Podcast
Questions and Answers
What is the recommended dosage range for the maintenance of anesthesia in adults?
What is the recommended dosage range for the maintenance of anesthesia in adults?
- 0.5–2.5 mcg/kg/min
- 0.05–2 mcg/kg/min (correct)
- 1–4 mcg/kg/min
- 0.1–3 mcg/kg/min
What is a common adverse effect of tramadol?
What is a common adverse effect of tramadol?
- Pulmonary edema (correct)
- Respiratory stimulation
- Severe hypotension
- Increased gastrointestinal motility
Which patient condition contraindicates the use of tramadol?
Which patient condition contraindicates the use of tramadol?
- Controlled epilepsy
- Hypersensitivity to tramadol (correct)
- Postoperative pain
- Moderate cardiac disease
For a pediatric patient, what is the initial dose of tramadol if no response is noted?
For a pediatric patient, what is the initial dose of tramadol if no response is noted?
What type of injection is indicated for immediate administration of tramadol at birth?
What type of injection is indicated for immediate administration of tramadol at birth?
What is the maximum total dose of paracetamol that can be administered including the initial bolus?
What is the maximum total dose of paracetamol that can be administered including the initial bolus?
Following surgery, what is the initial bolus dose of paracetamol given for pain management?
Following surgery, what is the initial bolus dose of paracetamol given for pain management?
Which of the following drugs is an alternative for postoperative pain relief that does not affect respiration?
Which of the following drugs is an alternative for postoperative pain relief that does not affect respiration?
What is one of the main features used in multimodal systems to reduce drug administration errors?
What is one of the main features used in multimodal systems to reduce drug administration errors?
What does the automated dispensing machine primarily enhance in medication management?
What does the automated dispensing machine primarily enhance in medication management?
Which of the following is NOT a reason for medication errors mentioned?
Which of the following is NOT a reason for medication errors mentioned?
What does a barcode reader assist with in a multimodal system?
What does a barcode reader assist with in a multimodal system?
Which aspect is improved by using well-built rules in medication management?
Which aspect is improved by using well-built rules in medication management?
In what way can medication errors specifically related to anesthetic gases be reduced?
In what way can medication errors specifically related to anesthetic gases be reduced?
Which of these factors does NOT contribute to medication administration errors?
Which of these factors does NOT contribute to medication administration errors?
What is one key benefit of having prefilled syringes for commonly used drugs?
What is one key benefit of having prefilled syringes for commonly used drugs?
What is the primary goal of general anesthesia?
What is the primary goal of general anesthesia?
Which agent is commonly used as a sedative-hypnotic in GA induction?
Which agent is commonly used as a sedative-hypnotic in GA induction?
What is the purpose of using a neuromuscular blocking agent (NMBA) during GA?
What is the purpose of using a neuromuscular blocking agent (NMBA) during GA?
What characterizes Stage I of general anesthesia?
What characterizes Stage I of general anesthesia?
Which method can also be used to sustain general anesthesia besides inhalation?
Which method can also be used to sustain general anesthesia besides inhalation?
What is the survival time of Mycobacterium Tuberculosis in soda-lime?
What is the survival time of Mycobacterium Tuberculosis in soda-lime?
What is the primary use of rocuronium bromide?
What is the primary use of rocuronium bromide?
What efficiency does High-Efficiency Particulate Air (HEPA) filters maintain?
What efficiency does High-Efficiency Particulate Air (HEPA) filters maintain?
What happens during the emergence phase of general anesthesia?
What happens during the emergence phase of general anesthesia?
What is a common contraindication for the use of atracurium?
What is a common contraindication for the use of atracurium?
What is the primary purpose of adjuvant IV agents during GA induction?
What is the primary purpose of adjuvant IV agents during GA induction?
Which area of anesthesia equipment requires cleaning as per manufacturer’s instructions?
Which area of anesthesia equipment requires cleaning as per manufacturer’s instructions?
During which stage of general anesthesia does the patient often exhibit excitement or delirium?
During which stage of general anesthesia does the patient often exhibit excitement or delirium?
What is the maintenance dose of cisatracurium for intubation?
What is the maintenance dose of cisatracurium for intubation?
What is the recommended disinfection method for vials’ rubber stoppers and necks?
What is the recommended disinfection method for vials’ rubber stoppers and necks?
Which of the following muscle relaxants has no contraindications for patients with renal impairment?
Which of the following muscle relaxants has no contraindications for patients with renal impairment?
What type of filter includes mechanical filters that stop larger particles?
What type of filter includes mechanical filters that stop larger particles?
Why is it important to disinfect peripheral intravenous tubing stopcocks?
Why is it important to disinfect peripheral intravenous tubing stopcocks?
What is the intubating dose of pancuronium?
What is the intubating dose of pancuronium?
Which type of filter attracts and holds charged particles?
Which type of filter attracts and holds charged particles?
Which adverse effect is common with the use of pancuronium?
Which adverse effect is common with the use of pancuronium?
What is a precaution to consider when administering rocuronium?
What is a precaution to consider when administering rocuronium?
What practice should be standard prior to each use of medication vials?
What practice should be standard prior to each use of medication vials?
Which of the following muscle relaxants is metabolized by Hofmann elimination?
Which of the following muscle relaxants is metabolized by Hofmann elimination?
What is the primary function of HME/filters in relation to the ETT?
What is the primary function of HME/filters in relation to the ETT?
Where should the HME/filter be placed to ensure effective patient humidification?
Where should the HME/filter be placed to ensure effective patient humidification?
Which technology is commonly used to produce ultraclean air in operating theatres?
Which technology is commonly used to produce ultraclean air in operating theatres?
What impacts the efficacy of the UV disinfection process?
What impacts the efficacy of the UV disinfection process?
What is a major advantage of UVGI over traditional systems in operating theatres?
What is a major advantage of UVGI over traditional systems in operating theatres?
What is one potential consequence of placing the HME/filter in a distal position?
What is one potential consequence of placing the HME/filter in a distal position?
Which of the following statements about UVGI systems is accurate?
Which of the following statements about UVGI systems is accurate?
Which component of the anesthesia machine is crucial for avoiding hypoxic gas mixtures?
Which component of the anesthesia machine is crucial for avoiding hypoxic gas mixtures?
Which type of lamps are commonly used in UVGI systems?
Which type of lamps are commonly used in UVGI systems?
What is one of the main functions of a scavenging system in anesthesia machines?
What is one of the main functions of a scavenging system in anesthesia machines?
Flashcards
General Anesthesia (GA)
General Anesthesia (GA)
A reversible state of Stage III surgical anesthesia characterized by hypnosis, amnesia, analgesia, muscle relaxation, autonomic and sensory blockade. It involves four stages that are often rapid and may not be observable.
GA Induction
GA Induction
The process of initiating general anesthesia in a patient.
GA Induction Agents
GA Induction Agents
Medications administered intravenously or inhaled to induce general anesthesia.
GA Maintenance
GA Maintenance
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Total Intravenous Anesthesia (TIVA)
Total Intravenous Anesthesia (TIVA)
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Neuromuscular Blocking Agents (NMBAs)
Neuromuscular Blocking Agents (NMBAs)
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GA Emergence
GA Emergence
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Stage I (Analgesia)
Stage I (Analgesia)
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Tramadol
Tramadol
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Opioid-induced respiratory depression
Opioid-induced respiratory depression
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Respiratory depression
Respiratory depression
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Paracetamol
Paracetamol
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Nonsteroidal anti-inflammatory drugs (NSAIDS)
Nonsteroidal anti-inflammatory drugs (NSAIDS)
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Hypotension
Hypotension
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Bradycardia
Bradycardia
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Ventricular tachycardia
Ventricular tachycardia
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Pancuronium
Pancuronium
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Cisatracurium
Cisatracurium
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Rocuronium
Rocuronium
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Neuromuscular Blockade
Neuromuscular Blockade
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Onset of Action
Onset of Action
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Duration of Action
Duration of Action
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Drug Metabolism
Drug Metabolism
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Non-enzymatic Degradation
Non-enzymatic Degradation
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Medication Administration Errors
Medication Administration Errors
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Error Reduction Strategies
Error Reduction Strategies
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Automated Drug Cabinet
Automated Drug Cabinet
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Automated Verification System
Automated Verification System
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Automated Dispensing Machines
Automated Dispensing Machines
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Aseptic Technique
Aseptic Technique
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Principles of Aseptic Technique
Principles of Aseptic Technique
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Stages of Aseptic Technique
Stages of Aseptic Technique
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Mechanical filters
Mechanical filters
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Electrostatic filters
Electrostatic filters
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HEPA filter
HEPA filter
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Airway Breathing System (ABS)
Airway Breathing System (ABS)
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Soda-lime canister
Soda-lime canister
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Internal components of anesthesia ventilators
Internal components of anesthesia ventilators
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Peripheral intravenous tubing stopcocks (triple ways)
Peripheral intravenous tubing stopcocks (triple ways)
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Disinfection of anesthesia drug containers
Disinfection of anesthesia drug containers
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Heat and Moisture Exchanger (HME) Filter
Heat and Moisture Exchanger (HME) Filter
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Closed Breathing System
Closed Breathing System
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Semi-Closed Breathing System
Semi-Closed Breathing System
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Ultraviolet Germicidal Irradiation (UVGI)
Ultraviolet Germicidal Irradiation (UVGI)
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Carbon Dioxide (CO2) Elimination
Carbon Dioxide (CO2) Elimination
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Ventilator
Ventilator
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Volume-Controlled Ventilation
Volume-Controlled Ventilation
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Pressure-Controlled Ventilation
Pressure-Controlled Ventilation
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Scavenging System
Scavenging System
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Vaporizer
Vaporizer
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Study Notes
Pharmacology of Anesthesia
- General anesthesia (GA) is used for most major surgeries
- GA aims to achieve hypnosis/unconsciousness, amnesia, analgesia, muscle relaxation, and autonomic/sensory blockade
- Stages of GA include analgesia (Stage I), excitement (Stage II), surgical anesthesia (Stage III), and medullary paralysis (Stage IV).
- Stage II (Excitement) is often bypassed by proper drug administration
- Induction of GA uses IV and/or inhalation agents, often with adjuvant IV agents and neuromuscular blocking agents (NMBA) if endotracheal intubation is planned
- Maintenance of GA often uses a primary inhalation technique or a combination of inhalation and IV anesthetic agents to reduce the total dose of any single agent
- Emergence from GA is the return of consciousness and movement after discontinuation of anesthetic agents.
Main Types of Medications Used in General Anesthesia
- Induction medications to induce and maintain unconsciousness (IV and volatile agents)
- Analgesics for pain relief
- Muscle relaxants to induce muscle relaxation
- Other frequently used medications in anesthesia include medications to quickly reduce memory loss or amnesia, prevent nausea and vomiting, counteract the effects of other medicines, and suppress or stimulate nervous reflexes
Essential Introduction to Pharmacology
- Pharmacokinetics (PK) is the study of what the body does to the drug and is divided into absorption, distribution, metabolism, and excretion
- Pharmacodynamics (PD) is the study of what the drug does to the body and how it acts, depends on the properties of the medication, or binding of specific receptors and enzymes
Induction Medications
- Generally, induction agents are either intravenous or inhalation
- Intravenous agents include thiopentone, etomidate, ketamine, and propofol, commonly used to quickly unconscious patients.
Intravenous Anesthetics-Thiopental Sodium
- Form: powder for solution for injection
- Uses: induction of anesthesia before administering inhalational anesthetics or for short duration procedures
- Contraindications: inability to maintain airway, cardiovascular disease, dyspnea, or hypersensitivity
Analgesics
- Analgesics vary in mechanism, but are commonly extracted from opium or synthetically created to reduce or remove pain.
- Opiate and opioid analgesics are often used in general anesthesia, along with other agents
- Examples of commonly used analgesics are morphine, fentanyl, and remifentanil
Antagonists
- Opioid antagonists can reverse the effects of opioid analgesics used in anesthesia, such as respiratory depression.
- An example of such an antagonist is naloxone hydrochloride.
Muscle Relaxants
- Muscle relaxants weaken or relax skeletal muscles, impacting voluntary and involuntary muscles.
- Examples of such relaxants include succinylcholine, vecuronium, pancuronium, rocuronium, mivacurium, and cisatracurium
Reversal of Neuromuscular Block
- Cholinesterase inhibitors, such as neostigmine methylsulfate, reverse the effects of muscle relaxants and allow for spontaneous respiration.
Medication Errors During Anesthesia
- Human error is a factor but there's still a lack of a clear plan for eliminating such errors in the delivery of medicines.
- Standardized procedures (e.g., systems for medication identification and storage), customized workspaces, and prefilled syringes for common drugs are ways to reduce errors.
- Using barcodes and drug labeling systems, and including a second staff member to verify high-alert medications and narcotics are crucial to preventing such errors
Infection Control Related to Drug Use (Aseptic Techniques)
- Aseptic technique aims to prevent the spread of potentially pathogenic micro-organisms to susceptible sites to avoid infections.
- The approach involves rigorous cleaning and disinfection of equipment and the operating environment
- Proper Hand hygiene (HH) is vital and should be performed at several critical points during procedures
- Single-use equipment is preferable to reduce contamination, and multiple use tools require thorough cleaning and sterilization between patients.
Cuff Pressure Gauge
- Cuff pressure gauge measures pressure in ETT, LMA, LT to ascertain safe pressure limits to prevent complications
- It has a luer attachment, rubber hand bulb for inflation, pressure display gauge, and pressure release valve.
Defibrillators
- Applying electrical current to the heart can help convert severe cardiac arrhythmias (VF/VT) into a normal sinus rhythm
- Defibrillators can provide electricity via pads/electrodes to the chest of patients undergoing cardiac arrest
- The device is an indispensable part of cardiopulmonary resuscitation (CPR) procedure and cardiac arrest management.
Laryngoscopes and Blades
- Laryngoscopes are instruments used during endotracheal intubation, helping visualize vocal cords, and facilitate intubation
- Laryngoscope blades vary in style and may be disposable or reusable, each with distinct advantages, depending on use patterns
Cleaning of the Operating Theatre
- Post-patient procedures, cleaning of the room and floor involving potential pathogens is required
- This ensures a safe environment for subsequent procedures, and the cleaning schedule and protocol should conform to facility and trust guidelines.
- Anaesthetists use PPE, such as gowns, masks, and gloves.
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