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ACC > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

What is the name for assessing fitness for surgery?

A

ASA grading

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2
Q

What are the stages of ASA grading?

A
  1. Normal healthy patient
  2. Mild systemic disease/ >80
  3. Systemic disease that causes definite functional limit to life
  4. Severe systemic disease that’s a constant threat to life.
  5. Moribund patient unlikely to survive 24hours without surgery
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3
Q

What are the grades of surgery?

A
  1. MINOR, excision of skin lesion, drainage of abscess
  2. INTERMEDIATE, inguinal hernia, tonsillectomy
  3. MAJOR, thyroidectomy, total abdo hysterectomy
  4. MAJOR+, colonic resection, total joint replacement
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4
Q

What are the fasting times for surgery?

A

8hours: Heavy meal
6hours: Non-human milk, formula, light meal
4hours: Breast milk
2hours: Clear liquids (no limit)
Alcohol: At least 24hours before surgery

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5
Q

What delays gastric emptying?

A 
Metabolic: DM, ESKD
Anatomical: Pyloric stenosis
Trauma
Mechanical: Pregnancy, obesity
High fat content
Anxiety
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6
Q

How is the airway assessed before surgery?

A
  1. Hx & Ex
  2. Mallampatti
  3. Teeth
  4. Thyromental & sternomental distance
  5. Neck movement
  6. 1-2-3
  7. Cormack & Lehane
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7
Q

What are METs?

A 
Metabolic Equivalents
1= eating & dressing
3= light household activity/ walk 100m @ 2-3mph
4= climb stairs
6-7= short run
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8
Q

What components make up a general anaesthetic?

A

Amnesia
Analgesia
Akinesis

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9
Q

What are the most common inducing agents

A

Propofol
Thiopentone
Ketamine
Etomidate

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10
Q

Propofol:

  • Properties
  • Reason for use
  • Side effects
A
  • MOST COMMON
  • Lipid based
  • Excellent suppression of airway reflexes & dec PONV (anti-emetic properties)
  • SE: drop in HR & BP, pain on inj, involuntary movements
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11
Q

Thiopentone:

  • Properties
  • Reason for use
  • Side effects
  • Example
A

-Barbituate
-Faster acting than propofol
-RSI
Antiepileptic properties & protects the brain
-SE: drops BP, rise HR, rash & bronchospasm, intraA injection
-CI in porphyria
-Pt w/GI perf

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12
Q

Ketamine:

  • Properties
  • Reason for use
  • Side effects
  • Example
A
  • Dissociative
  • Anterograde amnesia
  • Slow onset (90secs)
  • Activates sympathetic system
  • Bronchodilation
  • Moderate-strong analgesic properties
  • SE: Rise in BP & HR, N&V, emergence phenomenon
  • Change dressings for burns patients
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13
Q

Etomidate:

  • Properties
  • Reason for use
  • Side effects
  • Example
A
  • Rapid onset
  • Haemodynamically stable
  • Lowest incidence of hyperS
  • SE: pain on inj, spont movements, adreno-cortical suppression, PONV
  • HF patient
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14
Q

What is adreno-cortical suppression & what is it associated with?

A

Etomidate

Cortisol level suppressed >72hours after bolus. Not used in critically ill/septic patients

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15
Q

What is the problem with intra-arterial injection & what is this associated with?

A

Thiopentone

Blockage of capillaries due to large crystals can lead to thrombosis & gangrene

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16
Q

When are inhaled agents used?

A

After inducing agent to maintain amnesia and continued till the end of the operation

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17
Q

Name the most common inhaled agents

A 
Isoflurane
Sevoflurane
Desflurane
Enflurane
NO
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18
Q

What is MAC?

A

Minimum alveolar concentration

Concentration of inhaled agents

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19
Q

Isoflurane:

  • MAC
  • Properties
  • Example
A
  • 1.15%
  • Can be used as inhaled amnesic
  • Least effect on organs
  • Donor-recipient operations
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20
Q

Sevoflurane:

  • MAC
  • Properties
  • Example
A
  • 2%
  • Sweet smelling, inhalation induction
  • Chubby kid w/ no IV access
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21
Q

Desflurane:

  • MAC
  • Properties
  • Example
A
  • 6%
  • Can be used as inhaled amnesic
  • Low lipid solubility, rapid on/offset, long operations
  • 7hr op for finger re-implant
22
Q

MAC for NO & Enflurane

A

NO: 104%- cannot give 1 MAC of NO
En: 1.6%

23
Q

Name the short-acting opioids & when they would be used?

A 
Fentanyl
Alfentanil
Remifentanil
Used: Intra-operatively
Suppress response to laryngoscope
Surgical pain
24
Q

Name the long-acting opioids and when they would be used?

A

Morphine
Oxycodone
Used: Intra-operatively
Post-operatively

25
Q

What type of pain is tramadol used for?

A

Nociceptive

Neuropathic

26
Q

What type of pain is morphine used for?

A

Nociceptive
Acute
Severe
Cancer pain

27
Q

How do GAs stop movement?

A

As action potential arrives at NM junction, Acetylcholine is released which causes depolarisation of Nicotinic receptors leading to muscle contraction.

28
Q

What is the pathophysiology of the 2 types of akinesic agents?

A

Depolarising: Similar to acetylcholine on nicotinic receptors slowly hydrolysed by acetylcoA. Muscle contraction then fatigues
Non-depolarising: Block nicotinic receptors so muscle relaxes

29
Q

Name the main types of akinesic agents

A 
Suxamethonium- RSI
Atracurium
Mivacurium
Rocuronium
Vercuronium
Pancuronium
30
Q

Name the depolarising agents

A

Suxamethonium

Succinylcholine

31
Q

Name the non-depolarising agents & describe some of their characteristics

A

Less SE, slow onset & variable duration, compete with Ach for nicotinic receptors

Atracurium- Short acting
Mivacurium- Short acting
Rocuronium- Intermediate
Vercuronium- Intermediate
Pancuronium- Long acting
32
Q

How are muscle relaxants reversed?

A

Neostigmine: Anti-cholinesterase prevents breakdown of acetylcholine (SE= brady)
Glycopyrrolate: Antimuscarinic (SE= N&V)

33
Q

What anti-emetics can be used post-op?

A 
5HT3: Ondansetron
Anti-Histamine: Cyclizine
Steroid: Dexamethasone
Phenothiazine: Prochlorperazine
Anti-dopaminergic: Metoclopramide
34
Q

What is the definition of a local anaesthetic

A

Reversibly prevents transmission of the nerve impulse in the region to which it is applied without affecting consciousness.

35
Q

What is the composition of a LA?

A

Ester

Amide

36
Q

Describe esters

A 
Less stable in sol
Metabolised by PABA associated w/allergies
S-A: Procaine, Cocaine, Benzocaine
M-A: Prilocaine
L-A: Amethocaine
37
Q

Describe amides

A

Heat stable (autoclaved)
Rare for allergies
M-A: Lidocaine/lignocaine, Mepivacaine
L-A: Bupivacaine, Levobupivacaine

38
Q

What is the safe dosage of LA?

A

Lignocaine: 3mg/kg
(levo)Bupivacaine: 2mg/kg
Prilocaine: 6mg/kg

39
Q

What is the safe dose of LA with adrenaline?

A

Lignocaine: 7mg/kg
(levo)bupivacaine: 2mg/kg
Prilocaine: 9mg/kg

40
Q

What is the MOA of LA?

A
  1. Inhibition of voltage sensitive Na channel in axon preventing action potential
  2. Membrane stabilisation effect
  3. Prevent pain by causing reversible block of conduction along nerve fibres
  4. Exert toxicity by blocking Na channels found in the brain or heart:
    a. If plasma levels rise SLOWLY CNS is affected first (excitatory symptoms due to inhibition of GABA receptors- metallic taste, dizziness, slurred speech, diplopia, tinnitus, muscle twitching, confusion, convulsions)
    b. At high concentrations there is widespread Na channel blockade with generalised neuronal depression leading to coma, respiratory & cardiac arrest
41
Q

How is LA toxicity treated?

A 
Stop inj & call for help
Maintain airway, give 100% O2
Establish IV access
Control seizure (benzo/propofol/thiopental)
ARREST=CPR
IV intralipid (lipid emulsion)
42
Q

Where is a spinal block & an epidural placed?

A

BOTH: Skin, Subcut fat, Supraspinus lies, Spinal logs, Ligamentum flavum
S: Through dura & arachnoid to CSF space: L2-S2
E: Space between ligamentum flavum & dura below L1

43
Q

When is a spinal & epidural used?

A

S: Ops on lower half of the body
E: Intra-op analgesia & <72hours post-op

44
Q

How is a spinal & epidural given & onset?

A

S: Small amount Single injection, rapid onset (5-10mins)
E: Epidural catheter, onset 15-30mins, reliant on catheter placement

45
Q

Risk factors for PONV?

A

Female
Previous episodes
Non-smoker

46
Q

What factors make up the anaesthetic safety checklist?

A
  • Experienced & trained assistant to help with induction
  • Fasted appropriately
  • IV access that is functional
  • On a table that can be rapidly tilted
47
Q

What is the NCEPOD classification?

A

Classification of intervention

  • Immediate
  • Urgent
  • Elective
  • Expedited
48
Q

What are the anaesthetic emergencies?

A

LA toxicity
Airway: Laryngospasm, can’t intubate/can’t ventilate
Anaphylaxis
Malignant hyperthermia

49
Q

What are the SE of depolarising agents?

A 
Muscle pains
Fasciculations
HyperK
Malignant hyperthermia 
Rise in ICP, IOP, gastric pressure
50
Q

What is the pathway of identifying a potential organ donor patient?

A

1) Inform SNOD of potential donors

2) Speak to family

51
Q

Can you smoke before an operation?

A

No-ideally stop 48-72hours
Smoking makes airway more irritable
Raised Hb levels

ACC (21 decks)

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