Anaesthetics

Question 1

What are the two types of anaesthetics?

Answer 1

IV

Inhaled

Question 2

What are the two main types of Inhaled Anaesthetics?

Answer 2

Volatile Liquid

Nitrous Oxide

Question 3

Give some names of Volatile Liquids used in anaesthetics.

Answer 3

Isoflurane

Desflurane

Question 4

What are Volatile liquids (-flurane) used in?

Answer 4

Induction and maintenance of anaesthesia

Question 5

What are some risks associated with Volatile Liquids -fluranes

Answer 5

Myocardial suppression and hyperthermia

Question 6

What is Nitrous oxide used in?

Answer 6

Induction and maintenance of anaesthesia.

Often pre IV to relax

Question 7

When should NO be used in caution?

Answer 7

Patients with a Pneumothorax as can diffuse into space increasing the pressure.

Question 8

Give the main IV anaesthetic agents.

Answer 8

Propofol
Thiopental
Etomidate
Ketamine

Question 9

What is the most frequently used IV anaesthetic.

Answer 9

Propofol

Question 10

What is Propofol mode of action?

Answer 10

GABAa inducer

Question 11

What is a negative in regards to propofol

Answer 11

Very painful on injection

Causes hypotension

Question 12

If you are inducing a patient who has a history of severe post anaesthetic nausea what anaesthetic is most commonly used?

Answer 12

Propofol - Anti emetic effects

Question 13

What is Thiopentals MOA

Answer 13

GABAa

Question 14

Describe Thiopental and how this impacts its affect.

Answer 14

Highly lipid soluble so acts very quickly on the brain.

Used in Rapid Sequence Induction

Question 15

What is Thiopental associated with?

Answer 15

Laryngospasm

Question 16

If you have an surgery booked with a patient who is hypotensive what anaesthetic could you use?

Answer 16

Etomidate - less hypotensive affects

Question 17

What is Etomidate’s MOA

Answer 17

GABAa

Question 18

What are some risks associated with Etomidate?

Answer 18

Primary Adrenal Suppresion and Myoclonus

Question 19

If you’ve got an acute emergency surgery for a poltrauma patient who is haemo-dynamically unstable. What is your anaesthetic of choice?

Answer 19

Ketamine

Question 20

What are some issues with Ketamine?

Answer 20

Disorientation and Hallucination

Question 21

Ketamine MOA

Answer 21

NMDA antagonist

Question 22

What three things are required in surgery?

Answer 22

Anaesthetic
Paralytic
Pain Killers

Question 23

What are the two types of Paralytic drugs?

Answer 23

Depolarizing

Non Depolarizing

Question 24

You’ve got an acute patient requiring immediate intubation what paralytic would you use? Why?

Answer 24

Depolarizing - Suxamethonium

Rapid acting

Question 25

What do depolarising paralytics work on?

Answer 25

Nicotinic ACh receptors - Agonist

Question 26

If you see a patient who has been injected with a paralytic experience fasciculations what is the likely medication?

Answer 26

Depolarising | Suxamethonium

Question 27

What are some risks associated with Suxamethonium?

Answer 27

Hyperthermia and Hyperkalaemia | Fasciculations - anaesthetise first.

Question 28

When should suxamethonium be avoided?

Answer 28

Penetrating eye injuries | Acute angle Glaucome

Question 29

Why are non depolarising IV paralytics more commonly used for routine surgery?

Answer 29

Depolarising - no control when paralytic action stops. Withdrawal can happen randomly. Short half life Non depolarising - longer half life and can be reversed quickly

Question 30

Give some examples of non depolarising IV paralytics.

Answer 30

Vecuronium. Pancuronium Rocuronium -curonium

Question 31

What can be used to revere the paralysis caused by Non Depolarising Paralytics?

Answer 31

Neostigmine

Question 32

What are some issues with Non Depolarising - curonium - paralytics?

Answer 32

Can cause hypotension

Question 33

What Cardio Drugs should be stopped on the day of surgery?

Answer 33

ACE ARB Diuretics. Unless for HF

Question 34

If you decided to stop Antiplatelets prior to surgery how long should they be stopped for?

Answer 34

Aspirin and Clopidogrel 7 days

Question 35

What do Non Depolarising Paralytics work on?

Answer 35

Nicotinic ACh Antagonists

Question 36

A patient presents with apnoea post general anaesthesia. What is the likely culprit?

Answer 36

Suxamethonium - apnoea is linked to a deficiency in the enzyme needed to break it down.

Question 37

Which condition causes you to have an increased sensitivity to non depolarising anaesthetics.

Answer 37

Myasthenia Gravis

Question 38

Non depolarising anaesthetic works by.

Answer 38

Antagonistic binding of ACh receptors

Question 39

Depolarising anaesthetics work by.

Answer 39

Agonistic binding of ACh

Question 40

In rapid sequence induction what is the muscle relaxant of choice?

Answer 40

Suxamethonium

Question 41

What is the management of malignant hyperthermia?

Answer 41

IV Dantrolene

Question 42

Major side affect associated with etomidate?

Answer 42

Adrenal Suppression