Intro to Anaesthesia

Question 1

Definitions of Anaesthesia

Answer 1

Amnesia - LOC

Analgesia - pain relief

Akinesis - M paralysis

Question 2

what is PONV

Answer 2

post operative N/V

Question 3

common inducers of amnesia

Answer 3

porpofol - MJ milk

etomidate

Ketamine

Thiopentone

Question 4

Tell me about propofol

Answer 4

it is an amnesia induction agent

it is commonly used

lipid based

decreased incidence of PONV

Question 5

unwanted effects of propfol

Answer 5

these may include

marked drop in HR and BP

pain on injection

Involuntary movements - how likely

Question 6

Tell me about Thiopentone

Answer 6

it is a Barbiturate (drug that acts on CNS)

faster than propofol hence used in rapid sequence induction

good in that it has antiepileptic properties and protects the brain

Question 7

unwanted effects of Thiopentone

Answer 7

these may include

drops BP but rise in HR

rash / bronchospasm

arterial injection may cause throbosis and gangrene

Question 8

Tell me about Ketamine

Answer 8

dissociative anaesthesia??

slow onset

Rise in HR/BP
Bronchodilator

Question 9

Unwanted effects of Ketamine

Answer 9

N/V

vivid dreams and hallucinations

Question 10

Tell me about Etomidate

Answer 10

rapid onset

Hemodynamic stability?

lowest incidence of hypersensitivity reactions

Question 11

Unwanted effects of Etomidate

Answer 11

Pain on injection

spontaneous movements

adren-cortical suppresion

High incidence PONV

Question 12

How do you maintain Amnesia

Answer 12

through use of inhalation agents

Question 13

Give me examples of inhalation agents

Answer 13

Isoflurane

Sevoflurane

Desflurane

Question 14

Tell me about Sevoflurane

Answer 14

Sweet smelling

Inhalational induction

Question 15

Tell me about Desflurane

Answer 15

Low lipid solubility
Rapid onset and offset
Long operations

Question 16

Tell me about Isoflurane

Answer 16

Least effect on organ blood flow

Question 17

What is Minimum Alveolar concentration (MAC)

Answer 17

?

Question 18

What is a vapouriser

Answer 18

Device used to deliver accurately measured concentration of volatile anaesthetic agents

Question 19

Short acting Opioids (During operation)

Answer 19

Fentanyl (90), Remifentanil (IV infusion) ,Alfentanil (2nd)

Question 20

Long acting Opioids (After operation)

Answer 20

Intra-op and post-op analgesia

Morphine, Oxycodone

Question 21

Most common Analgesia drugs?

Answer 21

Most commonly used analgesic
Paracetamol
Most commonly used oral opioid in adults
Codeine
Intravenous NSAIDS
Ketorolac, Parecoxib

Question 22

What other opioid you can give with morphine

Answer 22

Tramadol

Question 23

Tell me about Suxamethonium

Answer 23

it is an Akinesis agent

Depolarising?

Rapid Sequence Induction (Rapid onset - Rapid offset)

Question 24

Unwanted effects of Suxamethonium

Answer 24

muscle pains, 
fasciculations,
hyperkalemia
malignant hyperthermia, 
rise in ICP,IOP and gastric pressure

Question 25

Provide examples of Non-depolarising Akinsis agents

Answer 25

Slow onset and variable duration, less side effects Compete with Ach for nicotinic receptors Short acting: Atracurium, mivacurium Intermediate acting: Vecuronium, rocuronium Long acting: Pancuronium (60-90minz) ‘Reversal’ with Neostigmine & Glycopyrrolate

Question 26

Vasoactive drugs to treat hypotension

Answer 26

Ephedrine Phenylephrine Metaraminol

Question 27

Vasoactive drugs to treat severe hypotension in ICU

Answer 27

Noradrenaline Adrenaline Dobutamine

Question 28

Ephedrine -

Answer 28

Rise in HR and contractility leading to rise in BP (direct and indirect action, alpha (α) & β receptors

Question 29

Phenylephrine

Answer 29

Rise in BP by vasoconstriction (Direct action, α receptors), drop in HR

Question 30

Metaraminol

Answer 30

Rise in BP by vasoconstriction (Direct and indirect action, predominant α receptors)

Question 31

So if you have Low BP, low HR what would you give

Answer 31

Ephedrine

Question 32

So if you have Low BP, High HR what would you give

Answer 32

Phenylephrine, Metaraminol

Question 33

So if you have a patients needing care in Intensive care, severe sepsis with BP and HR changes

Answer 33

Noradrenaline, Adrenaline

Question 34

How to reverse anaesthetics

Answer 34

Stop anaesthetic vapours Give oxygetion Perform throat suction Reverse muscle relaxation

Question 35

Drugs for reversal of anaesthetics

Answer 35

``` Neostigmine: Anti-cholinesterase Prevents breakdown of acetylcholine Muscarinic effects of acetylcholine: Bradycardia etc. Combined with antimuscarinic agent: Glycopyrrolate Side effects : nausea and vomiting ```