Fundamentals of anaesthetics

Question 1

Are the following general, topical or regional?

a) Spinal anaesthesia?
b) EMLA skin cream?
c) brachial plexus block

Answer 1

a) regional
b) local
c) regional

Question 2

What are the 3 elements to anaesthesia? (A’s)

Answer 2

Amnesia
Analgesia
Akinesis

Question 3

What induction agent should be used for a patient requiring a burn dressing change?

Answer 3

Ketamine: useful for single short procedures.

Question 4

Ketamine:
Dose.
Uses/advanatges
Unwanted affects

Answer 4

a) 1-1.5mg/kg

Use

• dissociative anaesthesia
• slow onset (90 secs)
• Cardiostable (rise in HR/BP
• Bronchodilation
• Good analgesic properties

Unwanted:
- emergence phenomenon (hallucinations)

Question 5

Which induction agent is best used for a patient undergoing an GA operation with a laryngeal masked airway?

Answer 5

Propofol

Question 6

What does of propofol should be used?

How often used?

Benefits?

Unwanted effects

Answer 6

1.5-2.5mg

Commonly used (95%)

-Excellent suppression of airway reflexes (putting in LMA)

• Drop in HR and BP
• Pain on injection
• Myoclonus

Question 7

What induction agent can be used for a patient with a history of heart failure requires a general anaesthetic?

Answer 7

Etomidate (haemodynamically stable)

Question 8

Etomidate:

Dose:

Use:

Unwanted effects

Answer 8

0.5mg/kg

• Haemodynamically stable use for heart conditions
• Rapid onset
• Low incidence of hypersensitivity

Unwanted:

• Pain on injection
• Adreno-corticol suppression > lower cortisol > lower BP > never use for septic shock. Cortisol low for 72 hours.
• High incidence of PONV

Question 9

What induction agent do you use for a patient with intestinal obstruction requires an emergency laparotomy?

Answer 9

Thiopentone (used for rapid sequence induction)

Question 10

Thiopentone
Dose

Use

Unwanted effects

Answer 10

Dose) 4-5mg/kg

Use)

• Rapid Sequence Induction (faster than propofol
• Anti-epileptic properties and protect brain

Unwanted)
- Drops BP and rise in HR
- No analgesic property
- Rash/bronchospasm
- Hangover effect
CI in prophyria

Question 11

All inhalation agents end in what?

Answer 11

-flurane

Question 12

Which inhalation agent is used for long operations as rapid onset and offset.

Answer 12

Desflurane

Question 13

Which inhalation agent is commonly used for paediatrics?

Answer 13

Sevoflurane

Question 14

Which inhalation agent is best for organ retrieval from a donor?

Answer 14

Isoflurane

Question 15

Which two inhalation agents have low potency and low solubiluity?

Answer 15

Sevoflurane and desflurane

Question 16

Name a depolarising muscle relaxant.

Answer 16

Suxamethonium

Question 17

What problems are associated with suxamethonium

Answer 17

Malignant hyperthermia 
Muscle pain
Fasiculations
Hyperkalaemia > arrythymias
Rise ICP

Question 18

When is it used?

Answer 18

Rapid Sequence induction.

Question 19

What drugs are used to reverse anti-muscarinics?

Answer 19

Neostigmine & Glycopyrrolate

Question 20

Which drug do you use if BP and HR are low?

How does it work

Answer 20

Ephedrine

Rises HR which increases BP

Question 21

Which drug(s) do you use when BP is low but heart rate is high.

How do they work

Answer 21

Phenylepherine
Metaraminol

Vasoconstriction increases BP which decreases HR.