Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anaethetics 2 > Peri-operative Pain Management > Flashcards

Peri-operative Pain Management Flashcards

(66 cards)

Start Studying
1
Q

Nociception?

A

Detection, transduction and transmission of a noxious stimulus, associated with tissue damage and/or inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is acute pain?

A

Recent onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chronic pain?

A

Persists beyond usual course of an acute illness or injury
>3 months
Outlasts the potential for healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a nociceptor?

A

Potential harmful
Thermal
Chemical
Mechanical stimuli activate free nerve endings = nociceptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is pain felt?

A

Activation threshold is reached
Depolarization
Propagation of an impulse from the nociceptors to the dorsal horn of the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What type of pain do A (delta) and C fibers transmit?

A

A (delta)fibers- sharp well localized pain

C fibers- dull persistent pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is hyperalgesia and how does it occur?

A

Increased sensitivity to pain

Release of inflam mediators (K, serotonin, sub P, histamine, cytokines, NO, and prostaglandins) lowers firing threshold of receptors in injured area = zone of primary hyeralgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is pain?

A

Unpleasant sensation and emotional experience associated with actual or potential tissue damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is pain transmitted?

A

1st order neurons synapse with 2nd in dorsal horn
Impulses then crosses midline and ascending in ant and lateral spinothalamic tracts to thalamus
Then synapses with 3rd –> axonal projections to sensory cortex, limbic system, cerebellum, peri-aquedal grey matter and reticular formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What neurotransmitters are released?

A

Glutamate, subs P, neurokin A+B, GABA, and glycine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where are the most NB points of pain modulation?

A

Horsal horn 1 and 2 neurons synapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is nociceptive transmission dampened?

A

Efferent neurons in the BRAINSTEM send impulses to the other layers of the dorsal horn, where release of neurotransmitter substances (endorphins, enkephalins, noradrenaline, serotonin and GABA) dampen nociceptive transmission.

They do so by making post-synaptic membranes more difficult to depolarize or by impairing the release of nociceptive neurotransmitters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the multi-modal approach to pain and why is it important?

A

Based on the knowledge that there are many different receptors and transmitters involved in nociception

Use several different class of drugs to act at different points in the pain pathway will give a more effect analgesia and the SYNERGISTIC action of the different classes will reduce total doses and side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the stepwise approach to treating pain?

A

Mild pain: simple analgesia (paracetamol), NSAIDS, and codeine (weak opioids)

Moderate pain: higher doses of codeine or tramadol

Severe pain: stronger opioids (morphine and fentanyl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the mechanism of action of paracetamol?

A

Acts centrally and peripherally and has an anti-prostaglandin effect via a COX 3 enzyme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where is paracetamol used?

A

Has mild analgesic properties

Can be used alone for minor surgery or with other stronger analgesics for major surgey

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What properties does paracetamol have?

A

No anti-inflammatory

Anti-pyretic properties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the side effects of paracetamol?

A

Only overdose causing fulminant hepatic necrosis and failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is paracetamol overdose treated?

A

With N-acetylcysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the dose of paracetamol and what is is onset and duration time?

A

1g orally or rectally 6hourly

MAX= 4g in 24 hours

Onset- 30mins
Duration 2-5hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is IV paracetamol called and what is its dosage and advantages?

A

Pefalgan

Improved bio-availability and faster onset of time 5-10 minutes

1g IV 6hourly (4doses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do NSAIDS work?

A

Inhibit COX and inhibits production of PG and thromboxanes from membrane phospholipids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does aspirin work?

A

Aspirin binds irreversibly to COX

NSAIDs cause reversible enzyme inhibition with an antipyretic action via inhibition of central PG.

The inhibition of thromboxane production results in reduced plt aggregation and risks of bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How many COD enzymes are there and why are they important?

A

3 COX enzymes

COX-1 is constitutive and helps maintain normal physiology with NB roles in renal blood flow, haemostatic function and mucosal integrity

COX-2 is inducible and expressed in response to tissue damage

NSAIDs are non- selective (COX 1&2)
Or selective (COX 2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are NB side effects of NSAIDS?
Gastric irritation, bronchospasm, renal dysfunction, plt dysfunction, hepatotoxicity, and MI NSAIDs can be given orally, rectally, intravenously and IM
26
What is the dose of aspirin?
10-15mgkg
27
What is the dose of ibuprofen?
Adults: 200-400mg orally 8hourly Children: 5-10mgkg orally 8hourly
28
Dose of diclofenac?
Adult: 50mg orally 8-12hourly Children: 1mgkg orally or 1-2mgkg rectally
29
Indomethacine dosages?
``` Adults: 25-50mg orally 8hourly, 100mg rectally (12hourly) ``` Children: 0,5-1mgkg (8hourly)
30
What is ketorolac and dosage?
It is a opioid sparing agent, decreased the amount of opioids needed Adults: 10mg orally (4-6hourly) 0,6mgkg IM stat, then 0,2-0,4mgkg 6hourly Oral onset: 30-60mins IM: 10mins IV: 5mins
31
Celecoxib dosage?
Adult: 100mg (12hourly) or 200mg daily Onset: 30-60mins Duration 8-10hours
32
Parecoxib dosage?
Adults: 40mg IV or IM followed by 20-40mg (6-12hourly) Onset of action= 5mins IV and 30mins IM Duration of action 8-10hours
33
What are endogenous agonists and how do they work?
B-endorphins and enkephalins Work with opioids act by reducing neuronal cell excitability
34
When endogenous agonist receptor are stimulated what are the effects?
Analgesia, drowsiness, change in mood, nausea, bradycardia, resp depression, miosis, pruritis and inhibition of gut motility with constipation They are selective for pain and don't interfere with other sensory modalities
35
Common side effects of opioids?
Nausea, vomiting, ictching, constipation and urinary retention More serious by less common- reduced LOC, resp depression and mm rigidity
36
Codeine dosage?
Adults: oral 30-60mg 4-6hourly
37
What is Panadeine?
Paracetaml 500mg, and codeine 8mg 10% is metabolism to morophine
38
Tramadol?
Adults: oral IV 50-100mg 4-6hourly Duration: 2-5hours
39
What dose tramadol do?
It is agonist at the opioid receptors. Also has an added mechanism of preventing the reuptake of noradrenaline and 5-hydroxytrytamine at the pre-synaptic nerve endings; and stimulates pre-synaptic 5-HTrelease. Particularly important in the descending inhibitory pathways It's produces less constipation, and resp depression but more nausea
40
Which other drugs interact with tramadol?
Selective serotonin reuptake inhibitors SSRIs and noradrenaline re-uptake inhibitors can result in seizures and serotonin syndrome
41
What is Tramacet?
325mg paracetamol and 37,5mg tramadol
42
What are some of the side effects of pethidine?
Anti- cholinergic causing dry mouth and tachycardia ``` If given with MAOI: Convulsions Hyperpyrexia Coma Labile circulation ```
43
Morphine dosage?
Adults and children: 0,1-0,2mgkg 4-6hourly IV and MI
44
How is morphine used intra-op?
It is titrated to effect with bolus of 1-5mg IV
45
What is morphines effect in RA?
In epidural and spinals it enhances the analgesic effect of LA BUT causes resp depression and needs monitoring
46
Patient controlled analgesia?
50mg morphine in 50mg of normal saline in an infusion pump Each time patient presses buttons 1-2mg bolus is release IV SAFELY: there is a 5-10min lockout time preventing overdose
47
Fentanyl dose?
1-2ug kg IV in adults and kids
48
Fentanyl is .... Potent than .... And 600 times more..... What does this mean?
Potent Morphine Lipid soluble Therefore it means it seldom causes delayed resp depression when given epidural or spinal
49
What are some the side effect of fentanyl?
Can cause chest wall rigidity and bradycardia
50
How is fentanyl used as a co-induction?
It is given at induction IV and aims to reduce dose of induction agent needed with a synergistic effect Is also depressed laryngeal reflexes which is useful for LMA and ETT intubation and is less likely to cause histamine release
51
What is fentanyl's onset and duration of action?
Onset 3-4mins | Short duration: 30-40mins but up to 6hours at high doses
52
What does sufentanil and alfentanil do? And what are there side effects?
They are synergistic opiated and are short acting when used as a bolus S/E: Cardiovascularly stable, depress laryngeal reflexes and inhibit increase in heart and blood pressure seen in "intubation response"
53
What is the dose and purpose of remifentanil?
0,05-0,5ugkgmin Ultra short acting opiate due to rapid metabolism by non-specific plasma and tissue esterases- not dependent on the liver metabolism or renal excretion Controls HR and BP during intubation and stimulating periods of surgery
54
What are the side effects of remifentanil?
Hypotension, bradycardia, chest wall rigidity, and resp depression
55
When must remifentanil be given at the end of a surgery and why?
Remifentanil must be given 15-20min before termination of a case as the analgesia wears off rapidly
56
What is naloxone and what is a the dose?
Opiate antagonist at u, k and s receptors 1-4 ugkg is given for opiate overdose Amp=0,4mg in 1ml dilute with 9ml of normal salon into a 10ml syringe and you have 40ugml It is an antanalgesic and makes you more susceptible to pain Can cause hypertension, dysrhymias and pul odema
57
What is ketamine?
Antagonises glutamate at NMDA Receptors, an agonist at s and k opiate receptors but antagonises at u receptors Dissociative anaesthesia
58
What are some of the effects of ketamine?
Indirect sympathetic stimulation results in hypertension and tachycardia Produced bronchodilation and airway is often maintained Salivation and emergence phenomena are a problem Good analgesia
59
Dose of ketamine?
Analgesic: 0,2-0,5mg kg IV 2-4mgkg INFUSION: 4ugkg min, 5mgkg orally
60
Name two alpha 2 agonists?
Clonidine and dexmedetomidine
61
What are the benefits of post-operative analgesia?
Patient comfort and satisfaction Adequate breathing and coughing (decreasing incidence of post-operative lunch infections) Early mobility (reducing DVT)
62
What is pre-emptive analgesia?
You pre-empt the pain by giving the analgesic with the premedication or induction before pain starts Reduced pain and stress response
63
What is sufficient for minor surgeries?
Intra-op: Local infiltration | Post-op: oral paracetamol and codeine
64
Major procedure pain management?
IV opioids added to simple analgesics and NSAIDS intra-op
65
Common plan for post-op pain?
Morphine 5-10mg IM 4-6hourly or tramadol 50-100mg orally 4-6hourly Paracetamol 1g orally/rectally 6hourly or combined Panadeine 2tablets 6hourly NSAIDS Ibuprofen 400mg 8hourly or Diclofenac 100mg rectally 12hourly Anti-emetic with opioids Prochloroerazine (stemetil) 12,5mg IM 8hourly Ondansetron (Zofrab) 4mg IV/IM 8hourly
66
Useful for chronic pain?
Radiofrequency ablation of nerves last 6months

Anaethetics 2 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions