Anaesthetics Flashcards by Aleksandra Łopuszko

what are the 2 types of anaesthesia?

general

- regional

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what is true NBM pre-operatively?

6h no food

- 2h no clear fluids

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which medications can be offered pre-op? give the indication for each one

BDZ, e.g. midazolam (anxiolytic)
opiates, e.g. alfentanil (reduces pain and HTN in response to laryngoscope)
alpha-2-adrenergic agonists, e.g. clonidine (sedation and pain relief)

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why and when is rapid sequence induction used?

to gain airway control as quickly and safely as possible
emergencies
GORD
pregnancy

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key complication in RSI? how can this be avoided?

aspiration of stomach contents into lungs

- apply cricoid pressure

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what is the triad of GA?

hypnosis
muscle relaxation
analgesia

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what is the role of hypnotic agents in GA?

to make the pt unconscious

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hypnotic agents which can be administered IV?

used to induce LOC:

propofol
ketamine
thiopental sodium
etomidate (rare)

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hypnotic agents which are inhaled?

mostly used to maintain LOC

volatile:

sevoflurane
desflurane
isoflurane

non-volatile:
- nitrous oxide

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where do muscle relaxants act?

NMJ

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name a depolarising muscle relaxant

suxamethonium

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name a non-depolarising muscle relaxant

rocuronium

- atracurium

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how can a muscle relaxant’s actions be reversed?

neostigmine

- sugammadex (only for non-depolarising ones)

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give examples of analgesic agents used in GA?

all opiates:

fentanyl
alfentanil
remifentanil
morphine

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which antiemetics are used prophylactically post-op?

ondansetron
dexamethasone
cyclizine

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drug class of ondansetron?

5HT3 (serotonin) receptor antagonist

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drug class of dexamethasone?

corticosteroid

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drug class of cyclizine?

H1 (histamine) receptor antagonist

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who should cyclizine be used with caution in?

pts with HF

- elderly

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who should dexamethasone be used with caution in?

pts with DM

- immunocompromised pts

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how can you test if the muscle stimulant has worn off?

train-of-four stimulation

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describe train-of-four stimulation

try to stimulate a nerve 4 times

- if the muscle responses get weaker with each stimulation, it means the relaxant has not yet worn off

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what is malignant hyperthermia?

rare but dangerous hypermetabolic response to anaesthesia

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which agents carry a risk of malignant hyperthermia?

volatile anaesthetics (isoflurane, sevoflurane, desflurane)
suxamethonium

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presentation of malignant hyperthermia?

- increased body temp LMAO - increased CO2 exhalation - high HR - muscle rigidity - acidosis - high K+

management of malignant hyperthermia?

dantrolene

how is a peripheral nerve block carried out?

- LA injected under ultrasound guidance - pt remains conscious - usually done to numb a single limb

indications for a spinal block?

- C-sections - TURP - hip fracture repairs

how is a spinal block carried out?

- LA injected into subarachnoid space in CSF - anywhere between L3 and L5 - all nerves below level of injection are numbed - cold spray used to test if it has worked

typical indication for an epidural?

woman in labour with vaginal delivery

how is an epidural carried out?

- catheter inserted into epidural space (OUTSIDE of CSF and spinal cord) - levobupivacaine inserted +/- fentanyl

key risks of using epidural in labour?

- prolonged second stage of labour | - increased chances of needing instrumental delivery

why is it important that a pt is able to do a straight leg raise under epidural anaesthesia?

- if not, catheter may be in subarachnoid space | - needs urgent anaesthetic review

example of LA?

lidocaine

examples of indications for LA use?

- skin sutures in A&E - dental procedures - carpal tunnel syndrome surgery - inserting central line - PCI

indications for a tracheostomy?

- resp failure where long-term ventilation will be needed (e.g. following brain injury) - prolonged weaning from mechanical ventilation - upper airway obstruction - to manage resp secretions - to reduce risk of aspiration (in unsafe swallow)

what can an arterial line be used for?

- measuring BP - getting ABG samples - NEVER to give drugs

where might a central venous catheter (central line) be inserted?

- internal jugular vein - subclavian vein - femoral vein

define chronic pain

pain that has been present for 3+ months

what is allodynia?

when pain is experienced with sensory inputs which should not cause pain, e.g. light touch

features of neuropathic pain?

- burning - tingling - pins and needles - electric shocks - loss of touch sensation in affected area

what are the 3 steps of the WHO analgesic ladder?

1. non-opioids (paracetamol, NSAIDs) 2. weak opioids (codeine, tramadol) 3. strong opioids (morphine, oxycodone, fentanyl, buprenorphine)

which adjuvants can be used to treat neuropathic pain?

- amitriptyline - duloxetine - gabapentin - pregabalin - capsaicin cream

common side effects of NSAIDs?

- indigestion - stomach ulcers - asthma exacerbations - HTN - renal impairment - CAD, HF strokes (rare)

in which pts are NSAIDs inappropriate / contraindicated?

- asthma - CKD - heart disease - uncontrolled HTN - pts with stomach ulcers

which drugs are co-prescribed with NSAIDs?

PPIs (e.g. omeprazole)

key side effects of opioids?

- constipation - pruritus - nausea - altered mental state - resp depression

how is opioid overdose reversed?

naloxone

how are opioids prescribed in palliative care?

- background opioids | - plus rescue doses for breakthrough pain

how is the rescue dose of an opioid calculated for palliative care?

rescue dose = 1/6 of total background dose over 24 hrs

how is bradycardia secondary to patient-controlled analgesia overuse managed?

atropine

common areas affected by chronic pain?

- headaches - lower back pain - neck pain - knee / hip pain

describe the analgesic ladder for treating pain secondary to OA

1. PO paracetamol + topical NSAIDs 2. add PO NSAIDs (+PPI) 3. consider opioids

which 4 medications are used first-line in the treatment of neuropathic pain?

- amitriptyline - duloxetine - gabapentin - pregabalin

1st line treatment for trigeminal neuralgia?

carbamazepine (different to other neuropathic pain conditions!)

describe the different "levels" of patient care needs in a hospital

- level 1 = ward-based care - level 2 = HDU - level 3 = ICU (highest level of support needed)

common reasons for ICU admission?

- following major surgery, e.g. AAA repair - severe sepsis - major trauma - following CPR - acute resp / renal / liver failure

how can enteral nutrition be given in the ICU setting?

- orally - NG tube - PEG

why is TPN given via central line rather than a cannula?

- it irritates peripheral veins | - causes thrombophlebitis

complications of mechanical ventilation?

- alveolar damage from over-inflation - barotrauma - pneumonia - cor pulmonale

which drug can be administered to treat agitated pts with delirium in ICU setting?

dexmedetomidine

Anaesthetics Flashcards

(61 cards)