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Finals - Acute & Critical Care & Anaesthetics > Anaesthetic Drugs > Flashcards

Anaesthetic Drugs Flashcards

(74 cards)

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1
Q

What is the triad of anaesthesia?

A

Hypnosis (unconscious)
Relaxation
Analgesia (pain-free)

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2
Q

What agents are used for hypnosis?

A

Anaesthetic agents (IV or Inhaled)

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3
Q

What agents are used for relaxation?

A

Muscle relaxants (depolarising or non-depolarising)

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4
Q

What agents are used for analgesia?

A

Analgesia (fentanyl or morphine)

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5
Q

What are the commonly used IV anaesthetic (hypnosis) agents?

A

Propofol - most common UK
Thiopentone
Ketamine
Etomidate

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6
Q

What is propofol?

A

An IV anaesthetic agent - ‘milk of anaesthesia’

Used for induction and maintenance

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7
Q

What is the dose of propofol for induction?

A

1.5-2.5 mg/kg

Less in elderly, more in children

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8
Q

When TICA is used for anaesthesia what does this refer to?

A

When an IV agent e.g. Propofol is used as a bolus for induction and then as an infusion for maintenance during the surgery

Total IV anaesthesia
CANULA MUST ALWAYS BE VISIBLE

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9
Q

What are the respiratory effects of Propofol?

A

Respiratory - short period of apnoea and suppression of larygeal reflex
Allows insertion of I-gel without muscle relaxant

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10
Q

What are the cardiovascular effects of Propofol?

A

Reduction in SVR (systemic vascular resistance), CO and BP

*risk in elderly

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11
Q

What are the CNS effects of Propofol?

A

Reduced intracranial pressure and cerebral oxygen concentration

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12
Q

What are the other effects of Propofol?

A

Anti-emetic effects

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13
Q

What is Thiopentone?

A

IV anaesthetic agent - Thiobarbiturate

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14
Q

In what situation is Thiopentone commonly used?

A

RSI - Rapid sequence induction

often in maternity unit

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15
Q

What is the dose of Thiopentone?

A

4-6 mg/kg

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16
Q

What is another use for Thiopentone?

A

Used in status epilepticus

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17
Q

What are the CNS effects of thiopentone?

A

Reduced intracranial pressure and metabolic rate of oxygen.

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18
Q

What are the CVS effects of thiopentone?

A

Reduction in SVR, CO and BP

Causes compensatory tachycardia

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19
Q

What are the respiratory effects of thiopentone?

A

Respiratory depression

Unlike propofol the reflexes are preserved so not suitable for use alone with laryngeal mask airway

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20
Q

What are the other effects of thiopentone?

A

Extravasation can cause pain and tissue damage due to high pH
Always flush with saline and avoid in porphyria

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21
Q

What is Ketamine?

A

IV anaesthetic agent - Antagonist of NMDA receptor

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22
Q

What is the dose of Ketamine?

A

1-2 mg/kg

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23
Q

What routes can ketamine be used by?

A

IV, IM, Rectally, Nasally, Epidurally

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24
Q

What patients is Ketamine commonly used in?

A

Shocked, burned or paediatric patients (haemodynamically compromised)
‘Field anaesthesia’

Also potent analgesic

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25
What are the CNS effects of ketamine?
Analgesia, raised ICP, hallucinations, dissociative anaesthetic
26
What are the CVS effects of ketamine?
Increases BP and HR, increased CO | Why useful in haemodynamically unstable patient
27
What are the respiratory effects of ketamine?
Preserved laryngeal reflexes (may cause laryngospasm), bronchodilator, minimal effect on central respiratory drive.
28
What is etomidate?
IV anaesthetic agent - agonist activation of GABA receptors
29
What is the dose of etomidate?
0.3 mg/kg
30
What are the benefits of etomidate?
Patients who require highly cardiovascular stability profile.
31
What is the downside of etomidate?
Inhibits adrenocortical steroid synthesis, observed endocrine effects. Reduction in cortisol and aldosterone. Increased N&V
32
What are the CVS effects of etomidate?
Stable CV profile (benefit) | Minimal effect on myocardial contractility
33
What are the CNS effects of etomidate?
Cerebral vasoconstriction, may cause involuntary muscle movements and tremor
34
What are the respiratory effects of etomidate?
Transient apnoea, | Coughing and hiccupping are common during induction
35
What are the other effects of etomidate?
Increased incidence of post-op N&V Pain on injection Potent inhibitor of steroidogenesis in adrenal cortex Unsuitable in porphyria Not commonly used anymore
36
What are the three major volatile inhalation anaesthetic agents?
Sevoflurane Isoflurane Desflurane
37
What is sevoflurane?
Volatile inhalation anaesthetic agent | Can be used in gaseous induction or maintenance Good in young children who won't tolerate canula
38
What is MAC?
Minimum alveolar concentration - alveolar concentration of gaseous agent required to ensure 50% of test population don't respond to surgical incision
39
What is isoflurane?
Volatile inhalation anaesthetic agent Cheaper and more potent than sevoflurane but irritant with a pungent smell - cannot be used for gaseous induction
40
What is desflurane?
Volatile inhalation anaesthetic agent Pungent - not suitable for gaseous induction Must be shielded from light and have Tec 6 vaporiser
41
What is a risk of all volatile inhalation agents?
Malignant hyperthermia
42
What are the two types of muscle relaxants?
Depolarising and non depolarising
43
What is the only depolarising muscle relaxant used in clinical practice?
Suxamethonium (Sux)
44
What is the function of Suxamethonium?
(Similar to ACh) | Agonist at post junctional NAChR (Nicoticic ACh receptor)
45
What are the uses of Suxamethonium?
Rapid and short periods of muscle relaxation (Rapid Sequence Induction), ECT Muscle function returns within 5 mins.
46
What is the dose of Suxamethonium?
1-1.5 mg/kg
47
What is the onset of Suxamethonium?
Rapid onset - 90% laryngeal muscle block in 50 seconds | Recovery begins after 3-5 minutes, complete within 12-15 min
48
What are the downsides to Suxamethonium?
Myalgia | Elevation of serum potassium (wouldn't use if already raised)
49
What are the potential complications of suxamethonium?
Bradycardia Anaphylaxis Malignant hyperthermia (rigidity, high temp) Prolonged block - sux apnoea
50
What is the treatment of malignant hyperthermia?
Dantrolene
51
What is malignant hyperthermia?
Autosomal dominant condition in which certain drugs induce increased muscle metabolism and dangerous hyperthermia
52
What are the non-depolarising muscle relaxants?
``` Rocuronium - Aminosteroid Vecuronium - " Pancuronium - " Atracurium - Bis-benzylisoquinolinium Cisatracurium - " Mivacurium - " ```
53
What are the two groups of non-depolarising muscle relaxants?
Animosteroids - CURONIUM | Bis-benzylisoquinoliums - CURIUM
54
How do non-depolarising muscle relaxants work?
Compete for the same binding site as ACh | Reducing potential number of interations - reducing in liklihood of action potential being reached
55
What side effects are reduced with non-depolarising muscle relaxants?
No fasiculations No myalgia No potassium released No malignant hyperthermia
56
What is Rocuronium?
Non-depolarising muscle relaxant - Aminosteroid
57
What is the intubating dose of Rocuronium?
0.6 mg/kg
58
What is the onset of rocuronium?
Rapid 75s duration 33m Rapid onset, low potency Can be used as an alternative to Sux for RSI
59
How can rocuronium be reversed?
Sugammadex
60
What do the aminosteroid non-polarising muscle relaxants (NMBA's) rely on for elimination?
Renal and hepatic function
61
What is Atracurium?
Non-depolarising muscle relaxant - Bis-benzylisoquinoliniums
62
What is the intubating dose of Atracurium?
0.5 mg/kg
63
What is the onset of Atracurium?
Slow onset time 110 seconds, not suitable for RSI
64
What population is Atracurium suitable in?
Elimination independent of liver and kidney function so suitable for use in critically ill patients.
65
What are the two main options for analgesia?
Fentanyl and Morphine
66
What is Fentanyl?
Synthetic morphine, potent agonist at mu opioid receptor
67
What is the potency of fentanyl?
100 x more potent than morphine, short acting
68
What dose of morphine is given at induction?
1-3 ug/kg often given at induction before IV induction agent
69
What function aside from analgisia does Fentanyl have?
Reduced response to laryngoscopy
70
What are the downsides to fentanyl?
``` Metabolised in the liver Bradycardia and low BP common Can cause respiratory depression N&V post-op Urinary retention Constipation and itching Chest wall rigidity ```
71
When are fentanyl and morphine usually used?
Fentanyl for induction (5m before) | Morphine during the operation
72
What is morphine?
Naturally occurring opiate
73
What is the potency and onset of morphine?
Less potent, slower onset than fentanyl
74
What are the downsides to morphine?
``` Metabolism occurs in the liver May reduce BP and HR Respiratory depression N&V post op Urinary retention Constipation Itching Histamine release - asthmatic bronchospasm ```

Finals - Acute & Critical Care & Anaesthetics (7 decks)

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