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Questions and Answers
What type of drugs are used to induce and maintain anesthesia during surgery in general anesthesia?
What type of drugs are used to induce and maintain anesthesia during surgery in general anesthesia?
Which type of drugs can be used as analgesics in general anesthesia?
Which type of drugs can be used as analgesics in general anesthesia?
Why do neuromuscular blocking drugs require positive-pressure ventilation?
Why do neuromuscular blocking drugs require positive-pressure ventilation?
Intravenous anaesthetics should be titrated to effect. Why are lower doses usually required in premedicated patients?
Intravenous anaesthetics should be titrated to effect. Why are lower doses usually required in premedicated patients?
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What is the main challenge in total intravenous anesthesia?
What is the main challenge in total intravenous anesthesia?
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'Target Controlled Infusion (TCI) systems' are used in total intravenous anesthesia for what purpose?
'Target Controlled Infusion (TCI) systems' are used in total intravenous anesthesia for what purpose?
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Which anesthetic is rapid-acting but not recommended for induction due to irritant effects on the upper respiratory tract?
Which anesthetic is rapid-acting but not recommended for induction due to irritant effects on the upper respiratory tract?
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What is the primary risk factor that patients taking antiplatelet medication or an oral anticoagulant pose for surgery?
What is the primary risk factor that patients taking antiplatelet medication or an oral anticoagulant pose for surgery?
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Which medication is specifically used to treat malignant hyperthermia, a rare but dangerous complication during anesthesia?
Which medication is specifically used to treat malignant hyperthermia, a rare but dangerous complication during anesthesia?
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For patients with stable angina at high thrombotic risk, which drug should be continued perioperatively?
For patients with stable angina at high thrombotic risk, which drug should be continued perioperatively?
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Which anesthesia-related medication should be administered slowly by experienced personnel due to its potential side effects, including apnea and hypotension?
Which anesthesia-related medication should be administered slowly by experienced personnel due to its potential side effects, including apnea and hypotension?
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What is the main adverse effect that herbal medicines may have when given with anesthetic drugs?
What is the main adverse effect that herbal medicines may have when given with anesthetic drugs?
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Which type of anesthesia is more potent but slower, often used for inhalational induction of anesthesia?
Which type of anesthesia is more potent but slower, often used for inhalational induction of anesthesia?
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Which medication can help reduce pain on injection during anesthesia induction?
Which medication can help reduce pain on injection during anesthesia induction?
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What is a rare but potentially lethal complication during anesthesia characterized by rapid temperature rise, muscle rigidity, tachycardia, and acidosis?
What is a rare but potentially lethal complication during anesthesia characterized by rapid temperature rise, muscle rigidity, tachycardia, and acidosis?
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What should be stopped before surgery to prevent potential complications during the procedure?
What should be stopped before surgery to prevent potential complications during the procedure?
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What is the recommended initial dose of cisatracurium for adults during surgery and intubation?
What is the recommended initial dose of cisatracurium for adults during surgery and intubation?
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Why should suxamethonium chloride be given after anaesthetic induction?
Why should suxamethonium chloride be given after anaesthetic induction?
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What complication is associated with suxamethonium chloride in patients with severe sepsis?
What complication is associated with suxamethonium chloride in patients with severe sepsis?
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Which condition is a contraindication for the use of suxamethonium chloride?
Which condition is a contraindication for the use of suxamethonium chloride?
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What are the side effects associated with atracurium besilate?
What are the side effects associated with atracurium besilate?
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What is the primary reason behind the recommendation to avoid pregnancy and breastfeeding while using neuromuscular blocking drugs?
What is the primary reason behind the recommendation to avoid pregnancy and breastfeeding while using neuromuscular blocking drugs?
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What is the main reason for caution in using neuromuscular blocking drugs in cases of hypersensitivity?
What is the main reason for caution in using neuromuscular blocking drugs in cases of hypersensitivity?
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Why is premedication with atropine recommended when administering suxamethonium chloride?
Why is premedication with atropine recommended when administering suxamethonium chloride?
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What is the primary reason for avoiding the use of suxamethonium chloride in patients with congenital myotonic disease?
What is the primary reason for avoiding the use of suxamethonium chloride in patients with congenital myotonic disease?
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What is the primary role of antimuscarinic drugs as premedicants?
What is the primary role of antimuscarinic drugs as premedicants?
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What is the emergency role of atropine sulfate in premedication?
What is the emergency role of atropine sulfate in premedication?
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Which drug is specifically mentioned for reversal of non-depolarising neuromuscular blocking drugs?
Which drug is specifically mentioned for reversal of non-depolarising neuromuscular blocking drugs?
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Why is the use of benzodiazepines like flumazepam not recommended in children during peri-operative periods?
Why is the use of benzodiazepines like flumazepam not recommended in children during peri-operative periods?
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What is the primary purpose of Dexmedetomidine and clonidine hydrochloride in intensive care patients?
What is the primary purpose of Dexmedetomidine and clonidine hydrochloride in intensive care patients?
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What is the main function of naloxone hydrochloride in anesthesia practice?
What is the main function of naloxone hydrochloride in anesthesia practice?
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Why is flumazepam used after anesthesia when benzodiazepines are administered?
Why is flumazepam used after anesthesia when benzodiazepines are administered?
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What is the manufacturer's recommendation for monitoring blood pressure after administering Esketamine?
What is the manufacturer's recommendation for monitoring blood pressure after administering Esketamine?
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Which of the following are interactions associated with Esketamine?
Which of the following are interactions associated with Esketamine?
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When should patients not eat before Esketamine treatment?
When should patients not eat before Esketamine treatment?
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How should Esketamine be administered for intranasal use?
How should Esketamine be administered for intranasal use?
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What is a specific instruction regarding nasal corticosteroids or decongestants for patients receiving Esketamine?
What is a specific instruction regarding nasal corticosteroids or decongestants for patients receiving Esketamine?
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Which condition is Esketamine advised to be used with caution during breastfeeding?
Which condition is Esketamine advised to be used with caution during breastfeeding?
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What is the purpose of administering Esketamine in emergency medicine?
What is the purpose of administering Esketamine in emergency medicine?
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Which healthcare professionals are recommended to administer Esketamine in emergency medicine?
Which healthcare professionals are recommended to administer Esketamine in emergency medicine?
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"Patients should be assessed for the risk of drug abuse prior to starting treatment." What action should be taken during therapy regarding this assessment?
"Patients should be assessed for the risk of drug abuse prior to starting treatment." What action should be taken during therapy regarding this assessment?
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"Pregnancy is advised to use Esketamine only if potential benefit outweighs risk." When should Esketamine be avoided during pregnancy?
"Pregnancy is advised to use Esketamine only if potential benefit outweighs risk." When should Esketamine be avoided during pregnancy?
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What is the recommended initial dose of Rocuronium bromide for adults during surgery and intubation?
What is the recommended initial dose of Rocuronium bromide for adults during surgery and intubation?
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Why should dose adjustments be made for obese patients when administering Mivacurium?
Why should dose adjustments be made for obese patients when administering Mivacurium?
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In what situations is Pancuronium bromide typically used besides surgery and intubation?
In what situations is Pancuronium bromide typically used besides surgery and intubation?
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What is the primary purpose of Neostigmine when used alongside competitive neuromuscular blockers?
What is the primary purpose of Neostigmine when used alongside competitive neuromuscular blockers?
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What distinguishes Sugammadex from anticholinesterases in reversing neuromuscular blockade induced by Rocuronium or Vecuronium?
What distinguishes Sugammadex from anticholinesterases in reversing neuromuscular blockade induced by Rocuronium or Vecuronium?
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Why should a multimodal approach using different analgesics be considered for postoperative pain management?
Why should a multimodal approach using different analgesics be considered for postoperative pain management?
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What allows Remifentanil to be administered at high dosages without significant respiratory depression risk?
What allows Remifentanil to be administered at high dosages without significant respiratory depression risk?
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'Ideal body weight' is emphasized when calculating Mivacurium dosages for obese patients to:
'Ideal body weight' is emphasized when calculating Mivacurium dosages for obese patients to:
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What distinguishes the recommended dosages of Pancuronium bromide between surgery/intubation and intensive care usage?
What distinguishes the recommended dosages of Pancuronium bromide between surgery/intubation and intensive care usage?
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Why should Rocuronium bromide have different initial dosages for adults and elderly patients during surgery and intubation?
Why should Rocuronium bromide have different initial dosages for adults and elderly patients during surgery and intubation?
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What is the main concern associated with prolonged infusion of propofol?
What is the main concern associated with prolonged infusion of propofol?
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Which of the following is NOT mentioned as a possible side effect of volatile halogenated anaesthetics?
Which of the following is NOT mentioned as a possible side effect of volatile halogenated anaesthetics?
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What is a potential complication associated with using nitrous oxide for anesthesia?
What is a potential complication associated with using nitrous oxide for anesthesia?
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Which anesthesia adjuvant is specifically mentioned in managing the risks associated with volatile halogenated anaesthetics?
Which anesthesia adjuvant is specifically mentioned in managing the risks associated with volatile halogenated anaesthetics?
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What is a potential effect of using desflurane during delivery?
What is a potential effect of using desflurane during delivery?
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Which of the following is NOT listed as a side effect of propofol?
Which of the following is NOT listed as a side effect of propofol?
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What is a potential complication of using nitrous oxide for anesthesia?
What is a potential complication of using nitrous oxide for anesthesia?
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Which medication form is mentioned for Isoflurane in the text?
Which medication form is mentioned for Isoflurane in the text?
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'Mandelson's syndrome' is crucial in which types of surgery according to the text?
'Mandelson's syndrome' is crucial in which types of surgery according to the text?
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'QT-interval prolongation' is a risk mentioned in the text associated with which types of medications?
'QT-interval prolongation' is a risk mentioned in the text associated with which types of medications?
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What are the contra-indications for using Dantrolene sodium?
What are the contra-indications for using Dantrolene sodium?
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In what conditions is Dantrolene sodium used?
In what conditions is Dantrolene sodium used?
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What is the primary action of Dantrolene sodium on skeletal muscle cells?
What is the primary action of Dantrolene sodium on skeletal muscle cells?
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When should pregnancy and intravenous use of Dantrolene sodium be considered?
When should pregnancy and intravenous use of Dantrolene sodium be considered?
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What are the potential risks associated with Dantrolene sodium use?
What are the potential risks associated with Dantrolene sodium use?
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Why should Dantrolene sodium only be administered by experienced personnel?
Why should Dantrolene sodium only be administered by experienced personnel?
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What is a key characteristic of remifentanil's duration of action?
What is a key characteristic of remifentanil's duration of action?
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Which medication is specifically indicated for maintaining sedation in intensive care units?
Which medication is specifically indicated for maintaining sedation in intensive care units?
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What is a contra-indication for using ketamine as an anesthetic?
What is a contra-indication for using ketamine as an anesthetic?
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Why should pregnancy be avoided when administering remimazolam?
Why should pregnancy be avoided when administering remimazolam?
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What is a potential side effect of dexmedetomidine administration?
What is a potential side effect of dexmedetomidine administration?
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How should muscle rigidity be managed during anesthesia?
How should muscle rigidity be managed during anesthesia?
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What is advised for patients with severe hepatic impairment before undergoing a procedure involving sedatives and analgesics?
What is advised for patients with severe hepatic impairment before undergoing a procedure involving sedatives and analgesics?
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What form is remifentanil available in for injection?
What form is remifentanil available in for injection?
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What is a significant difference between remifentanil and remimazolam?
What is a significant difference between remifentanil and remimazolam?
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What is the primary method mentioned in the text for enhancing anesthesia during maintenance?
What is the primary method mentioned in the text for enhancing anesthesia during maintenance?
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Study Notes
Anesthesia and Analgesia
- Remifentanil is used for analgesia and enhancement of anesthesia during maintenance of anesthesia, and undergoes rapid metabolism by plasma esterases, with a short duration of action independent of dose and duration of infusion.
Ketamine
- Ketamine is used for induction and maintenance of anesthesia for short procedures, with doses ranging from 6.5-13 mg/kg for intravenous injection and 1-5 mg/kg for intramuscular injection.
- Contraindications include acute porphyrias, eclampsia, head trauma, hypertension, pre-eclampsia, raised intracranial pressure, severe cardiac disease, and stroke.
- Individual interactions with ketamine can lead to various side effects.
Remimazolam
- Remimazolam is used for anesthesia and analgesia, and should only be administered by experienced personnel with adequate training in anesthesia and airway management.
- Cardiac disease can cause side effects such as arrhythmias, dyspnea, gas exchange abnormal, respiratory disorders, vomiting, chills, feeling cold, and hiccups.
Dexmedetomidine
- Dexmedetomidine is used for maintaining sedation during intensive care, with an adult dose of 0.7 micrograms/kg/hour, adjusted according to response.
- It should only be administered by experienced personnel with adequate training in anesthesia and airway management.
General Anesthesia
- General anesthesia involves the use of various drugs to induce and maintain anesthesia during surgery.
- These drugs can be volatile, intravenously administered, or inhaled, and are maintained with an anesthetic.
- Short-acting opioids are also used as analgesics.
Intravenous Anesthetics
- Intravenous anesthetics are used to induce or maintain anesthesia during surgery, with most producing their effect in one arm-brain circulation time.
- Care is required in mouth, pharynx, or larynx surgeries where maintaining the airway may be difficult.
Volatile Liquid Anesthetics
- Volatile liquid anesthetics are used for induction and maintenance of anesthesia, and following induction with an intravenous anaesthetic.
- Examples include isoflurane, desflurane, and sevoflurane, each with different characteristics and side effects.
Malignant Hyperthermia
- Malignant hyperthermia is a rare but potentially lethal anesthesia complication characterized by rapid temperature rise, muscle rigidity, tachycardia, and acidosis.
- Patients at high risk should avoid volatile anaesthetics and suxamethonium chloride during anesthesia.
Medications and Surgery
- The risk of losing disease control when stopping long-term medication before surgery is often greater than the risk posed by continuing it during surgery.
- Anesthetists must be aware of all patients' medications, including corticosteroids, antiepileptics, antiparkinsonian drugs, antipsychotics, anxiolytics, bronchodilators, cardiovascular drugs, glaucoma drugs, immunosuppressants, and thyroid or antithyroid drugs.
Neuromuscular Blocking Drugs
- Neuromuscular blocking drugs are used for surgery and intubation, with examples including suxamethonium chloride, atracurium besilate, and cisatracurium.
- These drugs can cause various side effects, including arrhythmias, bradycardia, flushing, muscle contractions, and allergic cross-reactivity.
Antimuscarinic Drugs
- Antimuscarinic drugs are used as premedicants to reduce bronchial and salivary secretions, which can be increased by intubation, upper airway surgery, or inhalational anaesthetics.
- Examples include atropine sulfate, hyoscine hydrobromide, and glycopyrronium bromide.
Benzodiazepines
- Benzodiazepines are commonly used for premedication, providing relief of anxiety, sedation, and amnesia.
- Examples include diazepam and flumazenil.
Sedative Alpha2-Adrenergic Agonists
- Sedative alpha2-adrenergic agonists are used for intensive care patients, with examples including dexmedetomidine and clonidine hydrochloride.### Esketamine
- Blocks N-methyl-D-aspartate (NMDA) receptors, resulting in dissociative anesthesia and analgesia
- Used for induction and maintenance of anesthesia, analgesia in emergency medicine, and inhalation
- Should be administered by experienced personnel with adequate training in anesthesia and airway management
- Patients should be assessed for the risk of drug abuse prior to starting treatment and monitored for signs of this during therapy
Side Effects of Esketamine
- General side effects: anxiety, dizziness, nausea, vomiting
- Specific side effects: drowsiness, dry mouth, dysarthria, feeling abnormal, hallucinations, headache, hyperacusia, hyperhidrosis, hypertension, mood altered, nasal complaints, oral disorders, perception altered, psychiatric disorders, sensation abnormal, tachycardia, taste altered, tinnitus, tremor, urinary disorders, vertigo, vision blurred
- Rare or very rare side effects: muscle tone increased, nystagmus, skin reactions, hypotension, cystitis, disorientation, drug-induced liver injury, dysphoria, hallucination
Pregnancy and Breastfeeding with Esketamine
- Pregnancy: use only if potential benefit outweighs risk, may depress neonatal respiration if used during delivery
- Breastfeeding: use with caution for Major Depressive Disorder
Administration and Monitoring of Esketamine
- Solution can be diluted with glucose 5% or sodium chloride 0.9% for intramuscular or intravenous use
- A single-use device is required for intranasal use
- Patients should be informed not to eat for at least 2 hours before treatment and not to drink liquids for at least 30 minutes before treatment
- Monitor blood pressure at baseline and approximately 40 minutes after treatment
- Monitor for urinary tract and bladder symptoms during treatment
Alfentanil and Remifentanil
- Alfentanil: used for short procedures, with indications and doses for spontaneous respiration, assisted ventilation, intravenous injection
- Remifentanil: used for analgesia and enhancement of anesthesia at induction, with doses ranging from 0.25-1 microgram/kg for adults
Mivacurium and Pancuronium Bromide
- Mivacurium: short-term medication used during surgery and intubation, initially administered by intravenous injection
- Pancuronium Bromide: long-term neuromuscular blocking drug used for long duration during surgery and intubation, with an initial dose of 100 micrograms/kg
Rocuronium Bromide
- Used during surgery and intubation, with an initial dose of 600 micrograms/kg for adults and 20-30 micrograms/kg for intravenous injections
- Side effects: common procedural complications, rare or very rare angioedema, face oedema, and paralysis
Anticholinesterases and Sugammadex
- Anticholinesterases: reverse nondepolarising neuromuscular blocking drugs like pancuronium bromide
- Sugammadex: used for rapid reversal of neuromuscular blockade induced by rocuronium bromide or vecuronium bromide, primarily used in emergency situations
Postoperative Pain Management
- Patients should be discussed postoperative pain management options, considering clinical features, type of surgery, pain history, preferences, expected impact, treatment benefits and risks, and discharge plan
- A multimodal approach using different analgesics should be offered, and pre-emptive analgesia should be prescribed to manage pain after local anesthesia wears off
Intra-operative Analgesia
- Opioid analgesics such as alfentanil, fentanyl, and remifentanil can be used, which act within 1-2 minutes and have short durations of action
- Repeated intra-operative doses should be given with care as respiratory depression can persist postoperatively
Propofol and Other Anesthetics
- Propofol: used for anesthesia in surgical and diagnostic procedures, with dose depending on patient's age and condition
- Propofol infusion syndrome can result from prolonged infusion of propofol doses exceeding 4mg/kg/hour
- Desflurane: used for inducing anesthesia in adults, maintaining anesthesia in nitrous oxide-oxygen, and maintaining anesthesia in oxygen or oxygen-enriched air
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Description
Learn about the drugs used to induce and maintain general anesthesia during surgery, including volatile, intravenous, and inhaled options. Explore the use of short-acting opioids for analgesia and neuromuscular blocking drugs for positive-pressure ventilation. Understand the role of anticholinesterases and antagonists in reversing drug effects post-surgery.
