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General Anaesthesia Flashcards

(43 cards)

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1
Q

What are the two main categories of anaesthesia?

A
  • General anaesthesia: making the patient unconscious
  • Regional anaesthesia: blocking feeling to an isolated area of the body
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2
Q

What is the triad of general anaesthesia?

A

Hypnosis
Muscle relaxation
Analgesia

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3
Q

What is the function of hypnotic agents in anaesthetics?

A

To make the patient unconscious

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4
Q

What ways can hypotonic agents be given?
When is each option used?

A
  • IV for induction
  • Inhalation to maintain general anaesthetic during operation
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5
Q

4 IV options of hypotonic agents for general anaesthesia

A
  • propofol (most common)
  • ketamine
  • thiopental sodium
  • etomidate
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6
Q

List 4 options of inhaled hypotonic agents for general anaesthesia

A
  • sevoflurane (most common)
  • desflurane (bad for environment)
  • isoflurane
  • nitrous oxide (in children in combination)
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7
Q

What does it mean if an anaesthetic agent is volatile?
List three examples

A

Volatile agents are liquid at room temp + need to be vaporised into a gas to be inhaled
e.g. sevoflurane, desflurane, isoflurane

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8
Q

What is total intravenous anaesthesia TIVA?
What drug is most commonly used?

A

Using IV medication for induction and maintenance of general anaesthetics
propofol

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9
Q

MOA of IV anaestheics

A

Potentiate GABAA
Expect ketamine - inhibits glutamate

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10
Q

What are the two categories of muscle relaxants during anaesthetics?
How do they work
Examples

A
  • depolarising: act as ACh receptor agonists e.g. suxamethonium
  • non-depolarising: competitive ACh receptors antagonists e.g. rocuronium + atracurium
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11
Q

What are used to reverse muscle relaxants medications?
Example

A
  • cholinesterase inhibitors e.g. neostigmine
  • sugammadex specifically for certain non depolarising muscle relaxants
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12
Q

What analgesia is most frequently used in anaesthetics?
Examples of most common

A

opiates
- fentanyl
- alfentanil
- remifentanil
- morphine

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13
Q

What are the most common drugs given at the end of procedure to prevent post-op N+V?

A

ondanestron
dexamethasone
cyclizine

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14
Q

What group of patients should ondansetron be avoided in?

A

Pts at risk of prolonged QT interval

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15
Q

What group of patients should dexamethasone used with caution in?

A

Diabetics
Immunocompromised pts

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16
Q

What group of patients should cyclizine be used with caution in?

A

Heart failure
Eldery

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17
Q

What is awareness under anaesthesia?

A

When a patient regains consciousness whilst still paralysed

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18
Q

A nerve stimulator can be used to test muscle responses before waking patient up.
Where is this often tested?
Explain the process

Study These Flashcards
A
  • ulnar nerve - watching for thumb movement
  • train of four stimulation - nerve is stimulated 4 times to see if the muscle response remains strong
19
Q

What is train of four stimuation

Study These Flashcards
A

nerve is stimulated 4 times to see if the muscle response remains strong

20
Q

Risks of general anaesthesia

Study These Flashcards
A
  • sore throat
  • post operative N+V
  • accidental awareness
  • aspiration
  • anaphylaxis
  • dental injury
  • CV events e.g. MI, stroke, arrhythmias
  • malignant hyperthermia
  • death
21
Q

Common adverse effects of general anaesthesia

Study These Flashcards
A

Sore throat
Post operative N+V

22
Q

What is malignant hyperthermia?
What does it cause?

Study These Flashcards
A

Hyper metabolic response to anaesthesia causing:
- hyperthermia
- increased CO2 production
- tachycardia
- muscle rigidity
- acidosis
- hyperkalaemia

23
Q

What agents have a risk of malignant hyperthermia?

Study These Flashcards
A
  • volatile anaesthetics e.g. isoflurane, sevoflurane
  • suxamethoium
24
Q

Treatment of malignant hyperthermia

Study These Flashcards
A

IV Dantrolene

25
Outline fasting before an operation
- 6 hours of no food or feeds - 2 hours of no clear fluids
26
Why must patients fast before operation?
Reduce the risk of stomach content reflux + aspirating into tranche > aspiration pneumonia + pneumonitis
27
What is preoxygenation?
Before being put under GA, patients breathe 100% oxygen for a few minutes
28
Why is preoxgenation done?
Gives the patient a reserve of oxygen for the period between losing consciousness and successful intubation + ventilation Displaces nitrogen in lungs with oxygen
29
What premedications can be given before GA? What are their functions?
- **benzodiazepines**: *e.g. midazolam* to relax muscles + reduce anxiety - **opiates**: *e.g. fentanyl* to reduce pain + hypertensive repsonse to laryngoscope - **alpha-2-adrenergic agonists**: *e.g. clonidine* help with sedation + pain
30
What is rapid sequence induction/intubation?
Used to gain control over airway as quickly + safely as possible in an emergency scenario (no fasting)
31
When is rapid sequence induction/itubation needed?
- emergency cases (no fasting) - pregnancy - GORD patients
32
What can be done during rapid sequence induction/intubation to reduce aspiration risk?
Upright bed position Cricoid pressure (controversial -only if trained)
33
Why is nitrous oxide often added to volatile agents?
To reduce the dosing > reduces the side effects
34
What does it mean if drug is 2%?
X10 > 20mg/ml
35
How do you get from drug % to mg/ml?
X10 *e.g. 1% > 10mg/ml*
36
What is the ASA scoring for surgery?
- **ASA 1**: normal, healthy patient - **ASA 2**: patient with mild, well controlled systemic disease - **ASA 3**: patient with severe systemic disease that limits activity - **ASA 4**: patient with severe, life threatening disease - **ASA 5**: morbid patient not expected to survive without the operation
37
What is ASA 4 and what diseases would make someone this?
- a patient with severe systemic life threatening disease - recent (<3 months) MI, TIA, stent - on going cardiac ischaemia, severe valve dysfunction - sepsis - ESRD without dialysis
38
What ASA score with a healthy pregnant person be? (even if they have well controlled gestational HTN or diet controlled gestational diabetes)
ASA 2 - patient with mild systemic disease
39
What scoring is used for airways?
Mallampatti score MP
40
What is the mallampatti scoring system for airways?
- **class I**: complete visualisation of the soft palate, tonsils + uvula - **class II**: visualisation of hard + soft palate, upper tonsils + uvula - **class III**: visualisation of only the base of the uvula - **class IV**: only hard palate visual
41
What neuromuscular blocker is contraindicated in hyperkalameia?
Depolarising muscle relaxants *e.g suxamethonium*
42
Pathophysiology of malignant hyperthermia
- Autosomal dominant condition of ryanodine receptor RyR1 - Excessive release of Ca2+ from sarcoplasmic reticulum of skeletal muscle - Causes over contraction of muscles
43
MOA of dantrolene
Prevents Ca2+ release from sarcoplasmic reticulum

Anaesthetics (9 decks)

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