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Anaesthesia Flashcards

(57 cards)

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1
Q

What is the effect of opiates

A

Analgesia and a little sedation

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2
Q

Effect of general anaesthetic agents

A

Sedation

Skeletal muscle relaxation (to a lesser degree)

Analgesia (small degree)

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3
Q

Effect of local anaesthetic

A

Analgesia and skeletal muscle relaxation

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4
Q

Effect of muscle relaxants

A

Relax skeletal muscle

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5
Q

How do general anaesthetic agents work

A

Interfere with neuronal ion channels

Hyperpolarise neurones

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6
Q

Which processes are interrupted first using general anaesthetic

A

Cerebral function lost from top down

  • more complex processes
  • LOC early and lose hearing later
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7
Q

How do IV anaesthetics differ from inhaled (general) with regards to induction

A

Faster induction for IV - 1 arm to brain circulation ~30 seconds

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8
Q

How do IV anaesthetics differ from inhaled (general) with regards to awakening

A

Rapid recovery in IV due to disappearance of drug from circulation

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9
Q

Sequence of general anaesthesia

A

Inhalational induction and maintainance

IV induction and inhalational maintenance

IV induction and IV maintenance (propofol or remifentanil)

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10
Q

How do GA affect the respiratory system

A

Respiratory depressants - reduce hypoxic and hypercarbic drive

Paralyse cilia

Decrease lung volumes and V/Q mismatch

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11
Q

Effect of GA on CVS

A

Venodilation and negatively inotropic effect so lower cardiac output

Arterial vasodilatation so reduced vascular resistance

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12
Q

Indications for muscle relaxants

A

Ventilation and intubation
When immobility is essential
Body cavity surgery

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13
Q

Problems with muscle relaxants

A

Awareness - being awake and unable to move

Incomplete reversal - airway obstruction and ventilatory insufficiency in immediate post op

Apnoea - dependence on airway and ventilatory support

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14
Q

How do you reverse a neuromuscular blocker (non-depolarising)

A

Increasing acetylcholine

- using anticholinesterases

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15
Q

What is the limiting factor in use of local anaesthetics

A

Toxicity - high plasma levels

Absorption > rate of metabolism so high plasma levels

Therefore vasoconstrictors reduce blood flow and absorption

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16
Q

Signs and symptoms of local anaesthetic toxicity

A

Circumoral and lingual numbess and tingling

Light-headedness

Tinnitus, visual disturb

Muscular twitching

Drowsiness

Cardiovascular depression

Convulsions

Coma

Cardiorespiratory arrest

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17
Q

Lignocaine, bupivacaine and prilocaine are all examples of

A

Local anaesthetics

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18
Q

How to local anaesthetics act

A

Sodium channel blockers that prevent propagation of action potential

  • they must pass into axon to block sodium channels from within and be un-ionised to cross membranes
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19
Q

What kinds of fibres are best blocked by local anaesthetics and why

A

Pain fibres are blocked easily because they have less myelinated fibres so more difficult to penetrate

Motor fibres are relatively spared

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20
Q

Affect of local anaesthetics

A

Venodilation - decreased CO

Arteriolar vasodilation - decreased SVR

So decreased MAP

Effects due to sympathectomy

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21
Q

Affect of regional block on respiratory

A

Inspiratory function mostly spared but expiratory function relatively impaired (cough dependent on abdo muscle function)

Increased V/Q mismatch

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22
Q

Contra-indications for spinal and epidural anaesthesia

A

Patient refusal
Fixed cardiac output - aortic/mitral stenosis

Infection

Bleeding diathesis/anticoagulation

Spinal problems/neurology

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23
Q

Indications for epidural and spinal anaesthesia

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A

Avoidance of general anaesthesia

Severe resp disease

Avoid airway problems - difficult intubation or obstruction

Allergies/reactions to GA

24
Q

How do spinal and epidural anaesthetics differ in location

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A

Spinal injection is subarachnoid

Epidural is extradural

25
Duration of spinal compared to epidural
Spinal 2-3 hours Epidural 3-4 hours and is extendable
26
IV induction agents
Propofol | Thiopentone
27
Gas induction agents
Sevoflurane (halothane)
28
Airway complications
Obstruction by loss of airway tone or laryngospasm - forced reflex adduction of the vocal cords Stimulation in light planes of anaesthesia and caused by stimulation so need to remove stimulus Aspiration of gastric content or food or surgical debris - endotracheal tube protects from this
29
The first step of the WHO pain ladder
Paracetamol and NSAIDS
30
The second step of the WHO pain ladder
Paracetamol and NSAIDS CODEINE
31
The 3rd step of the WHO ladder of pain
NSAIDS and paracetamol MORPHINE
32
Chronic pain is described as
Pain lasting > 3 months Lasting after normal healing
33
Description of nociceptive pain
Obvious tissue injury or illness Pain has protective function Sharp and or dull Well localised
34
Neuropathic pain
Nervous system damage or abnormality that does not have a protective function Burning, shooting +/- numbness, pins and needles Not well localised
35
A burning shooting pain with pins and needles which cannot be localised is likely
Neuropathic in nature
36
A localised sharp pain is likely
Nociceptive in nature
37
The ascending pain pathway is also called the
Spinothalamic tract
38
Which chemicals are released in the periphery in response to injury
Prostaglandins and substance P
39
What is the first relay station
Dorsal horn
40
Where is the second relay station
Thalamus
41
Where does pain perception occur
The cortex
42
How does modulation of pain occur
Descending pathway from brain to dorsal horn
43
Nerve trauma, diabetic pain, fibromyalgia and chronic tension headache are examples of ______ pain
Neuropathic Nervous system damage or dysfunction
44
Pathological mechanisms of neuropathic pain
Increased receptor numbers Abnormal sensitisation of nerves (peripheral and central) Chemical changes in the dorsal horn Loss of inhibitory modulation
45
Mild opioids
Codeine
46
Strong opioids
Morphine Oxycodone Fentanyl
47
Drugs for neuropathic pain
Tramadol Anti-depressants - amitriptyline, duloxetine Anticonvulsants - gabapentin
48
Disadvantages of morphine
Constipation Respiratory depression in high dose Misunderstandings about addiction Controlled drug Oral dose is 2-3 times higher IV/IM/SC
49
Advantages an disadvantages of tramadol
Less respiratory depression than other opioids Not a controlled drug like morphine Causes nausea and vomiting Causes withdrawal affect - anxiety, tremors, diarrhoea
50
Disadvantages for amitryptiline
Anti-cholinergic side effects e.g. Glaucoma, urinary retention
51
Is the WHO pain ladder applicable to neuropathic pain
Often not Use amitriptylline, gabapentin and duloxetine early
52
The 3 pillars of anaesthesia
Relaxation (skeletal muscle) Hypnosis (sleep) Analgesia (pain relief)
53
What is the best test to assess severity of a patients lung disease with regards to fitness for anaesthesia
Exercise tolerance - questionnaire asking about the ability to do activities without getting breathless
54
Drugs which increase risk of paracetamol toxicity
Carbamazepine | ...
55
Treatment of paracetamol overdose
N-acetyl cysteine
56
Suxamethonium is a
Muscular relaxant It has a very fast onset
57
What is the reported frequency of serious adverse events (that did result in serious harm, disability or death) among hospitalised patients in the UK
1-5%

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