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Clinical Pharmacology > 13.2 Anaesthetics > Flashcards

13.2 Anaesthetics Flashcards

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1
Q

How can anaesthesia be used ?

A

General
Local

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2
Q

How is general anaesthesia delivered?

A
  • Inhaled (volatile)
  • IV
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3
Q

How can local anaesthesia be used?

A

Regionally -can block an entire part of the body
Sometimes used if haemodynamically unstable and cannot use general

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4
Q

What is conscious sedation?

A

Small amount of anaesthetic or benzodiazepines used to produce a sleep state

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5
Q

What are the practical steps of anaesthesia?

A
  • Pre-medication to help anxiety- benzodiazepines
  • Induction -IV or inhalation
  • Intraop anaesthesia -opioids
  • Muscle paralysis for intubation
  • Reversal of muscle paralysis and recovery including post op analgesia
  • Post-op anti-emetics
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6
Q

Describe the structure of general anaesthetics

A

Lots of different structures

May have hydrocarbon with fluorine ring

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7
Q

What are some examples of inhaled general anaesthetics?

A
  • Nitric oxide (N2O)
  • Chloroform
  • Halothane
  • Fluroxene
  • Methoxyflurane
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8
Q

What are some examples of IV general anaesthetics?

A
  • Propofol
  • Barbiturates
  • Ketamine
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9
Q

What are Guedel’s signs?

A

Level of anaesthesia from the presentation of the patient

Eye movement and muscle tone

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10
Q

What are the different stages of Guedels signs?

A

Stage 1: Analgesia
Normal muscle tone
Some eye movement
Conscious

Stage 2: Excitement
Muscle tone normal to increased
Moderate eye movement
Uconscious
Breathing erratic
Delirium could occur

Stage 3: Surgical anaesthesia - Muscle relaxedness (slight, moderate, markedly, markedly ) increases until breathing becomes weak

Stage 4: Respiratory paralysis - Muscle tone flaccid
No eye movements
Death

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11
Q

What is anaesthesia a combination of?

A
  • Analgesia
  • Hypnosis - loss of consciousness
  • Depression of spinal reflexes
  • Muscle relaxation
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12
Q

What is anaeastheisa end point of determined by?

A

Concentration dependent

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13
Q

How do we describe potency in volatiles/inhalational agents?

A

MAC
Minimum alveolar concentration (EC50)

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14
Q

What order do responses go with anaesthesia?

A
  1. Memory
  2. Consciousness
  3. Movement
  4. Cardiovascular response
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15
Q

What is potency?

A

EC50

Concentration of drug needed to elicit half of the maximal response

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16
Q

What is MAC or minimum alveolar concentration?

A

Alveolar concentration of drug (1 atmosphere) at which 50% of patients fail to move to a surgical stimulus

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17
Q

What is alveolar concentration equal with at equilibrium?

A

Alveolar concentration of drug equals spinal cord concentration of drug at equilibrium

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18
Q

What are the different types of MAC?

A

MAC
MAC-Bar - autonomic response
MACawake

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19
Q

What is a main factor (compartment wise) affecting induction and recovery from anaesthesia?

A

Partition co-efficients - measures of solubility

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20
Q

What are some examples of partition co-efficients that can effect anaesthesia induction and recovery?

A

Blood Gas partition
Solubility in blood

Oil Gas partition
Solubility in fat

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21
Q

What is the relationship of Blood:Gas partition and anaesthesia?

A

Low value (so low solubility)

Fast induction and recovery as it is not in tissues and blood for long

E.g. desflurane

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22
Q

What is the relationship of Oil:Gas partition and anaesthesia?

A

Determines potency and slow accumulation due to partition in fat e.g halothane

Higher value so higher potency as it accumulates in fat

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23
Q

What affects MAC?

Study These Flashcards
A
  • Age- high in infants lower in elderly
  • Hyperthermia (increased), hypothermia (decreased)
  • Pregnancy (increased)
  • Alcoholism (increased)
  • Central stimulants (increased)
  • Other anaesthetics and sedatives (decreased)
  • Opioids (decreased)
24
Q

How does nitric oxide affect MAC?

Study These Flashcards
A

Nitric oxide decreases MAC

Need less of if you add nitric oxide

25
What is the relationship of GABA and the potency of anaesthesia?
Increased interaction with GABA Increases its inhibitory effects therefore increased potency of anaesthesia
26
What is the main receptor target for inhaled anaesthesia?
GABA- increases effects of GABA (potentiates, GABA still needs to bind) More hyperpolarisation, therefore further from threshold
27
What is the exception to the GABA binding rule?
Xenon, Nitric Oxide and Ketamine These work at NMDA receptors (glutamate receptors) and block them
28
What systems is the main target of anaesthesia?
Reticular formation- controls consciousness
29
What occurs to each part of reticular formation during anaesthesia?
**Thalamus** Transmits and modifies sensory information before reaching PSC **Hippocampus** Depressed, memory loss **Brainstem** Depressed, respiratory and CV effects **Spinal cord** Depressed, analgesia ( dorsal horn) and Motor neurone activity decreased
30
Howe can we see effects of anaesthesia on the brain?
PET scan
31
Give examples of fast acting anaesthesia
Propofol Barbiturates
32
Give an example of slow acting anaesthesia
Ketamine
33
What are IV anaesthetics often used for?
* Induction in surgery * TIVA (total intravenous anaesthesia)
34
What can Ketamine cause when you wake up?
Odd emergence reactions
35
What is the main receptor target for IV anaesthesia?
GABA- potentiates Not ketamine its binds to NMDA and inhibits GABA
36
How is IV anaesthesia potency described?
**Plasma concentration** Achieve a specific end point such as eyelash reflexes loss **For induction with mixed anaesthesia** IV bolus used to end point, then switched to inhaled agent
37
What does TIVA use to calculate potency and anaesthesia end-point?
**Total IV** Uses defined PK based algorithm to infuse at a rate to maintain a set point Given a bolus before this
38
When is local anaesthesia used?
* Dentistry * Obstetrics * Regional surgery * Post-op * Chronic pain management
39
What are some examples of local anaesthetics?
Lido**caine** Bupiva**caine** Ropiva**caine** Pro**caine** -**caine** suffix
40
What is the common structure of local anaesthetics?
Aromatic ring with ester or amide connecting to amine group
41
What are some characteristics of local anaesthesia?
**Lipid solubility** If it was higher they would have greater potency **Dissassociation constant** Lower pKa leads to a faster onset **Chemical links (ester vs amide)** Determines metabolism **Protein binding** More protein binding causes longer duration
42
How do different bonds alter the duration of local anaesthetics?
**Ester** Shorter acting, plasma contains esterases which break it down **Amide** Longer acting
43
How does local anaesthetic work in wound analgesia? | Buvipacaine
* Cocaine-like molecule * Cocaine enters channel via two ways - hydrophobic vs hydrophilic * Cocaine crosses plasma membrane if uncharged and picks up positiveve charge * Blocks Na+ channels that are open (hydrophilic pathway) or closed (hydrophobic pathway) * Na+ unable to travel through and depolarise resulting in decreased APs
44
What do molecules block in local anaesthesia?
**Dependent block** Only blocks channels if there is lots of firing **Blocks small myelinated afferent nerves in preference** Nociceptive and sympathetic block
45
How does adrenaline affect local anaesthetics?
* Vasoconstriction * Decreased blood flow * Increased duration of anaesthesia
46
What is the difference between Bupivacaine and Procaine?
**Bupivacaine** More potent Longer duration **Procaine** Ester metabolised Slower onset
47
What determines potency of local anaesthesia?
Determined by lipid solubility The higher the solubility the more potent
48
Write out the strength of local anaesthetics from highest to lowest
Bupivacaine Ropivacaine Lidocaine Procaine
49
What is the speed of acting from fastest to slowest of local anaesthesia?
Determined by pKa Low pKa means a faster onset 1. Lidocaine 2. Bupivacaine 3. Ropivacaine 4. Procaine
50
Outline the duration of local anaesthesia from longest to shortest
Determined by protein binding More binding causes a longer duration 1. Bupivacaine 2. Ropivacaine 3. Lidocaine 4. Procaine
51
What is regional anaesthesia?
Anaesthetising a part of the body Described as a nerve block Patient remains awake Uses local anaesthesia or opioids
52
Where do you use regional anaesthesia?
**Upper extremities** Supraclavicilar Interscalene Infraclavicular Axillary **Lower extremities** Femoral Sciatic Poplitieal Saphenous Extradural Intrathecal (spinal cord)
53
What are the side effcts of general anaesthesia?
* Nausea and vomiting acutely * Hypotension * Post operative cognitive dysfunction - increases with age and longer anaesthesia * Chest infection
54
Why can you get a chest infection follow general anaesthesia?
Lack of coughing following surgery Foreign tube with microorganisms directly into thoracic cavity
55
Main concern generally of anaesthesia from public too
Anaphylaxis/allergic reaction

Clinical Pharmacology (45 decks)

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