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Anaesthetics > Y3 Anaesthetics > Flashcards

Y3 Anaesthetics Flashcards

1
Q

What is pain?

A

pain is the unpleasant sensory and emotional experience associated with actual or potential tissue damage

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2
Q

What are the 3 durations of pain?

A

acute, chronic and acute on chronic

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3
Q

What are the two broad causes for pain?

A

Cancer and non-cancer

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4
Q

What are the 2 pathway mechanisms of pain?

A

nociceptive and neuropathic

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5
Q

What is acute pain described as?

A

pain of recent onset and probable limited duration

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6
Q

What is chronic pain defined as?

A

pain lasting more than 3 months, pain lasting after normal healing, often no identifiable cause

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7
Q

What is cancer pain defined as a?

A

Progressive, may be a mixture of acute and chronic

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8
Q

Nociceptive pain is caused by what happening?

A

Obvious tissue injury or illness

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9
Q

Is nociceptive pain sharp/dull and well/poorly localised?

A

Can be sharp or dull and is well localised

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10
Q

What causes Neuropathic pain?

A

Nervous system damage or abnormality.

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11
Q

What is often used to describe neuropathic pain and is it well/not well localised?

A

burning, shooting +/- numbness, pins and needles

not well localised

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12
Q

What occurs in the periphery that causes pain?

A

Tissue injury
release of chemical e.g. prostaglandins, substance P
Stimulation of pain receptors (nociceptors)

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13
Q

What nerves does pain travel in?

A

Ad or C nerve fibres

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14
Q

Where do these pain fibres enter the spinal cord?

A

The dorsal horn

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15
Q

What side of the spinal cord does the second nerve travel up?

A

the opposite side

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16
Q

What is the second relay station for the pain?

A

the Thalamus

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17
Q

Where does pain perception occur in the brain?

A

Occurs in the cortex

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18
Q

What is modulation and does it increase/ decrease pain signal?

A

A descending pathway from brain to dorsal horn. Usually decreases pain signal

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19
Q

What are some examples of neuropathic pain?

A

nerve trauma, diabetic pain, fibromyalgia, chronic tension headache

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20
Q

What are some of the simple analgesics?

A

Paracetamol, non steroidal anti inflammatory- NSAIDs- diclofenac, ibuprofen

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21
Q

What are some opioids?

A

Mild- codeine, dihydrocodeine

Strong- morphine, oxycodone, fentanyl

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22
Q

What type of treatment would be used to deal with the peripheral injury?

A

Non-drug treatments= RICE

NSAIDs, local anaesthetics

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23
Q

What kind of tx would you use to treat the spinal cord?

A

non drug: acupuncture, massage, TENS

local anaesthetic, opioids, ketamine

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24
Q

Treatments for the brain?

A

non drug tx: psychological

drug tx: paracetamol, opioids, amitriptyline, clondine

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25
Q

What are the advantages of paracetamol?

A

advantages- cheap, safe, can be given orally, rectally or IV.

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26
Q

What are the disadvantages of paracetamol?

A

liver damage in overdose

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27
Q

What are the three most common NSAIDs?

A

aspirin, ibuprofen, diclofenac

28
Q

What are the advantages of NSAIDs?

A

cheap, generally safe, good for nociceptive pain. Best given regularly with paracetamol (synergism)

29
Q

What are the disadvantages in NSAIDs?

A

GI and renal side effects plus sensitive asthmatics

30
Q

What are the advantages of codeine?

A

Cheap, safe, good for mild-moderate acute nociceptive pain. Best again given with paracetamol

31
Q

What are the disadvantages of codeine?

A

Constipation, not good for chronic pain.

32
Q

What are the advantages of morphine?

A

cheap, generally safe. Can be given oral, IV,IM, SC
Effective if given regularly.
Good for mod-severe nociceptive pain (e.g. post-op pain) and chronic cancer pain

33
Q

What are the disadvantages of morphine?

A

Constipation, respiratory distress in high dose. Misunderstanding about addiction. Controlled drug. Oral dose is 2-3 times IV/IM/SC dose

34
Q

What are some of the delivery routes available for pain relief?

A

oral, rectal, sublingual, subcut, transdermal, intramuscular, IV- boluses with possible for patient control.

35
Q

What are some of the delivery routes for local anaesthetics?

A

Epidural, intrathecal, wound catheters, nerve plexus catheters, local infiltration of wounds

36
Q

What are the three levels on the pain ladder?

A

mild to moderate pain, moderate to severe pain, severe pain

37
Q

What is the name of the scoring system used in confused and/or older patients?

A

the Abbey Pain Scale screening

38
Q

What should be given in step 1 of the ladder? mild to moderate pain

A

non opioids, aspirin, NSAIDs or paracetamol

39
Q

What should be given for step 2? moderate to severe pain

A

Step 1

+ mild opioids with or without non opioids

40
Q

What should be given for step 3? severe pain

A

Step 1 if first tx or as a build up should give-

strong opioids e.g. morphine with or without non opioids

41
Q

What is the RAT approach to pain?

A

Recognise, assess, treat

42
Q

What are the three components of the triad of anaesthesia?

A

Analgesia, relaxation and hypnosis

43
Q

What parts of the triad does general anaesthetic influence?

A

relaxation and hypnosis

44
Q

What is the basic action of general anaesthetic?

A

Interferes with neuronal ion channels. Makes them less likely to fire- it hyper polarises them. Inhalation agents dissolve in membranes. IV agents- allosteric binding on GABA receptors- open chloride channels.

45
Q

In what order do your higher functions “switch off” under GA?

A

LOC early and then hearing is later.

46
Q

How rapid an onset and recovery do IV anaesthetics have?

A

IV anaesthetics have a rapid onset time- one arm to brain circulation time. They also have a rapid recovery time as the drug disappears from the system very quickly due to it being fat soluble.

47
Q

What is the induction rate for inhaled anaesthetics like?

A

The induction rate for inhaled anaesthetics is very slow. They also then have a long duration.

48
Q

What is the sequence of GA in terms of induction and maintenance?

A

The induction of GA is mainly IV with a mix of inhalation thrown in. The maintenance of GA is then mainly inhalation with some IV options in modern centres. (IV options- propofol, opiate (remifentanil).

49
Q

What part of the triad do muscle relaxants work on?

A

Relaxation

50
Q

When are muscle relaxants indicated?

A

ventilation and intubation, when immobility is essential- microscopic surgery, neurosurgy. Body cavity surgery

51
Q

What are the problems of muscle relaxants?

A

Awareness, incomplete reversal, apnoea

52
Q

What is the basic action of muscle relaxants?

A

Competitive block of Ach receptors at NMJ.

53
Q

What is the most commonly used muscle relaxant?

A

Suxamethonium

54
Q

Which parts of the triad do analgesics work on?

A

Analgesia, relaxation (tiny bit hypnosis)

55
Q

What are the two main types of analgesia?

A

Opiates and local anaesthetic

56
Q

Why is it necessary to provide intraoperative analgesia?

A

To prevent arousal, as opiates add to hypnotic effect of GA, suppression of reflex responses to painful stimuli- tachycardia, hypertension

57
Q

What part of the triad does local anaesthetics act on?

A

Local anaesthetics act on the analgesia and relaxation parts of the triad

58
Q

What are three common local anaesthetics?

A

lignocaine, bupivacaine, prilocaine

59
Q

What is the basic action of LA?

A

Na channel blockers

60
Q

What is the limiting factor in local anaesthetics?

A

Toxicity

61
Q

What are some of the most common symptoms of local anaesthetic toxicity?

A

circumoral and lingual numbness, light headiness, tinnitus, muscular twitching, drowsiness

62
Q

What fibres are blocked by LA and what fibres are spared?

A

motor fibres are spared and pain fibres are blocked- luckily

63
Q

What level is spinal and epidural anaesthesia injected at?

A

L4

64
Q

What are the common medications in IV induction?

A

propofol and thiopentone

65
Q

What are the indications for gas induction and what is the most common gas induction for GA?

A

Op in a young child. Sevoflurane

66
Q

What does the triple airway manoeuvre involve?

A

head tilt, chin lift, jaw thrust

67
Q

What are the levels of ASA grading?

A 
ASA1- other wise healthy patient 
ASA2- mild to moderate systemic disturbances 
ASA3- severe systemic disturbance 
ASA4- life threatening disease 
ASA5- moribund patient 
(ASA 6 organ retrieval)

Anaesthetics (1 decks)

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