Intro to anaesthetics Flashcards by Colette McCambridge

what is general anaesthesia

total loss of sensation

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what is regional anaesthesia?

loss of sensation to a region or part of body

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what os local anaesthesia

topical or infiltration

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what 3 components are needed for GA

Amnesia
Analgesia
Akinesis

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what do induction agents do?

induce los of consciousness in one arm-brain circulation time

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what are inhalation/volatile agents usually used for

maintenance of amnesia

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what are the 4 main induction agents

Propofol
Thiopentone
Ketamine
Etomidate

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what is the dose of propofol

1.5-2.5 mg/kg

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benefits of propofol

excellent supression of airway reflexes

decreases incidence of PONV

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unwanted effects of propofol

marked drop in HR and BP
Pain on injection
Involuntary movements

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what type of drug is propofol

lipid based

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what type of drug is thiopentone

barbiturate

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what is the dose of thiopentone

4-5mg/kg

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what are the benefits if thiopentone

faster than propofol

anti-epileptic properties and protects the brain

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what is thiopentone usually used for

rapid sequence induction

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unwanted effects of thiopentone

drops BP and Increases HR
rash/bronchospasm
can cause thrombosis and gangrene if injected in to an artery

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what is thiopentone contraindicated in?

porphyria

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what effects does ketamine have

dissociative anaesthesia so it has amnesia and profound analgesia

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dose of ketamine

1-1.5 MG/KG

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How long is the onset of ketamine

90 sec (slow)

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benefits of ketamine

rise in HR and BP, bronchodilation

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unwanted effects of ketamine

nausea and vomiting

emergences phemomenon: vivid dreams and hallucinations

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what is the dose of etomidate

0.3mg/kg

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benefits of etomidate

haemodynamic stability

lowest incidence of hypersensitivity reaction

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unwanted effects of etomidate

pain on injection spontaneous movements adreno-cortical suppression high incidence of PONV

when should you never use etomidate

patients with septic shock

which patients is etomidate used?

cardiac failure, serial MI (patients with poor cardiac function)

what are the 4 inhalation agents

Isoflurane Sevoflurane Desflurane Enflurane

when is sevoflurane used

sweet smelling so to relax anxious children

benefits of desfluane

low lipid solubility rapid onset and offset good for long operations

benefits of isoflurane

least effect on organ blood flow

what use is isoflurane good for

transplant cases as want to minimise blood flow

what is MAC

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

what is the MAC of Nitrous oxide

104%

MAC of sevoflurane

MAC of isoflurane

1.15%

MAC of desflurane

MAC enflurane

1.6%

3 short acting opioids

Fentanyl Remifentanil Alfentanil

what are short acting opioid good for

intra-op analgesia | suppress response to laryngoscopy and surgical pain

what sort of onset and potency do short acting opioids have

rapid onset | high potency

what are 2 long acting opioids

morphine and oxycodone

what are long acting opioids good for

intra-op and post-op analgesia

3 NSAIDS

Diclofenac Parecoxib Ketorolac

2 weaker opioids

Tramadol | Dihydrocodeine

which NSAIDs can be given IV

Ketorolac | Parecoxib

how quickly does fentanyl act

1-2 mins

how long does fentanyl last

10 mins

how quickly does remifentanil work

2 mins

how long does alfentanil last

6-10 mins

what happens in muscle contraction

action potential arrives at muromuscular junction, ACh is released which causes depolarisation of nicotinic receptors leading to muscle contraction.

what are the 2 groups of muscle relaxants

depolarising | non-depolarising

how do depolarising receptors work?

act similarly to ACh on nicotinic receptors but are very slowly hydrolysed by acetlycholinesterase. so cause muscle contraction, the muscle then fatigues and relaxes (competitive)

how do non-depolarising receptors work

block nicotinic receptors therefore the muscle relaxes (non-competitive)

what is the depolarising muscle relaxant

suxamethonium

when is suxamethonium used

rapid sequence induction

benefits of suxamethonium

rapid onset and off set

adverse effects of suxamethonium

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

benefits of non-depolarising muscle relaxants

slow onset and variable duration. less side effects

how do non-depolarising muscle relaxants work

compete with ACh for nicotinic recpetors

what are the short acting non-depolarising muscle relaxants

atracurium, mivacurium

what are the intermediate acting non-depolarising muscle relaxants

vecuronium, rocuronium

long acting non-depolarising muscle relaxants

pancuronium

what agents are used to reverse non-depolarising muscle relaxants

neostigmine and glycopyrrolate

what drug class is neostigmine

anti-cholinesterase

how does neostigmine work

prevents breakdown of ACH

muscarinic effects of ACh

bradycardia

what agent is neostigmine combined with and why

glycopyrrolate - to prevent ACh being blocked at the heart

side effects of neostigmine

nausea and vomiting

5HT2 blocker antiemetic

ondansetron

anti-histamine anti-emetic

Cyclizine

steroid anti-emetic

dexamethasone

phenothiazine anti-emetic

prochlorperazine (Stemetil)

Anti-dopaminergic anti-emetic

Metoclopramide

what are vaso-active agents used for

to treat hypotension

commonly used vaso-active drugs

ephedrine phenylephrine Metaraminol

vasoactive drugs used in severe hypotension/ICU

Noradrenaline adrenaline dobutamine

effects of ephedrine

rise in HR and contractility causing rise in BP

what receptors does ephedrine work on

alpha and beta (direct and indirect)

effects of phenylepherine

rise in BP by vasocontriction drop in HR

what receptors does phenylepherine act on

alpha receptors (direct action)

effects of metaraminol

rise in BP by vasocontriction

what receptors does metaraminol act on

direct and indirect but predominantly alpha

pt requiring a burn dressing change, best induction agent

ketamine

best induction agent for pt undergoing arm op GA with LMA

propofol

best induction agent for pt with hx of HR and required GA

etomidate

best induction agent for pt with intestinal obstruction who requires emergency laparotomy

thiopentone

best induction agent for pt with porphyria who is having an inguinal repair

propofol (not thiopentone)

best inhalational agent for long, 8hr finger re-implantation

desflurane

best inhalational agent for paediatric pt with no IV access

sevoflurane

best inhalation agent for organ retrieval from a donor

isoflurane

most commonly used analgesia

paracetamol

most commonly used oral opioid in adults

codeine

IV NSAIDs

ketoralac and Parecoxib

best vasoactive agent for low BP and low HR

ephedrine

best vasoactive agent for low BP and high HR

phenylephrine, metaraminol

best vasoactive agent for intensive care, severe sepsis

noradrenaline, adrenaline

Intro to anaesthetics Flashcards

(97 cards)