Anaesthetics

Question 1

triad of anaesthesia

Answer 1

hypnotic agent
analgesic
muscle relaxant

Question 2

premedication for GA

Answer 2

6A’s

anxiolytic - benzodiazepam like lorazepam 2mg or midazolam or diazepam
analgesia e.g. in children topical anesthetic creams before inserting a cannula
antiemetics
antacids
antisialogues - glycopyronium to decrease saliva production
antibiotic propylaxis where indicated

none of these might be needed - depends on patient

Question 3

4 IV induction agnets

Answer 3

propofol
thiopentone
etomidate
ketamine

Question 4

reasons for delay in induction of anaesthesia

Answer 4

slow arm-brain circulation time e.g. elderly or CV disease
patient anxiety
recreational drug use

Question 5

what can be given alongside an IV induction agent

Answer 5

an opioid to reduce the dose of the induction agent and smooth the induction process

most commonly fentanyl

it also reduces response to instrumentaion of the airway

Question 6

most commonly used volatile agent to use as an induction agent

Answer 6

sevoflurane

NB intubation of the trachea can be achiveved under deep inhalational induction without muscle relaxation

Question 7

when is a volatile induction agent used

Answer 7

paediatric practice, cases of difficult airway, difficult venous access or inhaled foreign body where maintaining spontaneous ventilation is preferable

Question 8

how is maintenance of anesthesia achieved

Answer 8

usually with volatile agents

or can be done via TIVA

disadvatage of TIVA = difficulty in predicting wake up time (there is some accumulation)

an advantage of TIVA is that is good to avoid post-op nausea as it avoids ematogenic volaties