Anaesthetics

Question 1

name some antiemetics and what neurotransmitters they target?

Answer 1

Ondasteron (serotonin)
Cyclizine (Histamine)
Domperidone/Metoclopromide (Dopamine)

Question 2

what do you include in a Anaesthetics history?

Answer 2

• about previous anaesthetics/family history
• conditions: malignant hyperpyrexia and suxamethonium apnoea
• airway problems
• any previous PONV
• allergies to anaesthetic/analgesic/ABx/latex/eggs

Question 3

how do you treat malignant hyperpyrexia?

Answer 3

reverse with Dantralene

Question 4

What is suxamethonium apnoea?

Answer 4

patient doesn’t have the enzyme to break down propofol

Question 5

Name some drugs which should be stopped 24 hours before the operation?

Answer 5

ACEi/ARB

Question 6

What do you include in a pre-operative assessment?

Answer 6

CVS - HTN/IHD/pacemaker/PVD

RESP - COPD/asthma - can they take NSAIDS/OSA/exercise tolerance

other - reflux, DM, thyroid problems, previous VTE, rheumatoid, smoking, alcohol, drugs]

O/E - heart and lungs, teeth, neck flexibility airway assessment

Question 7

name some causes of a difficult airway

Answer 7

down's syndrome
rheumatoid arthritis
ankylosing spondylitis
obesity
dental abscesses
smally mouth and chin
expensive dental work

Question 8

name some predictive airway tests

Answer 8

mallampati - how much of the oropharynx is visible
extension of the upper c spine
thyromental test - distance from tip of thyroid to tip of mandible at extension (<6 = difficult)

Question 9

what is the triad of anaesthetic drugs?

Answer 9

anaesthesia
analgesia
muscle relaxant

Question 10

what is anaesthesia?

Answer 10

pharmacologically induced and reversible state of sleep characterised by lack of pain/awareness/memory of events

Question 11

what are the stages of anaesthesia?

Answer 11

1. INDUCTION - normally IV (sevofluorane), secure airway to give O2.
2. MAINTENANCE - volatile N2O/O2.

Question 12

when do you need to ventilate?

Answer 12

if muscle relaxants given

GCS <8

Question 13

name some simple manouvres for airway control?

Answer 13

head tilt
chin lift
jaw thrust

Question 14

name some complex airways used for airway control?

Answer 14

oropharyngeal
nasopharyngeal
supraglottic
ET tube

Question 15

how can you determine the correct placement of the ET tube?

Answer 15

chest movement
misting mask
trace on capnography

Question 16

how does local anaesthetic act?

Answer 16

blocks Na channel

Question 17

name some different types of LA (where theyre placed)

Answer 17

nerve block
plexus block
epidural block
spinal block

Question 18

name some benefits of LA

Answer 18

avoids GA
can stay awake
no airway problems
reduced N&V
better pain control peri-op

Question 19

what are the differences between onset and duration of lidocaine and bupivacaine

Answer 19

LIDOCAINE - immediate onset, lasts 15 mins, used in small procedures

BUPIVOCAINE - 10 minute onset, lasts 2 hours, regional blocks use

Question 20

what is a spinal block?

Answer 20

needle goes through ligament and dura

LA bolus which lasts 2 hours

Question 21

what is an epidural?

Answer 21

needle between ligament and dura

LA administered via catheter as a confusion

Question 22

why do we need to use muscle relaxants during surgery?

Answer 22

relax the glottis
relax muscles for surgery
so patient doesn’t resist ventilator

Question 23

name the two types of muscle relaxants

Answer 23

polarising and depolarising

Question 24

name a depolarising muscle relaxant and explain how it works

Answer 24

Suxamethonium - 2ACh molecules bidn to both sites simultaneously - causes contraction and then flaccid paralysis

Question 25

name a non-depolarising muscle relaxant and explain how it works

Answer 25

Rocuronium - competitively inhibits ACh by blocking binding site

Question 26

how can you reverse a muscle relaxant?

Answer 26

Neostigmine - blocks ACh, causes build up of ACh, creates competition with muscle relaxant for binding site.

Question 27

Name 2 drugs you can give if the HR is too slow during surgery

Answer 27

ATROPINE - inhibits vagus | DOBUTAMINE - stimulates B adrenoreceptors in myocardium

Question 28

how can you manage the BP being too low in surgery

Answer 28

stimulate the A adrenoreceptors - causes vasoconstriction

Question 29

name some SE of NSAIDS?

Answer 29

peptic ulcers, AKI, thins blood

Question 30

name some SE of paracetamol?

Answer 30

liver failure, cachexia

Question 31

what is crystalloid solution?

Answer 31

ions and small molecules dissolved in water

Question 32

what are colloids?

Answer 32

large insoluble molecules which are retained within plasma for longer e.g. blood/albumin/starch/gelitin

Question 33

what do you check before prescribing fluids?

Answer 33

``` haemodynamic status ongoing losses can patient drink orally weight renal function UEs ```

Question 34

What is T1RF? name some causes and which ventilation would you use

Answer 34

low O2 and normal CO2 causes: pneumonia, COVID, LVF Use CPAP - maintains the alveolus open and forces fluid from the lungs

Question 35

what is T2RF? name some causes and which ventilation would you use

Answer 35

low O2 and high CO2 causes: COPD, muscular dystrophy, MND, MS use BiPAP - helps with CO2 removal

Question 36

name some complications of IV

Answer 36

VAP, VILI, sedation and muscle relaxants, immobility, stockings, O2 toxicity

Question 37

name some ET tube indcations

Answer 37

protect airway, UA obstructed, NM paralysis, improve oxygenation