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Anesthetics > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

What are inhalational agents used for?

A

Maintaining amnesia

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2
Q

What is the process for general anaesthesia?

A

Monitoring

IV access

Induction of anaesthesia

Start analgesia + muscle relaxant

Maintain process

Reverse proces

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3
Q

What is the minimum monitoring needed?

A

ECG

Sp02

NIBP

Airway gases (O2, CO2, vapour)

Airway pressure

Nerve stimulator (if muscle relaxant used)

Temperature (due to hypothermia risk)

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4
Q

What drugs can be used as induction agents?

A

Propofol, Ketamine, Etomidate

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5
Q

Describe propofol, its properties + SE

A

Most common

Lipid based

Excellent suppression of airway reflexes + Reduces PON+V

SE: drop in HR + BP, pain on injection, involuntary movements

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6
Q

Describe the use of ketamine (properties + SE)

A

Causes dissociative anaesthesia - anterograde amnesia + profound analgesia

Sole anaesthetic for short procedures

Slow onset (90s)

SE: rise in HR + BP

Bronchodilation

N+V, emergence phenomenon

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7
Q

Describe etomidate’s properties + SE

A

Rapid onset

Haemodynamic stability

Lowest incidence of hypersensitivity reaction

SE: pain on injection, spontaneous movements, adreno-cortical suppression, high incidence PONV

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8
Q

What are the 4 amnesia inhalational agents?

A

Isoflurane, Sevoflurane, Desflurane, Enflurane

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9
Q

What is MAC?

A

Minimum alveolar concentration

Min concentration of the vapour that prevents the reaction to a standard surgical stimulus in 50% of subjects

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10
Q

What is emergence phenomenon?

A

Can occur with ketamine

Pt is elated or depressed after coming round

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11
Q

Short + long acting opioids

A

Short acting = fentanyl

Long acting = morphine, oxycodone

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12
Q

Which muscle relaxant is depolarising how does it work + give the uses + SE?

A

Succinylcholine

Ach receptor agonists

Works by causing an action potential (causing fasciculations) + then remains in the nerve so acetylcholine can’t bind

Good for rapid sequence induction

SE: muscle pain, fasciculations, hyperkalaemia, malignant hyperthermia, rise in ICP, IOP + gastric pressure

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13
Q

Which muscle relaxants are non-depolarising + give how it works, uses + SE?

A

Slow onset + variable duration, less SE

Compete with acetylcholine at the NMJ (antagonists)

Atracurium, mivacurium, pancuronium, rocuronium

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14
Q

What do you use to reverse the non-depolarising muscle relaxants + how do they work?

A

Neostigmine - anticholinesterase = increases amount of acetylcholine to displace the muscle relaxant (prevents breakdown of acetylcholine)

Glycopyrrolate - anticholinergic used to counter the SE of neostigmine (bradycardia, hypotension) = essentially atropine but longer acting

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15
Q

What vasoactive drugs are used to maintain BP?

A

Ephedrine Phenylephrine Metaraminol

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16
Q

What drugs are used in severe hypotension?

A

Noradrenaline Adrenaline Dobutamine

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17
Q

Describe when you’d use ephedrine + how it works

A

Causes a rise in BP if its falling

Also causes rise in HR - only use when HR is low

Uses A + beta receptors

18
Q

Describe when you’d use phenylepherine + how it works

A

Rise in BP via vasoconstriction

Causes a drop in HR - used when HR is too high

Direct action via A receptors

19
Q

Describe when you’d use metaraminol + how it works

A

Rise in BP via vasoconstriction

Used when HR is already high

Predominantly via A receptors

20
Q

How common is PONV?

A

20-30%

21
Q

What anti-emetics are used and what receptors do they affect?

A

5HT3 blockers: Ondansetron

Anti-histamine: Cyclizine

Steroids: Dexamethasone

Phenothiazine: Prochlorperazine (Stemetil)

Anti-dopaminergic: Metoclopramide

22
Q

How to reverse the process of GA?

A

Stop vapours

Give O2

Perform throat suction

Reverse muscle relaxant

23
Q

Describe the process of a LMA

A

Give O2

Opioid (fentanyl)

Induction agent (propofol)

Turn on volatile agent (sevoflurane)

Bag valve mask ventilation

LMA insertion

24
Q

Describe the process of intubation

A

Give O2

Opioid (fentanyl)

Induction agent (propofol)

Turn on volatile agent (sevoflurane)

Muscle relaxant

Endotracheal intubation

25
Q

Why is etomidate not used in sepsis?

A

Increases mortality due to suppression of adrenalcortical system + reduced cortisol levels

26
Q

Which GA is good for HF?

A

Etomidate

27
Q

Which NSAIDs are IV?

A

Parecoxib, ketorolac

28
Q

What is ASA grading?

A

1: healthy pt no disease
2: mild to mod disease, no functional limits
3: severe systemic disorder with limits on function
4: severe disease with threat to life
5: moribund pt not expected to survive
6: brainstem dead pt for organ removal

E: suffix for emergency

29
Q

Risk of inadequate fasting

A

Pulmonary aspiration

30
Q

What is the risk of prolonged fasting?

A

Headache, light-headedness, anxiety

N+V, dehydration, hypotension

31
Q

Recommended fasting times

A

Solids = 6 hrs

Breast fed infants = 4 hrs

Clear fluids = 2 hrs

Alcohol = 24 hrs

Boiled sweets/ gum = avoid but can do surgery

32
Q

What is the indication for rapid induction?

A

Full stomach - high risk of aspiration

33
Q

Describe the process of rapid induction

A

Preoxygenation: tight fitting mask for 3 mins or 5 full FVC breaths

Drugs: Thiopentone, Propofol, Suxamethonium

Technique: cricoid pressure, no ventilation, remove cricoid after confirmation of tube position (EtCO2)

34
Q

Doses of local anaesthetics (lignocaine w + w/o adrenaline, bupivacaine, prilocaine)

A

Lignocaine without adrenaline: 3 mg/kg

Lignocaine with adrenaline: 7 mg /kg

Bupivacaine / levobupivacaine ( with or without adrenaline): 2 mg/kg

Prilocaine: 6mg/kg (with = 9mg)

35
Q

How much water is allowed as a ‘sip’ before GA?

A

30ml

36
Q

Considerations of a diabetic going under GA

A

CVS: silent MI, HTN, autonomic neuropathy

RS: increased infection

Renal failure

Delayed gastric emptying

Increased risk of infection + poor healing

37
Q

SE of propofol

A

Apnoea

Hypotension

Pain

Myoclonus

CI in egg or soya allergy

38
Q

SE of atropine

A

Decreased secretions

Reduced gastro sphincter tone

Urinary obstruction

Tachycardia

Confusion

39
Q

Use + dose of midazolam

A

Procedural sedation + induction

1mg IV

40
Q

What does neostigmine do?

A

Reverses effect of non-depolarising muscle relaxants

Anesthetics (6 decks)

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