22 Questions
What type of anaesthesia can be achieved by combining nitrous oxide with fentanyl and droperidol?
Neurolept anaesthesia
What is the shortest acting opioid, and how is it metabolized?
Remifentanil, metabolized by esterases
What is the primary mechanism of action of droperidol?
D2 receptor blocker
What is the effect of adding sodium bicarbonate to local anesthetics?
Accelerates onset of action
What is a potential allergenic compound formed during the metabolism of ester local anesthetics?
Para-aminobenzoic acid (PABA)
What is the primary adverse effect of local anesthetics?
Systemic absorption of toxic amounts
What is the order of nerve function loss due to local anesthetics?
Sympathetic function, pinprick sensation and temperature, and finally motor function
What is alfentanil used for?
Day care surgery and total intravenous anaesthesia
Which local anesthetic is used intravenously in the treatment of cardiac arrhythmias?
Lidocaine
What is unique about cocaine as a local anesthetic?
It is a vasoconstrictor, has sympathomimetic effect, and should not be given intravenously or with adrenaline.
Why is procaine the local anesthetic of choice in malignant hyperthermia?
No specific reason is given in the content, but procaine is the preferred choice in malignant hyperthermia.
How does cocaine differ from other local anesthetics in terms of its effect on blood pressure?
It increases blood pressure.
What is unique about the metabolism of cocaine compared to other ester local anesthetics?
It is metabolized in the liver, not by pseudocholinesterase.
What is the primary difference in the mechanism of action of cocaine compared to other local anesthetics?
It has a sympathomimetic effect due to inhibition of nor-adrenaline reuptake.
What is the site of action of dissociative anaesthesia, responsible for the effect seen while recovery from anaesthesia?
Thalamocortical junction
Which anaesthetic has the maximum analgesic effect among anaesthetics?
T
Which anaesthetic is an excellent choice for asthmatics?
Propofol
What is the benefit of using propofol infusion during maintenance of anaesthesia?
It can be supplemented with intravenous opioids and neuromuscular blockers as needed
Why is etomidate the agent of choice for aneurysm surgeries and cardiac disease?
It does not interfere with cardiovascular functions
Which benzodiazepine is commonly used in pre-anaesthetic medication?
Lorazepam
What is the most potent opioid used in anaesthesia?
Sufentanil
What is the use of midazolam in anaesthesia?
It is used for day care surgery
Study Notes
Anaesthetics
- Thalamocortical junction is the site of action for dissociative anaesthesia
- Analgesic with maximum potency among anaesthetics
- Can be given in full stomach
- Increases all pressures
- NMDA antagonist
- Excellent for asthmatics
Propofol
- Most frequently administered drug for induction of anesthesia
- Alternative to inhaled anesthetics for maintenance of anesthesia
- Common choice for sedation in monitored anesthesia care
- Can be used for total intravenous anesthesia (TIVA)
- Intravenous anaesthetic of choice in patients with malignant hyperthermia
Etomidate
- Does not interfere with cardiovascular functions
- Agent of choice for aneurysm surgeries and cardiac disease
- Causes minimal respiratory depression
- Maximum incidence of nausea and vomiting
Benzodiazepines
- Important benzodiazepines: diazepam, lorazepam, and midazolam
- Not analgesic agents
- Possess muscle relaxing and anticonvulsant properties
- Lorazepam is commonly used in pre-anaesthetic medication
- Midazolam is used for day care surgery
- Can cause sedation and anterograde amnesia
Opioids
- Fentanyl, alfentanil, sufentanil, and remifentanil are used in anaesthesia
- 100 times more potent than morphine
- Sufentanil is the most potent opioid
- Possess strong analgesic activity
- Can lead to post-operative muscle rigidity
- Alfentanil is used for day care surgery and total intravenous anaesthesia
- Remifentanil is the shortest acting opioid
Neuroleptic Agents
- Neurolept anesthesia combines neuroleptic and analgesic to produce sedation, analgesia, and amnesia
- Droperidol is a D2 receptor blocker used with fentanyl to produce neurolept analgesia and anaesthesia
- Can produce extrapyramidal symptoms
Local Anesthetics
- Applied locally and block nerve conduction
- Loss of sympathetic function occurs first, followed by loss of pinprick sensation and temperature, and finally, motor function
- Effect is reversible, with complete recovery of nerve function
- Commonly used for minor surgical procedures, often in combination with vasoconstrictors
- Onset of action may be accelerated by the addition of sodium bicarbonate
- Metabolism of ester local anesthetics leads to formation of para-aminobenzoic acid (PABA), which is thought to be allergenic
Important Facts
- Lidocaine is used intravenously in the treatment of cardiac arrhythmias
- Cocaine is an effective local anesthetic with sympathomimetic effect
- Cocaine should never be given by intravenous route or with adrenaline
- Procaine is the local anaesthetic of choice in malignant hyperthermia
This quiz covers the properties and uses of different anaesthetics, including dissociative anaesthesia, analgesic potency, and suitability for various medical conditions. Test your knowledge of thalamocortical junction, NMDA antagonists, and total intravenous anesthesia.
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