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Anaesthetics, ED and Plastics > Conduct + Principles of Anaesthesia > Flashcards

Conduct + Principles of Anaesthesia Flashcards

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1
Q

What is the triad of anaesthesia and what types can you get

  • General
  • Regional - epidural / spinal
  • Local
A

Analgesia
Relaxation
Hypnosis

Balanced anaesthesia has contribution from all 3 but doesn’t require all 3
Allows flexibility
Can titrate doses so more accurate
Avoid overdosage

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2
Q

What provides analgesia

A

LA
Regional block
Opiates

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3
Q

What provides relaxation

A

LA
Muscle relaxants
General anaesthetics

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4
Q

Why is relaxation needed

A

Provide immobility for procedures and allow ventilation

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5
Q

What provides hypnosis / unconsciousness

A

GA

Opiates - small affect (lessen pain so less GA needeD)

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6
Q

What is always needed with a GA

A

Hyponosis

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7
Q

What is a GA

A

Central acting drugs which cause whole body unconsciousness except ketamine

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8
Q

What is regional anaesthesia

A

Insensbility in an area or region
Applied to nerves supplying area
Nerve and plexus block including spinal and epidural

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9
Q

What is a LA

A

Insensibility in relevant part of body

Applied directly to tissues

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10
Q

How can GA be given

A

Inhaled or IV

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11
Q

What does GA lead too

A

Hypnosis
Small degree of relaxation
Neglible analgesia except for ketamine

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12
Q

What does GA require

A

Airway management

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13
Q

How does GA work

A

Hyperpolarise neuronal ion channels
Less likely to fire
More complex processes lost first e.g. cerebral function and reflexes relatively spared

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14
Q

What is halothane and what are SE

A

Inhaled GA
Hepatotoxity - NO LONGER USED DUE TO THIS
Myocardial depression
Malignant hyperthermia

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15
Q

What is thiopental and what are SE

A 
IV GA
Cause laryngospasm
Rapid onset 
Quickly affects brain
Use if short procedure or risk of ICP
Reduces CO so not in truama/. hypovolaemia
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16
Q

What is propofol used for

A 
Rapid onset 
Rapid loss of reflexes
No obvious planes of GA 
Widely used to maintain sedation / total IV anaesthesia and day case 
Radidly metabolised 
Anti-emetic
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17
Q

SE

A

Pain on IV injection so use with LA

Moderate myocardial and resp depression

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18
Q

What is agent of choice for rapid induction

A

Sodium thiopentone

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19
Q

SE / disadvantages

A

Metaoblites build up quick
Little analgesia
Marked myocardial depression

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20
Q

What is used in young children and why

A

Sevoflurane gas
Slow
More obvious planes of anaesthesia

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21
Q

When is ketamine useful for

A

Can be used for induction
Little myocardial depression and does not cause hypo so better if haemodynaimcally unstable / polytrauma
Also has mod-strong analgesic properties
Can increase BP so avoid in HTN or ICP

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22
Q

What has most favourable cardiac safety

A

Etomidate

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23
Q

What is it unsuitable for

A

Maintaining sedation as risk of adrenal suppression

Also high post-op vomiting

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24
Q

What is the sequence of GA

A 
Pre-op
- Premeds 
- Pre-oxygen 
Preparation
Induction
Maintenance
Emergencies 
Recovery
Post op care and pain management
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25
What is IV induction
Rapid onset with rapid recovery
26
What is inhalation induction WHAT IS MAC
Slow and prolonged duration Minimum alveolar conc = minimum drug to produce anaesthesia Low MAC = very potent
27
What is most common
IV induction with inhalation maintenance
28
What are planes of anaesthesia
Analgesia Excitation Anaesthesia - light then deep Overdose
29
What is needed during GA
``` Careful monitoring of conscious - Loss of verbral - Movement - RR - EEG - Planes Airway maintenance ```
30
What is minimum monitoring with GA
``` SpO2, FiO2, ETCO2 NIBP - non-invasive BP ECG Temp / UO / NMG Invasive venous / arterial ```
31
What happens when awakening
``` Change inspired gas to 100% O2 only Discontinue anaesthetic Use nerve stimulator to check some reversal has occurs Muscle relaxation wears of Anaesthetic wears of Can give anti-cholinesterase to reverse Return of airway reflex Remove ET once breathing spontaneous Adminster O2 via facemask Transfer to recovery ```
32
What happens in recovery
Dedicated area Many may still be unconscious or requiring airway control Pain control - Pain ladder - Have naloxone written up PRN incase of opiate overdose N+V management
33
What is the physiology of GA
Depress CVS - Reduced sympathetic - -ve inotrope - Vasdilaton so decreased resistance - Ventilation so decreased return and CO - Decreased MAP Depress Resp - Reduced hypoxic and hypercarbic drive - Reduced TV and increased RR (opiates opposite) - Decreased FRC
34
What can be prolonged after GA
Decreased FRC Lower lung volume / V/Q mismatch May need post op O2
35
How do muscle relaxants work
Paralyse skeletal muscle by blocking NMJ | Affects resp and airway muscles
36
What are indications for muscle relaxant
Ventilation and intubation Microscopic surgery Neurosurgery Body cavity surgery
37
What are problems with relaxant
Awaerness Incomplete reversal leading to obstrcution Apnoea so need airway support
38
What is used to reverse muscle relaxant
Neostigmine if non-depolarisation
39
What are types of muscle relaxant
Depolarizing | Non-depolarizing
40
Example of depolarising
Suxamethonium
41
How do they work
Bind to Ach receptors and first activates Cause fasciculation then paralysis Deactivated by acetylcholinesterase Rapid onset and short acting
42
What happens if cholinesterase deficiency / myasthenia graves Rx
Prolonged action leading to resp arrest | Keep ventilated whilst drug degrades
43
What are SE
Malignant hyperthermia | Hyperkalaemia
44
What is muscle relaxant of choice for rapid
Suxamethonium
45
What are CI to suxamethonium
Penetrating eye injury Acute narrow angle glaucoma as increased pressure Causes a transient rise in IOP FH suxamethonium apnoea
46
What are examples of non-depolarising
Tubcurarine Vecuronium Pancuronium
47
How do they work and what is used to reverse
Antagonise Ach receptor Neostigmine Longer onest and longer lasting No fasciculation
48
AE
Hypotension
49
Why is intraoperative analgesia used
Prevent arousal Suppress reflex responses to painful stimuli e.g. tachy and hypertension Opiates can contribute to hypnosis of GA
50
Why are regional good
Less GA needed as eliminates pan | Has no sedative effects itself
51
Physiology of local and regional anaesthetic
``` Retain awareness and consciousness Affects CVS proportional to size of area Veno and vasodilation Decreased FRC Increased V/Q mismatch ```
52
How does lidocaine work
Blocks Na channels so no AP is sent Hepatic metabolism Protein bound Renal excretion
53
What does lidocaine interact with
BB Ciprofloxacin Phenytoin
54
What is it useful for
Local wounds Fast acting Doesn't last long
55
What may be added to LA and what does it do
Adrenaline Prolongs duration of action Permits uses of higher doses as limits systemic absorption as vasoconstriction
56
When is adrenaline CI
MAOI TCA Procedures where risk of digital ishaemia
57
Max safe dose of lidocaine
3mg / kg | 7mg / kg if 1% or 2% adrenaline 1 in200,000
58
Max safe dose of bupivacaine
2mg / kg
59
Max sae dose of prilocaine
6mg / kg
60
What is buivacaine good for
Topical wound infiltration at end of surgery as longer duration
61
When is it CI
Regional as cardiotoxic so if tourniquet fails will affect heart
62
What is 1st line in regional
Prilocaine as less cardiotoic
63
How is cocaine applied
Paste in conc of 4% + 10% Causes vasoconstriction Lipophillic and cross BBB causing arrhythmia / tachy
64
When is cocaine used
ENT Nasal mucosa Otherwise not used
65
What must you do if injecting LA
Aspirate to make sure not in blood vessel as would constrict the heart
66
Calculations = important for exam
1% lidocaine = 10mg in 1 ml If max dose worked out as 180mg then this is 18ml (move decimal point) If 2% = 20mg in 1ml If given 20ml = 40mg of drug If 20ml of 2% lidocaine given what is the mg = 400mg 2g in 100ml 20ml = 400mg
67
What are signs of lidocaine toxicity
``` Tingling Light head Tinnitus Visual disturbance Muscle twitching Confusion Agitation Drowsy CVS depression Seizure Collapse Abnormal ECG ```
68
What increases risk of toxicity
Liver issue | Low protein
69
How do you monitor
ABCDE Help - ICU / anaethestist IV intra-lipid Benzo - midalazam to prevent seizure
70
What level of care does LA require
Same IV access Anaesthesist
71
If need more than LA what can you do
Regional nerve block | Epidural or spinal
72
What are indications for spinal
Avoid a GA Severe respiratory disease / cardio Allergy to GA
73
What are CI
``` Fixed CO due to stenosis Infection Bleeding Anti-caog Technical difficulties Spinal problem ```
74
What is a TIVA
Total IV anaesthesia
75
What is malignant hyperthermia
AD condition following administration of anaesthetic | Often FH
76
What happens
``` Excessive release of Ca2 from SER of skeletal muscle Sudden increase in O2 requirement Hyperpyrexia - can be a late sign Muscle rigdity Tachycardia CK raised ```
77
What causes
Halothane Suzemthonium Anti-psychotics= NMS
78
How do you Rx
Stop offending agent Hyperventilate Dantrole - prevents Ca2 release Take to ITU
79
Why is analgesia used in maintenance
Body still response to pain i.e. BP and HR increase
80
What should you always have written up with opiates
Naloxone PRN incase of overdose
81
What are complications of GA
``` Anaphylaxis Oesophageal intubation / airway management Temp control Loss o protective reflexes VTE Atelectasis Awareness - Careul monitoring of sedation Bronchospasm Laryngospasm Malignant hyperthermia Suxamethonium apnoea Unable to consent ```
82
What do you do for bronchospasm
``` 100% O2 Salbutamol Steroid Mg Same as asthma ```
83
What causes laryngospasm
Irritation with vapour | Make sure patient paralysed fully
84
What is suxamethonium apnoea
Pseudo-cholinesterase definceicny | AD
85
What happens
Prolonged muscle relaxation Lasts 24 hours Have to keep in ITU ventilated till it wears of as nothing to reverse
86
What are signs of anaphylaxis if under GA
Hypotension + tachycardia = 1st signs Desaturation = later sign Rash + angioedema = late sign Won't have cough or resp distress as under GA
87
What are signs of oesophageal intubation instead of tracheal
Desaturation CO2 trace diminishes Unable to hear air entry despite being able to hand ventilate

Anaesthetics, ED and Plastics (14 decks)

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