Neuromuscular Blockade, Local and General Anaesthetic

Question 1

Effects on

• nerves
• vascular smooth muscle
• heart
• CNS

Answer 1

Nerves => decrease/stop conduction

Vascular SM => VD

Heart => bradycardia

CNS => generalised depression

Question 2

Uses of LA

-examples

Answer 2

Lidocaine - topical/wound closure
Prilocaine - IV regional anaesthesia
-both dissociate in tissues
-adrenaline can be added to prolong duration of action and allows for higher doses

SE

• initial CNS overactivity => depression
• cardiac arrythmias

Question 3

Neuromuscular blockade

• function
• types and examples

Answer 3

Muscle relaxants - adjunct to GA
-intubation, endoscopy

Non depolarizing blockers - curonium, curare, curiums

• reversed = AChin
• SE - low BP

Depolarizing blockers - suxamethonium (v rapid onset)

• cannot be reversed, spontaneous recovery
• 1ST LINE FOR INTUBATION - initial fasciculations
• Don’t use in narrow angle glaucoma => increased IOP

Question 4

General anaesthetics

• inhaled examples and uses
• IV examples and uses

Answer 4

Volatile liquid - isoflurane
-induction and maintenance
NO
-analgesia and maintenance

Propofol - potentiates GABA
-induction and maintenance
-antiemetic effects
Thiopental - potentiates GABA
-quickly affects the brain
Etomidate - potentiates GABA
-used in induction of hemodynamically unstable patients
Ketamine - NMDA receptor blocker
-dissociative anaesthetic
-used in trauma due to no BP effects

Question 5

TIVA

• what is it
• pros and cons

Answer 5

Total IV anesthesia
-propofol + remifentanyl

Pros

• no gas
• stable CV
• decreased N+V
• increased tube tolerance

Cons

• based on algorithms
• risk of patient awareness