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Anaesthetics Brian > Principles of Anaesthetics and Pharmacology > Flashcards

Principles of Anaesthetics and Pharmacology Flashcards

1
Q

What are the different kinds of anaesthesia?

A
  • General
    • Produces insensbility in the whole body, usually causing unconsciousness
    • Centrally acting drugs – hypnotics/analgesics
  • Regional
    • Producing insensibility in an area or region of the body
    • Local anaesthetics applied to nerves supplying relevant area
  • Local
    • Producing insensibility to only the relevant part of the body
    • Local anaesthetics applied directly to the tissue
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2
Q

What is anaesthesia?

A

Anaesthesia = insensibility

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3
Q

What is general anaesthesia?

A
  • Produces insensbility in the whole body, usually causing unconsciousness
  • Centrally acting drugs – hypnotics/analgesics
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4
Q

What is regional anaesthesia?

A
  • Producing insensibility in an area or region of the body
  • Local anaesthetics applied to nerves supplying relevant area
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5
Q

What is local anaesthesia?

A
  • Producing insensibility to only the relevant part of the body
  • Local anaesthetics applied directly to the tissue
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6
Q

What are different types of drugs used in anaesthesia?

A
  • Inhalation anaesthetics
  • Intravenous anaesthetics
  • Muscle relaxants
  • Local anaesthetics
  • Analgesics
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7
Q

What are some different techniques and equipment used in anaesthesia?

A
  • Tracheal intubation
  • Ventilation
  • Fluid therapy
  • Regional anaesthesia
  • Monitoring
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8
Q

What are some of the functions of the modern anaesthetic machine?

A
  • Regulation of fresh gases and mixing to deliver precise concentrations of gaseous agents
  • Addition of precise concentrations of inhaled anaesthetics gases
  • CO2 removal to allow recirculation of inhaled gases
  • Mechanical ventilation, now microprocessor controlled contained within machine
  • Most monitoring now normally integrated into anaesthetic machine
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9
Q

What is the operative and anaesthetic mortality rate?

A
  • Operative mortality 1:25 (4%)
  • Anaesthetic mortality 1:400,000 (0.00024%)
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10
Q

What system is used to assess anaesthesia patients?

A

ASA system

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11
Q

What are the biggest drivers for improved safety in anaesthesia?

A
  • Training of specialist anaesthetists
  • Modern anaesthetic drugs and techniques
  • Modern monitoring standards and equipment
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12
Q

What are the 3 components of anaesthesia (triad of anaesthesia?

A
  • Hyponosis
    • Unconsciousness
  • Analgesia
    • Pain relief
  • Relaxation
    • Skeletal muscle relaxation to provide immobility and permit artificial ventilation
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13
Q

Balanced anaesthesia uses different drugs for different jobs, what are advantages and problems with this?

A
  • Advantages:
    • Avoid over-dosage
    • Great flexibility
    • Since titrated doses separately is more accurate to requirements
  • Problems
    • Polypharmacy – chance of drug reactions/allergies
    • Muscle relaxation – problems controlling airway
    • Separation of relaxation and hypnosis – “awareness”, possibility of patient being awake yet paralysed and unable to communicate
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14
Q

What are the effects of general anaesthesia?

A
  • Hypnosis (mainly)
    • Cerebral functions lost from most complex functions to primitive functions being lost later (such as reflexes) – higher doses required to affect these primitive functions
  • Relaxation
  • Analgesia (barely any)
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15
Q

What is the mode of action of general anaesthesia?

A
  • Open chlorine channels to hyperpolarise neurons making them less likely to fire
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16
Q

What is the adminstration of general anaesthesia?

A
  • IV
    • Allosteric binding to GABA receptors, opening chloride channels
    • Rapid onset, rapid recovery due to redistributing to other areas of the body such as muscle and fat
    • Concentration builds up slower in fat and muscle due to them having less blood supple than viscera
  • Inhalation
    • Dissolve in membranes having direct physical effect – uptake and excretion via lungs using partial pressures lungs > blood > brain
    • MAC = minimum alveolar concentration, measure of potency with low number being a high potency
    • Onset of action is slow, effect lasts longer, awakening requires stopping inhalation agent or wash out (reversal of concentration gradient)
    • Can be monitored better than IV by using inhalation and exhalation
  • Most anaesthesia is IV induction then inhalation maintenance
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17
Q

What is the mode of action of IV GA?

A
  • Allosteric binding to GABA receptors, opening chloride channels
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18
Q

Describe the duration of IV GA?

A
  • Rapid onset, rapid recovery due to redistributing to other areas of the body such as muscle and fat
  • Concentration builds up slower in fat and muscle due to them having less blood supple than viscera
19
Q

What is the mode of action of inhalation GA?

A
  • Dissolve in membranes having direct physical effect – uptake and excretion via lungs using partial pressures lungs > blood > brain
20
Q

What is MAC?

A
  • MAC = minimum alveolar concentration, measure of potency with low number being a high potency
21
Q

What does a low MAC mean?

A
  • MAC = minimum alveolar concentration, measure of potency with low number being a high potency
22
Q

Describe the duration of inhalation GA?

A
  • Onset of action is slow, effect lasts longer, awakening requires stopping inhalation agent or wash out (reversal of concentration gradient)
23
Q

How is most GA administered?

A
  • Most anaesthesia is IV induction then inhalation maintenance
24
Q

What are the risks of GA?

A
  • Cardiovascular impact
  • Care of unconscious patient
  • Impairment of respiratory function and control of breathing
25
Q

What effects does GA have on the CVS?

A
  • Central
    • Depress cardiovascular centre
      • Reduce sympathetic outflow
      • Negative inotropic/chronotrophic effect on heart
      • Reduced vasoconstrictor tone -> vasodilation
  • Direct
    • Negatively inotopic
    • Vasodilation -> decreased peripheral resistance
    • Venodilation -> decreased venous return, decrease cardiac output
26
Q

What are consequences of GA depressing CV centre?

A
  • Reduce sympathetic outflow
  • Negative inotropic/chronotrophic effect on heart
  • Reduced vasoconstrictor tone -> vasodilation
27
Q

Does GA cause veso/venodilation to increase or decrease?

A
  • Negatively inotopic
  • Vasodilation -> decreased peripheral resistance
  • Venodilation -> decreased venous return, decrease cardiac output
28
Q

What effect does GA have on the respiratory system?

A
  • All aesthetic agents are respiratory depressants
    • Reduce hypoxic and hypercarbic drive
    • Decreased tidal volume and increased rate
  • Paralyse cilia
  • Decreased functional residual capacity
    • Lower lung volumes
    • VQ mismatch
29
Q

What are consequences of GA depressing respiratory system?

A
  • Reduce hypoxic and hypercarbic drive
  • Decreased tidal volume and increased rate
30
Q

Regional anaesthesia has what effects?

A

Muscle relaxants

31
Q

Why must muscle relaxants be used with drug for unconsciousness?

A

If uses systemically must also be used with a drug for unconsciousness as being paralysed and awake is very unpleasant

32
Q

What are indications for muscle relaxants?

A
  • Ventilation and intubation
  • When immobility is essential
    • Microscopic surgery, neurosurgery
  • Body cavity surgery (access)
33
Q

What are potential problems of muscle relaxants?

A
  • Awareness
  • Incomplete reversal
    • Airway obstruction, ventilatory insufficiency in immediate post-op period
34
Q

What is the most important aspect of anaesthesia triad?

A

Anaesthesia is the most important aspect of the triad, often sufficient on its own with no other drugs for procedure

35
Q

Why is analgesia needed even when patient is unconscious?

A
  • Prevention of arousal (being woken up)
  • Opiates contribute to hypnotic effect of GA
  • Suppression of reflex responses to painful stimuli
    • Such as tachycardia, hypertension
36
Q

Why is regional anaesthesia often used with GA?

A

Regional anaesthesia is often used with GA to remove painful stimuli to allow lower levels of GA to be used

37
Q

What drugs does general analgesia use?

A
  • Opiods, includes
    • Fentanyl
      • Short acting and potent
    • Morphine
    • Oxycodone
    • Remifentianil
      • Very short acting and very potent
  • Effect – analgesia and hyponosis
38
Q

What are the effects of GA drugs?

A
  • Effect – analgesia and hyponosis
39
Q

What drugs does local analgesia use?

A

Local anaesthetic drugs, lignocaine, bupivacaine and ropivacaine produce analgesia with no hypnosis.

40
Q

What is the mode of action of local analgesia?

A
  • Mode of action – blocking Na channels and preventing action potential from propagating
41
Q

What is the effect of local analgesia?

A
  • Effect – analgesia and relaxation
42
Q

What are advantages and risks of local analgesia?

A
  • Advantages – retain awareness, lack of global effect of GA, relative sparing of respiratory function
  • Risks – derangement of CVS physiology
43
Q

What are advantages of using US guided regional anaethesia?

A
  • Safer more effective delivery of LA
  • Less likelihood of LA going intravenously or direct nerve or vascular injury

Anaesthetics Brian (6 decks)

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