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Anaesthetics, Geriatrics and Genetics > Principles and Pharmacology > Flashcards

Principles and Pharmacology Flashcards

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1
Q

What is general anaesthesia?

A

Produces insensibility in the whole body, usually causing unconsciousness
Centrally acting drugs- hypnotics/analgesics

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2
Q

What is regional anaesthesia?

A

Produces insensibility in an area or region of the body, local anaesthetic applied to nerves supplying relevant areas

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3
Q

What is local anaesthetic?

A

Producing insensibility in only the relevant part of the body, local anaesthetic applied directly to the tissues

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4
Q

What types of drugs are used as anaesthesia?

A 
Inhalational anaesthetics 
Intravenous anaesthetics 
Muscle relaxants
Local anaesthetics 
Analgesics
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5
Q

What types of techniques and equipment are used in anaesthesia?

A 
Tracheal intubation 
Ventilation 
Fluid therapy 
Regional anaesthesia 
Monitoring
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6
Q

Why are hypnotics needed in anaesthesia?

A

Provides unconsciousness for general anaesthesia

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7
Q

Why are analgesics used in anaesthesia?

A

Pain relief, still required under GA to suppress reflex autonomic responses to painful stimulus

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8
Q

Why are muscle relaxants used in anaesthesia?

A

Provide immobility for certain procedures to allow access to body cavities and to permit artificial ventilation amongst other things

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9
Q

What problems can arise with anaesthesia?

A

Polypharmacy
Muscle relaxation
Separation of hypnosis and relaxation

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10
Q

How do general anaesthetic agents work?

A

Interfere with neuronal ion channels
Hyperpolarise neurones - less likely to ‘fire’
Inhalational agents dissolve in membranes
IV agents- allosteric binding on GABA receptors, open Cl channels

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11
Q

What type of molecules are inhalation anaesthetics formed of?

A

Halogenated hydrocarbons

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12
Q

What part of the body uptakes and excretes inhalation anaesthesia?

A

Lungs

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13
Q

What is MAC?

A

Minimum alveolar concentration- the concentration of the drug required in the alveoli which is required to produce anaesthesia with any particular agent

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14
Q

What does a low MAC number mean?

A

High potency

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15
Q

What is the main role of inhalation anaesthesia?

A

Extension or continuation of anaesthesia

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16
Q

What effects does GA have centrally on the cardiovascular system?

A

Depresses cardiovascular centre
Reduces sympathetic outflow
Negative inotropic/ chronotropic effect on heart
Reduced vasoconstrictor tone

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17
Q

What effects does GA have directly on the cardiovascular system?

A

Vasodilation - decreased peripheral resistance

Venodilation - decreased venous return, decreased cardiac output

18
Q

What is the equation for mean arterial pressure?

A

MAP= Cardiac output x systemic vascular resistance

19
Q

What effects does GA have on the respiratory system?

A

Respiratory depressants
Reduce hypoxia and hypercarbic drive
Decreased tidal volume and increase rate
Paralyse cilia
Decrease FRC - lower lung volumes, VQ mismatch

20
Q

What are the indications for muscle relaxants?

A

Ventilation and intubation
When immobility is essential
Body cavity access needed

21
Q

What are the problems with muscle relaxants?

A

Awareness
Incomplete reversal (airway obstruction, ventilatory insufficiency)
Apnoea

22
Q

What are non-polarising NMBs?

A

Competitive block of nicotinic acetylcholine receptors at NMJ that prevents the opening of sodium channels

23
Q

What are depolarising NMBs?

A

Depolarise motor end plate

Renders post-junctional membrane refractory to further stimulus

24
Q

What depolarising NMBs is commonly used?

A

Suxamethonium

25
Q

What are the benefits of using suxamethonium?

A

Very rapid onset

Short duration of action (<5min)

26
Q

What are the risks of using suxamethonium?

A

Myalgia
Anaphylaxis
Malignant hyperthermia

27
Q

What is the reason for intraoperative analgesia?

A

Prevention of arousal
Opiates contribute to hypnotic effect of GA
Suppression of reflex responses to painful stimuli

28
Q

What are some examples of local anaesthetic drugs?

A

Lignocaine
Bupivacaine
Prilocaine

29
Q

How do local anaesthetic drugs work?

A

Sodium channel blockers

Prevent propagation of action potential

30
Q

What is the main factor that limits how much LA can be used?

A

Toxicity

31
Q

What does LA toxicity depend on?

A

Dose used
Rate of absorption
Patient weight
Drug

32
Q

What are the signs and symptoms of LA toxicity?

A 
Circumoral and lingual numbness and tingling 
Light-headedness 
Tinnitus, visual disturbances 
Muscular twitching 
Drowsiness 
Cardiovascular depression 
Convulsions 
Coma 
Cardiorespiratory arrest
33
Q

What are the benefits of regional and local anaesthesia?

A

Retain awareness/ consciousness
Lack of global effects of GA
Relative sparing of respiratory function

34
Q

What are the physiological effects of regional anaesthesia?

A

Inspiratory function relatively spared
Expiratory function relatively impaired
Decrease FRC
Increased VQ mismatch

35
Q

What are the indications for spinal and epidural anaesthesia?

A

Avoidance of GA
Severe respiratory disease
Avoid airway problems
Allergies/reactions to GA agents

36
Q

What are the contraindications for spinal and epidural anaesthetic?

A 
Patient refusal 
Fixed cardiac output (aortic/ mitral stenosis) 
Infection 
Bleeding diathesis/ anticoagulation 
Technical difficulties 
Spinal problems/neurology
37
Q

What is the location used in spinal anaesthesia?

A

Subarachnoid

T4 3-4ml LA

38
Q

What is the usually duration of a spinal anaesthesia?

A

2-3 hours

39
Q

What is the usually duration of an epidural anaesthesia?

A

Extradural

Block to T4 20+ml LA

40
Q

What is the usually duration of an epidural anaesthetic?

A

3-4 hours

Anaesthetics, Geriatrics and Genetics (14 decks)

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