10

what neuro system do anaesthetics affect?

at what receptor do they act?

Answer 10

ascending reticular acftivating system

type A GABA receptor

Question 11

muscle relaxants divided into

Answer 11

depolarising

non-depolarising

Question 12

depolarising muscle relaxant

Answer 12

suxamethonium

Question 13

mechanism of action of muscle relaxants

Answer 13

binds to ACh nicotinic receptor of muscle fibre

Question 14

non-depolarising muscle relaxants

Answer 14

pancuronium , rocuronium, vecuronium

atracurium, cisatracurium, mivacurium

Question 15

what drug can be used to revferse rocuronium or vecuronium

Answer 15

sugammadex

Question 16

when is suxa used

Answer 16

emergency - extremely rapid action

Question 17

post op meds

Answer 17

anagesia
fluids/blood
inotropes/vasopressors
antiemetics
anticoags
antibiotics
OXYGEN!!!

Question 18

analgesics used

Answer 18

use pain ladder!

can also give regional blocks and epidurals

Question 19

side effects of propafol

Answer 19

hypotension!! can watch this on screen just after propofol goes in

Question 20

how are patients put and maintained asleep

Answer 20

put to sleep using propofol
kept asleep using inhaled agents

sometimes they are kept asleep using IV propofol too (total IV anaesthetic (TIVA). just depends on anaesthetist.

Question 21

how do you know sux is working

Answer 21

see fasculations (don’t see fasciculations in the non-depolarising muscle relaxants)

Question 22

what type of anaesthetic method is used in an emergency and what is included in this

Answer 22

rapid sequence induction (done if pt with presumed full stomach, not in most pts as they are starved)

method of achieving rapid control of the airway whilst minimising the risk of regurgitation and aspiration of gastric contents

1. prefill lungs with high conc O2 gas
2. cricoid pressure
3. propafol + suxamethonium
4. insert ET tube
5. release cricoid pressure

Question 23

how do you reverse the non-depolarising ones and why is this a god-send to anaesthetists everywhere

Answer 23

sugammadex
non-depolarising muscle relaxants work for 30 mins. if can’t intubate the patient, you are in a v sticky situation where they can’t breathe for 30 mins. however, now you can use sugammadex to reverse the muscle relaxant

Question 24

2 dangerous familial complications in anaesthesia

Answer 24

malignant hyperpyrexia

suxamethonium apnoea

Question 25

what drugs cause malignant hyperpyrexia

Answer 25

suxamethonium

volatile agents

Question 26

rx malig hyperpyrexia

Answer 26

dantrolene