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Sem 3, Case 10 (anaesthesia, sleep and GCS) > Sem 3, case 10 (general anaesthetic) > Flashcards

Sem 3, case 10 (general anaesthetic) Flashcards

1
Q

What are the 2 drugs used in induction of general anaesthetic

A

Propofol
Isoflurane

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2
Q

How is propofol administered?

A

IV injection

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3
Q

What are the pros and cons to IV induction (propofol)?

A

Pros:
- rapid onset (3 secs)
- reduced number of complications
- misses excitatory phase
Cons:
- might not be easy to find the vein on some patients

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4
Q

What are the pros and cons of inhalation induction (isoflurane)?

A

Pros:
- easier in difficult to obtain IV patients
- easier to use in paediatrics
- easier patients with airway difficulty
Cons:
- slower onset (7 mins)

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5
Q

Which neurotransmitter do induction agents interact most with?

A

GABA
(via GABA-A receptor)

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6
Q

What is the MOA of propofol?

A

Positive modulation of GABA inhibition via GABA-A receptor

= Increase GABA interaction with the GABA-A receptor = more inhibition of action potentials

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7
Q

What is the MOA of isoflurane?

A

Binds to receptors:
- GABA
- NMDA
- Glycine

(Full MOA unknown)

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8
Q

What are the side effects of propofol ?

A

Hypotension
Respiratory depression
Brady cardia
Nausea + vomiting
Adrenocortical suppression

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9
Q

What are the side effects of isoflurane?

A

Hypotension
Respiratory depression
vasodilation (coronary)

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10
Q

What are the main aspects of maintenance?

A

Maintaining:
- unconsciousness
- analgesia
- muscle relaxation
- airways

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11
Q

How is unconsciousness maintained during general anaesthesia?

A

Continue administering the drug used in induction (propofol or isoflurane)

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12
Q

How are airways maintained during general anaesthesia?

A

Usually:
- endotracheal tube (ET) = tube inserted past vocal cords
- tracheostomy tube = tube inserted at level of 2nd tracheal ring, passes vocal cords
- supraglottic airway (SGA) = tube inserted that sits on/in vocal cords

ventilate with O2 and Nitrous Oxide (NO)

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13
Q

How is muscle relaxation maintained during general anaesthesia?

A

Using Ach antagonists
- atracurium
- suxamethonium

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14
Q

How is atracurium administered?

A

IV injection

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15
Q

How is suxamethonium administered?

A

IV injection

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16
Q

What is the MOA of atracurium?

A

Ach antagonist at the motor end plate (NMJ) = competitive inhibitor

= NON-DEPOLARISING agent

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17
Q

What is the MOA of suxamethonium?

A

Ach agonist (acetylcholinesterase resistant)
- mimics Ach but takes way longer to hydrolyse
- stays in NMJ receptors for longer, prolonging depolarisation
= neuromuscular blockade

= DEPOLARISING agent

18
Q

How does atracurium leave circulation?

A

Spontaneously hydrolyses in plasma

19
Q

How does suxamethonium leave circulation?

A

Hydrolysed by acetylcholinesterase rapidly after withdrawal

20
Q

What are the side effects of atracurium?

A

Hypotension
Bronchospasm
Ganglion block

21
Q

What are the side effects of suxamethonium?

A

Bradycardia
Hyperkalaemia
Increased intraocular pressure
Postoperative pain

(Same as glycopyrrolate)

22
Q

How is analgesia maintained during general anaesthesia?

A

Fentanyl = Opioid analgesic

23
Q

How quickly do induction agents ware off if not replenished?

A

After 5-10 minutes

24
Q

How is unconsciousness reversed in the process of general anaesthesia?

A

Stop giving the induction agents (propofol or isoflurane)

25
Q

How is muscle relaxation reversed in the process of general anaesthesia?

A

Administer neostigmine and glycopyrrolate

26
Q

How is neostigmine administered?

A

IV injection

(Or intramuscular injection/subcutaneous injection)

27
Q

How is glycopyrrolate administered?

A

IV injection

(Or intramuscular injection/orally/topically)

28
Q

What is the MOA of neostigmine?

A

Reverses non-depolarising muscle relaxants (e.g atracurium)

  • blocks acetylcholinesterase
    = increases Ach in NMJ
    = increases muscle contraction
29
Q

Which drug must be administered alongside neostigmine?

A

Glycopyrrolate

30
Q

Why does glycopyrrolate need to accompany neostigmine?

A

Limits the parasympathomimetic side effects of neostigmine

(Parasympathomimetic drug = activates parasymp NS by mimicking/modifying Ach action)

31
Q

What are the side effects of neostigmine?

A

Hypotension
Bradycardia
Bronchoconstriction
Muscular fasiculations

32
Q

What is the MOA of glycopyrrolate?

A

Muscarinic receptor ANTagonist
= inhibits Ach transmission

33
Q

Which drugs in general anaesthesia can cross the BBB?

A

Induction agents (propofol, isoflurane)
Atracurium metabolites (muscle relaxant)
Atropine (a less potent alternative to glycopyrrolate, as that cannot cross BBB)

34
Q

What are the side effects of glycopyrrolate?

A

Bradycardia
Hyperkalaemia
Increased intraocular pressure
Postoperative pain

(Same as suxamethonium)

35
Q

What are the 2 main drugs used in induction?

A

Propofol (IV)
Isoflurane (inhalation)

36
Q

What are the 2 main drugs used as muscle relaxants?

A

Atracurium
Suxamethonium

37
Q

What are the 2 main drugs used in reversal of general anaesthesia?

A

Neostigmine
Glycopyrrolate

38
Q

What are the most common drugs used as for analgesia in general anaesthesia?

A

Opioids
- fentanyl
- morphine
- hydromorphone

39
Q

What are some of the premeds used before general anaesthesia? What do they do?

A
  • benzodiazepines (sedation and amnesia)
  • opioids (analgesia and sedation)
  • anticholinergics (antiemetic = stops vomiting)
  • antibiotics (infection prophylaxis)
40
Q

Which drug does not get reversed by simply stopping administration?

A

Atracurium
(use neostigmine and glycopyrrolate)

41
Q

What is some info needed before commencing general anaesthesia?

A
  • Age
  • consent
  • BMI
  • airway inspection for intubation
  • PMHx
  • administer pre-meds

Sem 3, Case 10 (anaesthesia, sleep and GCS) (4 decks)

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