Peri-operative pharmacology Flashcards
satges of ASA (american sosciety anaesthesiologists)
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
preop rx
o2 fluids analgesia sedatives antiemetics antacids (preg women or if undx acid reflux) -normal meds (NB some are stopped!_
drugs omitted preop
ACEi (24-72 hrs)
ARBs (24-72 hr)
anti TNF (2 weeks)
aspirin, clopidogrel
when can NSAIDs not be used
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
why can NSAIDs cause AKI
prostaglandins usually released when renal blood flow low causing vasodilation
NSAIDs inhibit this
groups of drugs given intraoperatively
o2 fluids blood/blood products antibiotics anaesthesia analgesia muscle relaxation
what is anaesthesia
from greek and means without feeling -
state of controlled, temporary loss of sensation or awarenes
inhaled anaesthetics
isoflurane
sevoflurane
desflurane
iv anaesthetic
propofol
what neuro system do anaesthetics affect?
at what receptor do they act?
ascending reticular acftivating system
type A GABA receptor
muscle relaxants divided into
depolarising
non-depolarising
depolarising muscle relaxant
suxamethonium
mechanism of action of muscle relaxants
binds to ACh nicotinic receptor of muscle fibre
non-depolarising muscle relaxants
pancuronium , rocuronium, vecuronium
atracurium, cisatracurium, mivacurium
what drug can be used to revferse rocuronium or vecuronium
sugammadex
when is suxa used
emergency - extremely rapid action
post op meds
anagesia fluids/blood inotropes/vasopressors antiemetics anticoags antibiotics OXYGEN!!!
analgesics used
use pain ladder!
can also give regional blocks and epidurals
side effects of propafol
hypotension!! can watch this on screen just after propofol goes in
how are patients put and maintained asleep
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.
how do you know sux is working
see fasculations (don’t see fasciculations in the non-depolarising muscle relaxants)
what type of anaesthetic method is used in an emergency and what is included in this
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
- prefill lungs with high conc O2 gas
- cricoid pressure
- propafol + suxamethonium
- insert ET tube
- release cricoid pressure
how do you reverse the non-depolarising ones and why is this a god-send to anaesthetists everywhere
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
2 dangerous familial complications in anaesthesia
malignant hyperpyrexia
suxamethonium apnoea
