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Medicine > Anaesthetics > Flashcards

Anaesthetics Flashcards

0
Q

What is the triad of anaesthesia?

A 
Narcosis = pt rendered unconscious following administration of drugs
Analgesia = lack of pain and suppression of physiological reflexes
Relaxation = reduction or absence of mm tone
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1
Q

What are the three types of anaesthetics?

A

General
Local
Regional (blocks)

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2
Q

What is the minimum alveolar concentration (MAC)?

A

Amount of gas required to prevent 50% of humans from moving when given painful stimulus

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3
Q

What agents are used for IV induction and what are the risks?

A

Propofol, thiopental, etomidate

Complications = Cardiovascular and respiratory depression
Reaction to drugs
Arterial injection
Subcutaneous tissue injection

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4
Q

What are the indications for gaseous induction?

A

Avoid IV induction in children
Maintain spontaneous respiration where difficult intubation anticipated
Inhaled foreign body
Bronchopleural fistula

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5
Q

What agents are used for maintenance?

A

Volatile gases

Isoflurane, sevoflurane, desflurane

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6
Q

What are the stages of anaesthesia?

A 
1 = Analgesia - administration until  loss of consciousness
2 = Excitement - LoC until regular breathing begins and settles
3 = Surgical anaesthesia - pts breathing settled
4 = Overdose - breathing stops
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7
Q

What is RSI?

A

Rapid sequence induction

Rapid anaesthesia in emergency situations by administering rapidly acting muscle relaxant immediately after induction agent,
Runs risk of being unable to ventilate patient

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8
Q

Are local anaesthetics vasodilators or vasoconstrictors?

A

Vasodilators, this is why they can sometimes be administered with adrenaline (vasoconstrictor) to minimise dispersion and absorbtion

nb Do NOT use adrenaline in end-artery systems

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9
Q

What are the signs of local anaesthetic toxicity?

A 
Tingling of lips
Light-headedness
Disorientation and drowsiness
Respiratory depression
Shivering
mm twitching and tremors (lips and distal limbs)
Tonic-clonic convulsions
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10
Q

Where is the anaesthetic injected to in a spinal anaesthetic?

A

CSF fluid

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11
Q

Are patients likely to become hypo or hypertensive following spinal anaesthesia?

A

Hypotensive because of sympathetic blockade, .: always have fluids and vasoconstrictors available

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12
Q

Complications of GA?

A

Respiratory arrest
Suxamethonium apnoea
Allergy to agents used

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13
Q

Complications of spinal?

A 
High spinal block
Bladder distension
Bradycardia
Infection
Spinal headache
Hypotension
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14
Q

Cardiovascular risk factors to anaesthetics

A

Unstable coronary syndromes
Decompensated congestive heart failure
Significant arrythmias
Severe valvular disease

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15
Q

What is the ASA classification and how is it used?

A

American Society of Anaesthesiology to classify urgency of operation and patient status

16
Q

What is the ASA grading of patient status?

A

ASA PS 1 = normal healthy patient
ASA PS 2 = patients with mild systemic disease
ASA PS 3 = patients with severe systemic disease which is not incapacitating
ASA PS 4 = patients with severe systemic disease which is a constant threat to life
ASA PS 5 = moribund pts who will die within 24 hours without surgery
ASA PS 6 = brain dead patients whose organs are being harvested for donor purposes

17
Q

What is the ASA classification of surgery?

A 
Immediate
Urgent a) within 6 hours of decision to operate
            b) within 24 hours
Expedited
Elective
18
Q

What are the pre-op starvation times?

A 
Solid foods (includes milk) = 6 hours
Clear fluids = 2 hours
19
Q

What are the risks and benefits of starvation pre-op?

A

Benefits = decreased post-op dehydration, headache, NnV, hunger and thirst

Risks (if starved too long) = dehydration, catabolism, NnV, hypoglycaemia, ketosis,

20
Q

How would you manage a diabetic patient?

A

Minimise pre-op fasting times and put first on operating list

21
Q

What is the difference between acute and chronic pain?

A

Acute pain = 3 months, eu = neuropathic and unresolving

22
Q

Describe the pain pathway

A

A-delta fibres give rise to the perception of sharp, immediate pain
C-delta fibres give rise to slower onset, diffuse and prolonged pain
(nb. think Acute and Chronic)

Enter spinal cord via dorsal spinal roots
Ascend in dorsal posterior column or spinothalamic tract

23
Q

What are the adverse effects of pain?

A

Decreased respiratory effort –> hypoventilation
GI atony –> NnV, ileus (loss of peristalsis)
Bladder atony –> urine retention
Catecholamine release –> vasoconstriction, ^viscosity, ^clotting, platelet aggregation, reduced wound perfusion + tissue O2 + healing
Psychological effeccts

24
Q

What is the dose, cautions, C/I and S/E of paracetemol?

A

Oral = 0.5-1g every 4-6 hours –> max of 4g

Cautions = hepatic or renalimpairment
No C/I
S/E = rare, rashes and blood disorders

25
Q 
Ibuprofen:
Dose
Cautions
C/I
S/E
A

Oral = 300-400mg 3-4times/day –> max 2.4g/day

Cautions = elderly, Hx hypersensitivity, breast-feeding
C/I = severe heart failure or active peptic ulceration
S/I = GI discomfort, diarrhoea, nausea, bleeding and ulceration
26
Q 
Codeine:
Dose
Cautions
C/I
S/E
A

Oral = 30-60mg every 4 hours to max 240mg/day

Cautions = impaired RS fXn, acute asthma attack, hypotension, shock, obstructive or inflammatory bowel disorders
C/I = acute respiratory depression, rx of paralytic ileus,
S/E = NnV, constipation, dry mouth, biliary spasm, abdo pain, anorexia
27
Q 
Morphine/diamorphine:
Dose (acute pain, MI, Acute pulmonary oedema, Chronic pain)
Cautions
C/I
S/E
A

Acute pain = M 10-15mg/2-4hrs IV/IM OR DM 5mg SC
MI = slow IV injection 5mg @ 1mg/min, morphine
Acute pulmonary oedema = Slow IV 2.5-5mg (1mg/minute)
Chronic pain = 5-10mg/4hrs PO/SC/IM

Cautions = impaired RS fXn, hypotension, obstructive/inflammatory bowel disease, severe diarrhoea, CNS depression
C/I = acute RS depression, risk of paralytic ileus
S/E NnV, constipation, dry mouth, ALWAYS co-prescribe antiemetic eg prochlorperazine 12.5mg

28
Q

What are the advantages and disadvantages of PCA (patient controlled analgesia)?

A 
ADV = Available on demand 
           Pt has more control over pain
           Easily adjustable dose (vs eg breakthrough pain)
           Avoids repetitive injections
           Reduce demands on nurses

DIS = Limits pt mobility
Needs IV access
Need to educate pt and staff

29
Q

How is an epidural different from a spinal?

A 
Epidural space, not CSF
Can be 'topped up' ---> prolonged activity
Slower onset (45 mins)
30
Q

What are the complications of an epidural?

A 
Hypotension
CSF/dural puncture --> spinal headache OR total spinal effect
RS depression
Failed block
Local anaesthetic toxicity
31
Q

What are examples of non-drug analgesia?

A 
Splinting
CBT
Acupuncture
TENS
Aromatherapy
Hypnotherapy
32
Q

How would you treat post-op NnV (PONV)?

A

Step 1 = cyclizine 50mg IV/PO
Step 2 = prochlorperazine/buccastem
Step 3 = ondansetron
Step 4 = contact pain team

nb can also consider dexamethasone

33
Q

What causes post-op NnV?

A

Chemoreceptor stimulation = chemotherapy, anaesthetic, opioids
Stomach/small intestine = chemotherapy, radiotherapy, surgery
Higher cortical centres = sensory input, fear, anticipation

34
Q

What are the risk factors for PONV?

A 
Patient = female, children, obesity, Hx PONV, non-smoker
Procedure = Abdo, gynae, ENT, opthalmic, laparoscopic
Anaesthetic = long surgery, N2O, opioids, GA
Post-op = pain, opioids, hypotension, dehydration
35
Q

Antihistamines:
Indications
Doses
C/I

A

vs NnV, labyrinthitis, vertigo, motion + radiation sickness

50mg IV

C/I = severe heart failure, renal impairment, urinary retention, hepatic disease, rx close angle glaucoma

36
Q 
Ondansetron:
Class of drrug
Indications
Dose
C/I
A

5-HT3 antagonist

Prophylactically pre-op or before chemotherapy, 4-8mg IM/IV

C/I = hepatic impairment, QT prolongation, pregnancy, breast feeding

37
Q 
Metocloperamide/prochlorperazine:
Class of drug
Indications
Dose
C/I
A

Dopamine antagonist
Both vs PONV, pro- also vs opiod and GA emesis

Met = 10mg IV/IM/PO, Pro = 12.5mg IM

C/I Met = GI obstruction, haemorrhage, epilepsy, renal/hepatic disease
C/I Pro = Hypotension, comatose, Parkinsons, hepatic/renal disease

38
Q 
Dexamethasone:
Class of drug
Indications
Dose
C/I
A

Glucocorticosteroid
Augments the activity of ondansetron, metocloperamide, prochlorperazine

0.5-24mg slow IV/IM infusion

C/I = systemic infection, hypertension, glaucoma, pregnancy, breast feeding, epilepsy

Medicine (9 decks)

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