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Homework

1. What do you understand by the term inhalational?


2. What are inhalational agents used for?
Used to provide general anaesthesia for patients. They provide analgesia ,
amnesia and skeletal muscle relaxation.
Name the first 3 inhalational agents
used.
1. Nitrous oxide
2. Chloroform
3. Ether

Name 3 current inhalational agents


used.
1. Halothane , Isoflurane
2. Sevoflurane
3. Desflurane

1. Namethe organ that is the site of action of inhalational agents.


2. Describe the general mechanismof action of inhalational agents.

1. CNS

2. CVS

3. Respiratory

4. Others

List 3 general effects that the current inhalational will


have on these various systems.
1. Cerebral vasodilatation and increases cerebral blood
flow
2. Reduces oxygen consumption by the brain
3. Raised ICP
1. Myocardial depression - reduces myocardial
contractility
2. Reduce systemic vascular resistance
3. Heart rate
1. Reduced alveolar minute ventilation
2. Reduced tidal volume and increased respiratory rate
3. Reduces respiratory response to hypoxia and
hypercarbia
1. Reduced muscle tone and potentiation of muscle
relaxants
2. Reduced basal metabolic rate.

CNS Many agents produce a dose-dependent reduction in cerebral


activity (represented as a reduction in level of consciousness and EEG
activity). Oxygen consumption is reduced and cerebral blood flow (and
intracranial pressure) increases.
RS Many agents cause reduced alveolar minute ventilation by reduced
tidal volume and increased respiratory rate. Respiratory response to
hypoxia and hypercarbia is reduced.
CVS Many agents cause myocardial depression by reducing myocardial
contractility; they reduce systemic vascular resistance and change

heart rate. All produce a net hypotensive effect.


Skeletal muscle There is reduced muscle tone and potentiation of
muscle relaxants.
Basal metabolic rate This is reduced; a MAC of 2 reduces oxygen
consumption by 30%.

1. Whatare IV induction agents?


2. What are IV inductionagents used for?
They are widely used to facilitate rapid induction of anaesthesia or to provide
sedation during monitored anesthesia care and for patients in intensive care
settings - maintanenace of anaesthesia.

Barbiturate Phenol

Imidazole

Phenylcyclidin
e

Fentanyl
Midazolam

1. Example
2. Receptors
3. Dose
4. Advantages
5.
Disadvantage
s
MUSCLE RELAXANTS
1.Name the first muscle relaxant discovered in the 16thcentury.
2.What type of muscle to muscle relaxants act on?
Skeletal muscle
3.When are muscle relaxants used for in anaesthesia (indications)? List 3.
- Facilitation of tracheal intubation
- Emergency - mechanical ventilation
- Surgery

- Cardiopulmonary resuscitation
1. Example of drugs

2. Mechanism of action
3. Side-effects

Depolarizing NMB
1. Succinylcholine

Non-depolarizing NMB
1. Mivacurium
2. Vecorunium
3. Rocuronium
4. Atracurium
5. Cisatracurium
6. Pancuronium

1. Cardiac dysrhythmias
- sinus bradycardia ,
junctional rhythm , sinus
arrest
2. Fasciculations
3. Hyperkalemia
4. Myalgia
5. Myoglobinuria
6. Increased intraocular
pressure , increased
intragastric pressure
7. Trismus

1.
2.
3.

1. What are anti-cholinesterases used


for in anaesthesia?
2. Name 3 anti-cholinergics used in
the practice of anaesthesia
3. What are systemic side effects of
anticholinesterases?
a) CVS
b) Respi
c) GI
d) Ocular
d) Salivary glands

- Reversal of neuromuscular blockade


- Neostigmine
- Physostigmine
- Pyridostigmine

1. What isthe other name for anti-cholinergics?


Anti-muscarinics.
2. What are anti-cholinergics used for in anaesthesia?

3. Name 3 anti-cholinergics used in the practice of anaesthesia.

Atropine
Scopolamine
Glycopyrrolate

ANALGESICS

1. What plant is this?


Papaver somniferum (poppy plant)
2. What is it used for?
3. Who discovered its anaesthetics properties?
Friedrich Wilhelm Adam ???
1. What are the other names for PCM?
2. In what form can PCM be
administered?
3. What is the maximum dose for
children and adults?
4. What is PCM used for?
5. How does PCM work ?
6. What are the advantages of PCM?
7. What are the contraindications to
PCM?

Acetaminophen

Analgesia
Anti-pyretics
Paracetamol is contraindicated in
hypersensitivity, analgesic
nephropathy, renal and hepatic
impairment.

8. Outline your management of a


patient with PCM overdose?

1. How are NSAIDS broadly classified?


2. Name 3 properties of NSAIDS.

1.
2.
3.

3. What is the mechanism of action?

COX-1 inhibitors
1.
2.

COX-2 inhibitors
1.
2.

DESCRIBE PROSTAGLANDIN SYNTHESIS.


Absolute contraindications

Relative contraindications

1. Pre-existing renal dysfunction


2. History of GI bleeding
3. Hypersensitivty to NSAIDs / aspirininduced asthma

1.What are local anaesthetics?


2. State 3 uses.

1. High risk of intraoperative bleeding


2. Concurrent use of ACE inhibitors ,
anticoagulants , nephrotoxic drugs
3. Hepatic dysfunction , bleeding
disorders , elderly ( > 65 years) ,
pregnancy and during lactation ,
asthma

1. What plant is this?


2. What is it used for?
3. Who first discovered its anaesthetics properties?

State the maximum safe dosages for


the following local anaesthetics

1.Lignocaine
2. Lignocaine + Adrenalaine
3.Bupivacaine
4. L Bupivacaine
5. Ropivacaine

1.How does LA toxicity occur? State 2 ways.


2.List 3preventive measures to ensure that LA toxicity doesnt happen?
The best method for avoiding systemic toxicity from local anesthetics is through prevention,
including using frequent syringe aspirations, a small local anesthetic test dose (3 mL), and slow
injection or fractionation of the dose of local anesthetic.

3.Outline your management of a patient with LA toxicity?


The best method for avoiding systemic toxicity from local anesthetics is through prevention,
including using frequent syringe aspirations, a small local anesthetic test dose (3 mL), and slow
injection or fractionation of the dose of local anesthetic.

Table 21-11 Treatment of Systemic Toxicity from Local Anesthetics


Stop injection of local anesthetic
Administer supplemental oxygen
Support ventilation
Insert tracheal intubation and control ventilation if necessary
Suppress seizure activity (thiopental, midazolam, propofol)
Treat ventricular dysrhythmias (electrical cardioversion, epinephrine, vasopressin,
amiodarone; 20% lipid solutions should be considered to remove bupivacaine from
its sites of action)
2. Treatment of systemic toxicity is primarily supportive.
3. A promising treatment for cardiac toxicity from bupivacaine is intravenous administration of
lipid to theoretically remove the local anesthetic from sites of action.

INOTROPES AND VASOPRESSORS

1. Define-Inotropes
-Chronotropes
-Vasopressors
2. Whenare inotropes and vasopressors used?
1.
3. What is the function of inotropes and vasopressors?
1.
4. Are thereany mechanical methods to perform the above function?

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