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Neurological, neuromuscular and musculoskeletal disease > Anaesthesia > Flashcards

Anaesthesia Flashcards

1
Q

Sleep =

A

Period of rest of body and mind. Rapidly reversible with external stimuli

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2
Q

Sedation =

A

Allows patients to tolerate unpleasant diagnostic/surgical procedures.

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3
Q

What is maintained in sedation?

A

Verbal contact

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4
Q

Coma =

A

State of extreme unresponsiveness in which an individual exhibits no voluntary movement or behaviour

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5
Q

Anaesthesia is classified into:

A

General

Local

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6
Q

Triad of balanced anaesthesia =

A

Hypnosis
Areflexia
Analgesia

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7
Q

Areflexia =

A

no response to surgical stimuli

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8
Q

Undesirable effects of anasthesia =

A

Decreased cardiac contractility
Sympathetic inhibition
Respiratory depression

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9
Q

At too high concentrations, anasthesia can cause =

A

All brain functions to be depressed

Respiratory failure - death

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10
Q

Classes of general anasthetics

A

Inhalation

Intravenous

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11
Q

Inhalational anasthetics:

A

Gas

Liquids

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12
Q

Ex of gas GA

A

N2O

Cyclopropane

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13
Q

Ex of liquid GA

A

Halothanes: halothane, isoflurane

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14
Q

Intravenous GA:

A

Inducing
Dissociative
Neurolept

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15
Q

Inducing GA ex:

A

Propofol
Thipentane
Etomidate

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16
Q

Dissociative DA ex;

A

Ketamine

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17
Q

MoA of inducing GA

A

GABA agonist, increase GABA sensitivity

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18
Q

MoA of ketamine:

A

NMDA antagonist

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19
Q

Thiopentane is a

A

Barbituate

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20
Q

Side effects of thiopentane

A
  • CVS depression
  • Resp depression
  • Bronchoconstrictions
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21
Q

What shouldn’t be given to asthmatics?

A

Thiopentane

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22
Q

MoA of inhalational GA

A

NMDA antagonist

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23
Q

Onset of IV vs inhalational

A

Inhalation: slow, alveolar gas exchange
IV: rapid

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24
Q

Offset of IV vs inhalational:

A

Inhalational: alveolar gas exchange
IV: redistribution, metabolism

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25
Metabolism of inhalational vs IV
Inhalational: almost none IV: liver
26
Types of local anaesthetics:
Esters | Amides
27
MoA of LA:
Voltage gated Na+ antagonists
28
Effect of LA depends on:
Diffusion graident Fiber size Myelination
29
Which fibers do LAs work on?
Alpha delta | C fibers
30
Alpha delta fibers nociceptors:
Mechanical | Thermal
31
C fiber nociceptors:
Polymodal
32
1st pain vs 2nd pain
1st pain = alpha delta, sharp, localised | 2nd pain = c fibers, dull, diffuse
33
LA are less effective in what type of tissue?
Acidic
34
Due to LAs being weak bases, what do they not work on
Abscesses
35
LA toxicity occurs when
Sodium channels in ALL excitable tissue potentially blocked
36
What organ shows the first sign of LA toxicity?
Brain
37
First signs of LA toxicity =
Perioral tingling | Feeling of doom
38
LA toxicity is initially
Excitory = agitation confusion perioral tingling
39
After excitatory LA toxicity becomes
Depressive: CNS = LOC, respiratory arrest Heart = cardiac arrest
40
General management of LA toxicity -
- Recognise - Stop injecting - ABC, oxygen, crash call - Intralipid
41
Intralipid =
20% lipid solution provides lipid load to vascular space. LA absorbed into lipid solution.
42
2 types of neuromuscular blocking agents =
1. Depolarising | 2. Non-depolarising
43
Neostigmine =
AChE
44
Tubcurarine =
Non-depolarising blocking agent
45
Suxamethonium =
Depolarising blocking agents
46
Succinylcholine =
Depolarising blocking agents
47
Depolarising NMB agent =
- Binds to nicotinic cholinergic receptor and causes depolarisiation
48
What patient should you not give depolarising NMB agent to?
Hyperkalaemic
49
Effects of depolarising NMB on parasympathetic NS:
Muscle fasiculations Bradycardia Hyperkalaemia
50
Moa of non-depolarising NMB agent =
Competes with Ach for binding site. Doesn't stimulate receptor
51
Non-depolarising NMB agent has no=
K+ efflux | No fasiculations
52
Novochock is =
AchEi
53
Side effects of nerve agents:
``` Bradycardia Increase secretions (saliva, bronchial, GI - foaming at mouth) ```
54
Treatment for nerve agents =
Atropine
55
Risks of GA
- CNS, CVS, RS depression - Aspiration of gastric contents - Awareness - Postop nausea and vomiting, respiratory complications - death
56
Why are patients of GA nil by mouth?
Apiration of gastric contents
57
Benefits of GA
Unconscious Optimal access Total control of RS< CVS, CNS Complications easy to treat
58
Risks of LA
Not suitable for operation Fails Nerve injury Toxicity
59
Benefits of LA
Avoid GA complications Less GI disturbance Less risk of DVT
60
4 stages of anasthesia:
1. Induction 2. Excitement 3. Surgical 4. Danger
61
Induction stage:
Analgestia --> LOC
62
Pupils in induction stage:
Reflex present
63
Excitement phase:
FOllows LOC. | Irregular respiration, HR, uncontrolled movement, vomiting, breath holding, pupil dilation
64
Pupils in excitement phase:
Dilated, reflex present
65
Surgical phase:
Resp depression, skeletal muscles relax
66
Pupils in surgical phase:
dilate , no reflex
67
Overdose phase:
Severe brainstem and medullary depression
68
Pupils in overdose phase:
Dilated
69
MAC:
Measures exhaled concentration
70
BIS =
Bispectral index monitor
71
What does BIS do?
Interprets EEG into wakefulness scale
72
BIS when fully awake =
100
73
BIS when no EEG activity
0
74
BIS scale for surgical anaesthesia =
45-60

Neurological, neuromuscular and musculoskeletal disease (22 decks)

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