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P3 - ANAESTHESIA > IV Anaesthetic Agents > Flashcards

IV Anaesthetic Agents Flashcards

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1
Q

What is IVA (intravenous anesthetic agent )

A

Drug or combination of drug used to induce anaesthesia safely and reversible and cause loss f consciousness in one arm brain (30-60s)

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2
Q

What is the ideal IVA agent

A

Water soluble
Résistant to microbial contamination
Long shelf life and stable
No pain on injection
Safe after inadvertent arterial injection
Non toxic
Rapid onset
Potent
Fast recovery
No excitatory/depressive effect on CNS, CVS, and respi
Inexpensive

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3
Q
A
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4
Q

What are the fast acting IVA

A

Barbiturates - thiopentone
Etomidate
Propofol

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5
Q

Slow acting

A

Ketamine
Benzodiazepine - diazepam, midazolam
Opioids ( large doses) - fentanyl, alfentanil ,sufentanil

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6
Q
A
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7
Q

MOA of barbiturate - thiopentone

A

Depress RAS in brainstem , nerve synapse, excitatory neurotransmitter
Increase inhibitory neurotransmitter transmission

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8
Q

Appearance of thiopentone

A

Water soluble pale Yellow powder with garlic smell

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9
Q

Mode of administration of thiopentone with dosage

A

IV - 4-6mg/kg for induction
Rectal - 22mg/kg (rare)

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10
Q

Can you use thiopentone for continuous infusion

A

No because accumulate in body due to zero order kinetics

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11
Q

Metabolism of thiopentone

A

Liver oxidation and de sulphuric ion
Excreted in urine

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12
Q

CNS effects of thiopentone

A

Sédative
Hypnotic
Potent Anticonvulsant
Anti analgesic
Decreases CBF, CMO2, ICP, IOP

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13
Q

CVS effects thiopentone

A

Depressant - myocardial contractility, BP, CO, SVR

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14
Q

Respi effect thiopentone

A

Dépression
Increased Bronchospasm, laryngeal spasm

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15
Q

Which IVA anaesthetic should you avoid in asmathic patient due to bronchospasm risk

A

thiopentone

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16
Q

Complications of thiopentone

A

Thrombophlebitis
Pain at site
Extravascular injection -> tissue necrosis
Intrarterial injection - > severe pain and vasospasm,delayed loss of consciousness
Anaphylaxis

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17
Q
A
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18
Q

Indications thiopentone

A

Induction
Status epileptics
Severe head injury
Sedation (bolus not infusion)

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19
Q

Contraindications thiopentone

A

Absolute - Airway obstruction, rxn to barbiturate, acute intermittent porphyria, no IV access

Relative - alcohol, severe hepatic or renal dx , poorly controlled asthma , severe CVS dx
b

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20
Q

Appearance of propofol

A

Milky white emulsion

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21
Q

propofol composition

A

Soya bean oil + egg phosphatide +glycerol

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22
Q

Formats of propofol available

A

1% or 2%solution in 10,20,50 or 100ml vials

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23
Q

Administration of propofol

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A

IV Induction only

24
Q

MOA propofol

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A

GABA mediated

25
Metabolism of propofol
Inactivation in Liver to glucuronides Excreted in urine
26
Is propofol good for day care surgery
Yes
27
Induction dosages propofol
Less than 60yo- 2-2.5mg/kg More than 60 1-1.5mg/kg Children 3-3.5mg/kg Infusion 3-12mg/kg/hr
28
What method used to assess loss of conscious in thiopentone and propofol
Thiopentone - eyelash reflexes propofol - loss of verbal contact
29
Complications of propofol
Pain at infection site Involuntary muscle movements - myoclonus Allergic Propofol infusion syndrome
30
Duration of action or propofol
3-10mins
31
CNS effect propofol
Sédation hypnosis Depressant - CBF, ICP, IOP, CMRO2 Convulsion (rare)
32
CVS effect propofol
Decreased CO, SVR, HR, BP
33
Respi effect propofol
Decreased airway reflexes (good for LMA), Apnoea,
34
Symptoms of propanol infusion syndrome (syndrome due to prologonged infusion or large dose )
Metabolic acidosis Hyperkalemia Lipid Emia Rhabdomyolysis Hepatomegaly Cardiac failure Renal failure
35
Usage of propofol
Induction Day care anaesthesia Sedation Endoscopy ICU TIVA
36
37
Available preparation of ketamine
10mg/ml 50mg/ml 100mg/ml 10ml,2ml, 1ml vials
38
Whic anaesthetic causesdissocatove anaesthesia
Ketamine
39
What’s dissociative anaesthesia
Gaze into distance , hypertonus, involuntary muscle movements, jaw rigidity, nystagmus Intense analgesia and superficial sedation
40
Route and dosage Ketamine
Iv - 2mg/kg Oral - 10mg/kg TIVA 2-4mg/kg/hr Analgesia - 0.1-0.5mg/kg/hr IV, 3-5mg/kg/ IM Intrathecal, epidural
41
Ketamine MOA
NMDA receptor antagonist
42
Metabolism Ketamine
Liver to norketamine Excreted in urine
43
Ketamine CNS effect
Dissociative anaesthesia Increased CBF, ICP, IOP, CMRO2 Hallucination, delusion, delirium, nightmares
44
Effects ofCVS Ketamine
Increased HR, SVR, BP, CO
45
46
Respi effects Ketamine
Bronchodilation Increased secretions
47
Other system effect Ketamine
Salivation N/V Hypertonus
48
Usage Ketamine
Induction in poor risk patients , asthmatics , difficult airway TIVA Analgesia adjunct Epidural analgesia Burn dression, radiotherapy
49
Ketamine contraindications
HPT, IHD Epilepsy Increased ICP, IOP, CVA Eye and head injury Psychosis
50
MOA benzodiazepines
Bind to GABA and cause hyperpolarisation -> decrease Limbic system
51
Types of benzodiazepines
Short acting - midazolam Intermediate - temazepam Long acting - diazepam Very long acting - lorazepam
52
Metabolism benzodiazepines
Liver oxidation and glucuronidation Excretion in urine
53
54
CNS effect benzodiazepines
Sédation Hypnosis Anticonvulsant Muscle relaxant Decreased CBF, ICP, IOP,CMRO2, anterograde amnesia
55
Uses of benzodiazepines
Prémédication - anxiolytics, sedation, amnesia Insomnia agitation Induction Co induction with propofol Muscle relaxation Anticonvulsant
56
Route of midazolam
IV, 0.07-0.15MG/KG Oral 0.05-0.1mg/kg IM Intrathecal Epidural
57
Indications for midazolam
Prémédication Sédation Co induction Maintenance of anaesthesia Anticonvulsant

P3 - ANAESTHESIA (20 decks)

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