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Anaesthetics > Principles and Pharmacology > Flashcards

Principles and Pharmacology Flashcards

1
Q

Operative mortality vs Anaesthetic mortality

A

1 in 25
vs
1 in 400,000

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2
Q

Which system is used to classify patient fitness for undergoing anaesthetic?

A

American Society of Anaesthesiologists Classification
ASA

1- Normal, fit
2- Mild systemic disease

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3
Q

In which group of ASA classification is mortality concentrated?

A

Groups 3-5

Severe systemic disease to brain-dead

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4
Q

What is the triad of anaesthesia?

A
  1. Analgesia
  2. Hypnosis
  3. Relaxation
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5
Q

Types of medication used for Analgesia

A

Opiates
General anaesthetic
Local anaesthetic

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6
Q

Types of medication used for Hypnosis

A

General Anaesthetic

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7
Q

Types of medication used for Relaxation

A

Muscle relaxants
LA
GA

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8
Q

Complications of Anaesthesia

A

Polypharmacy
Muscle relaxation
Separation of hypnosis and relaxation

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9
Q

What effect does GA have on neuron channels?

A

Hyperpolarises - less likely to fire

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10
Q

Action of inhalational GA

A

Dissolves in membranes

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11
Q

Action of IV GA

A

Allosteric binding

GABA receptors open chloride channels

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12
Q

Which functions are lost first under GA?

A

Cerebral functions- more complex

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13
Q

Which functions are relatively spared under GA?

A

Reflexes - more primitive - small number synapses

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14
Q

Management priorities

A 
ABC
Airway management
Respiratory function
Cardiovascular impact
Care for unconscious
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15
Q

Name two intravenous anaesthetic agents

A

Thiopentone

Propofol

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16
Q

Features of IV anaesthetics

A

Rapid onset of unconsciousness

Rapid recovery

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17
Q

Which tissues are slow to effect of IV anaesthetics?

A

Muscle- slow but large effect

Fat - fat solubility - storage

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18
Q

In which tissues/organs does IV anaesthetics exhibit a quick effect and quick decline?

A

Blood and vessel rich organs (brain)

19
Q

Which compounds are Inhalational Anaesthetics>

A

Halogenated hydrocarbons

20
Q

Mechanism of Inhalational Anaesthetics

A

Uptake and excretion via lungs

21
Q

Which direction does the concentration gradient flow for inhalational compounds>

A

Lungs -> blood -> brain

22
Q

How is the potency of inhalational anaesthetics measured?

A

Using Minimum Alveolar Concentration

Low = high potency

23
Q

Inhalational anaesthetics cross the alveolar basement membrane easily. How does this impact arterial concentration of the drug?

A

Arterial concentration roughly equal to alveolar partial pressure

24
Q

Sequence of general Anaesthesia

What is mostly used for induction?

A

Intravenous

25
Q

What mode is mostly used for maintenance?

A

Inhalational

26
Q

Whta is the central effect of GA in the cardiovascular system?

A

Depresses cardiovascular centre

27
Q

Depression of the cardiovascular centre exhibits what effect?

A

Decreased sympathetic outflow
Decreased vasoconstrictor tone
Vasodilation

28
Q

What is the direct effect of GA?

A

NEGATIVELY IONOTROPIC
Vasodilation
Venodilation

29
Q

Effect of vasodilation on peripheral resistance?

A

Decrease

30
Q

Effect of venodilation on cardiac return?

A

Decreased -> decreased cardiac output

31
Q

Effect of GA on respiratory system

A

Depressants
Paralyse cilia
Reduced Functional Residual Capacity

32
Q

Effect on hypoxic and hypercabic drive

A

Decreased

33
Q

Effect on tidal volume and rate?

A

Decreased

34
Q

Features of reduced FRC

A

Lower lung volumes

VQ mismatch

35
Q

Mechanism of muscle relaxants

A

Relax skeletal muscle

36
Q

Which muscles are of particular concern using muscle relaxants?

A

Airway and respiratory

37
Q

Indication for muscle relaxant use?

A
  • ventilation & Intubation
  • when immobility is essential
  • microscopic surgery, neurosurgery
  • body cavity surgery (access)
38
Q

Issues using muscle relaxants

A

Awarness
Reversal
Apnoea

39
Q

Purpose of intraoperative analgesia?

A

Prevent arousal

Suppress reflexes to painful stimuli - HT, tachycardia

40
Q

Examples of local anaesthetics

A

Lignocaine, bupivacaine ropivacaine

41
Q

Mechanism of Lignocaine, bupivacaine ropivacaine

A

Analgesia without hypnosis

Block Na+ channels - prevents action potential from propagating

42
Q

Benefits of Local/Regional Anaesthetics

A

Retain awareness/consciousness
 Lack of global effects
 Derangement of CVS physiology
 Relative sparing of resp function

43
Q

Delivery of regional anaesthetics may be guided using which imaging technique?

A

Ultrasound

Anaesthetics (3 decks)

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