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Surgery > IV and inhalational anaesthetics > Flashcards

IV and inhalational anaesthetics Flashcards

1
Q

What drug is used for induction and maintenance using IV drugs alone?

A

Propofol

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2
Q

Which drug has:

  • anti-emetic properties?
  • what is it used for?
A

Propofol

  • anti-emetic properties
  • used for maintaining sedation on ITU, total IV anaesthesia, day case surgery
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3
Q

Which agent has a rapid sequence of induction?

  • what are the disadvantages?
A

Sodium thiopentone

  • marked myocardial depression
  • metabolites accumulate quickly
  • little analgesic effect
  • unsuitable for a maintenance
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4
Q

Ketamine

  • what is it used for?
  • what are its advantages?
  • what is its disadvantage?
A

Ketamine

Use: may be used as induction

Advantages:

  • has moderate - strong analgesic properties
  • produces little myocardial depression (useful in haemodynamically unstable patients)

Disadvantage:

  • may produce dissociative anaesthesia -> nightmares, hallucinations, agitation (as a drug wears off)
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5
Q

Etomidate

  • advantage (1)
  • disadvantages (3)
A

Etomidate

Advantage: has a good cardiac profile (very little haemodynamic instability)

Disadvantages:

  • no analgesic properties
  • may result in adrenal suppression (even short use) -> therefore not used for maintenance
  • post-op vomiting is common
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6
Q

Components of checklist before introduction of anaesthesia (7)

A

Before the induction of anaesthesia, the following must have been checked:

  • Patient has confirmed: Site, identity, procedure, consent
  • Site is marked
  • Anaesthesia safety check completed
  • Pulse oximeter is on patient and functioning
  • Does the patient have a known allergy?
  • Is there a difficult airway/aspiration risk?
  • Is there a risk of > 500ml blood loss (7ml/kg in children)?
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7
Q

Mechanism of action of propofol

A

Not yet fully understood, thought to act on GABAA receptors and sodium channels on the reticular formation

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8
Q

What allergies predispose the patient to anaphylactic reaction with propofol use?

A

Egg and soy -> as propofol is mixed with the substances containing these components (poor solubility in the water)

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9
Q

Propofol infusion syndrome

  • cause
  • clinical features
  • management
A

Propofol infusion syndrome

Etiology: high doses and prolonged administration of propofol

Clinical features: severe metabolic acidosis, rhabdomyolysis, renal failure, and/or cardiac failure (often fatal)

Management: discontinue propofol immediately, symptomatic treatment (catecholamines, fluid resuscitation)

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10
Q

Mechanism of action of Etomidate

A

Etomidate

MoA: GABA receptors in reticular formation

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11
Q

What’s Etomidate good for? Why?

A

Etomidate

It has the least effect on CVS (it does not cause depression of the myocardium)

* therefore used in anaesthesia of the patients with myocardial instability

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12
Q

Mechanism of action of Ketamine

A

Ketamine

MoA: NMDA receptor antagonist (type of glutamate receptor)

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13
Q

What’s the advantage of Ketamine over other anaesthetics in an emergency setting?

A
  • it can be administrated IM (apart from IV) -> so if IV access is difficult we still can give it
  • good for polytrauma and hypotensive patients -> it does not induce CV depression
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14
Q

What type of procedure Ketamine is good for?

What is other use of Ketamine (aside from surgeries)?

A

Ketamine

  • short and painful procedures e.g. fracture reduction

*Ketamine used in treatment of resistant asthma

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15
Q

Mechanism of action of barbiturates

A

Barbiturates

MoA: enhance GABA action -> via increased duration of Cl channels opening -> hyperpolarisation of post-sympathetic neurones -> reduced neural excitability

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16
Q

What’s disadvantage of barbiturate use?

A

They are highly lipid soluble -> have high potency with narrow therapeutic index

Rapid onset of action and recovery

17
Q

Examples of barbiturates (name few)

A
  • thiopental
  • phenobarbital
  • pentobarbital
  • secobarbital
  • methohexital
18
Q

Side effects of barbiturates

A
  • Hypotension (dose-dependent)
  • Respiratory depression and/or apnea (dose-dependent)
  • Laryngospasm, bronchospasm (histamine release)
  • Myoclonus
  • Painful injection
  • Dependence
  • Cytochrome P450 induction
  • Contraindicated in porphyria
19
Q

Indications for barbiturate use

A
20
Q

Barbiturate overdose

  • clinical features
  • management
A

Barbiturate overdose

Clinical features: impaired consciousness, coma, respiratory failure, cardiovascular depression

Management

21
Q

What are inhalational anaesthetics used for?

A
  • induction and maintenance of general analgesia
  • sedation
22
Q
  • What are the three most commonly used inhalational anaesthetics?
  • Which one of these is MOST COMMONLY used?
A

Sevoflurane is the most commonly used -> due to its rapid onset of action and also patient recover quickly from it

23
Q

Which one of the inhaled GA is the most commonly used?

A

Sevoflurane is the most commonly used -> due to its rapid onset of action and also patient recover quickly from it

24
Q

What are the physiological effects of the use of inhalational anaesthetics?

A
  • respiratory depression
  • decrease in arterial blood pressure
  • decrease in cerebral metabolic demand
  • increase in cerebral blood flow
25
Q

What is the disadvantage of the use of inhalational anaesthetics?

A

They do not provide post-op pain relief

26
Q

How do inhalational anaesthetics are taken up into the blood?

A

Passively, via diffusion

27
Q

How are inhalational anaesthetics eliminated?

A

They are eliminated via the lungs

28
Q

Can Nitrous Oxide be administrated on its own?

A
  • Nitrous oxide is not effective on its own
  • it would be often administrated with another inhalational anaesthetic

Nitrous oxide increases the speed of onset of action of the other anaesthetic

29
Q

Sevoflurane

  • advantages
A

Sevoflurane is the most commonly used inhalational anaesthetic

  • rapid onset of action -> narcosis can be achieved within one minute
  • rapid onset of recovery
  • good for induction

*also can be given via mask -> very good for paediatric surgery

30
Q

General side effects of inhalational anaesthetics

A

General side effects

  • Nausea/vomiting → inhalational anesthetics are contraindicated in patients who are not sober
  • Risk of malignant hyperthermia
  • Postoperative shivering
31
Q
A

Surgery (18 decks)

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