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James Holding. Green for Danger - Rank Films 1946. 2009 Anaesthesia. Intravenous induction Short acting opiate - e.g. fentanyl ‘anaesthetic’ - e.g. propofol Set up of anaesthetic maintenance - e.g. sevoflurane vapour in oxygen and air Specific muscle paralysis may be needed

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2009 Anaesthesia

  • Intravenous induction

  • Short acting opiate - e.g. fentanyl

  • ‘anaesthetic’ - e.g. propofol

  • Set up of anaesthetic maintenance - e.g. sevoflurane vapour in oxygen and air

  • Specific muscle paralysis may be needed

  • Definitive analgesia

  • Anti-emetic




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Maintenance

Concepts of partial pressure and MAC

  • Isoflurane (ISO) – MAC = 1.1

  • Desflurane (DES) – MAC = 6

    • The most insoluble – so the fastest to equilibrate – but a respiratory irritant, so unsuitable for gaseous induction.

  • Sevoflurane (SEVO) – MAC = 2.2

    • Used for gaseous induction.

  • Nitrous Oxide – a gas. MAC = 105

  • Propofol and Remifentanil




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Neuromuscular blockers

  • Depolarising

    • Suxamethonium

  • Non-depolarising

    • Atracurium

    • Vecuronium

    • Rocuronium



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Reversal of Paralysis

  • Neostigmine

    • Blocks cholinesterase

    • Stimulates nicotinic and muscarinic

    • Given with an anticholinergic

  • Sugammadex


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Uppers

  • Anticholinergics

    • Atropine

    • Glycopyrulate

  • Symatheto-mimetics

    •  agonists

      • Phenylepherine

      • Metaraminol

    • Ephidrine

      • A mixed  and  adreno agonist


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Downers

More anaesthetic or opiate

Short acting -blockers (labetalol, esmolol)

GTN

Clonidine - 2 agonist clonidine


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Opiates

Morphine

Fentanyl

Alfentanil

Remifentanil



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Antiemetics

  • Cyclizine – an anti-histamine (SE – tachycardia and other anti-cholinergic effects)

  • Granisetron and ondansatron – 5-HT3 receptor antagonists (SE – constipation)

  • Prochlorperazine (stematil) – a dopamine and mACh receptor antagonist (SE – extrapyramidal)

  • Dexamethasone – a glucocorticoid (SE – deranged glucose control)


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