James Holding
Mar 28, 2015
James HoldingJames Holding
Green for Danger - Rank Films 1946
2009 Anaesthesia2009 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
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
Propofol Propofol
MaintenanceMaintenance
MaintenanceMaintenance
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
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
MAC = minimum alveolar concentration
Muscle ParalysisMuscle Paralysis
Neuromuscular blockersNeuromuscular blockers
Depolarising Suxamethonium
Non-depolarising Atracurium Vecuronium Rocuronium
Depolarising Suxamethonium
Non-depolarising Atracurium Vecuronium Rocuronium
Nicotinic ACh ReceptorNicotinic ACh Receptor
Reversal of ParalysisReversal of Paralysis
Neostigmine Blocks cholinesterase Stimulates nicotinic and
muscarinic Given with an
anticholinergic
Sugammadex
Neostigmine Blocks cholinesterase Stimulates nicotinic and
muscarinic Given with an
anticholinergic
Sugammadex
UppersUppers
Anticholinergics Atropine Glycopyrulate
Symatheto-mimetics agonists
Phenylepherine Metaraminol
Ephidrine A mixed and adreno agonist
Anticholinergics Atropine Glycopyrulate
Symatheto-mimetics agonists
Phenylepherine Metaraminol
Ephidrine A mixed and adreno agonist
DownersDowners
More anaesthetic or opiate
Short acting -blockers (labetalol, esmolol)
GTN
Clonidine - 2 agonist clonidine
More anaesthetic or opiate
Short acting -blockers (labetalol, esmolol)
GTN
Clonidine - 2 agonist clonidine
Opiates
MorphineFentanylAlfentanilRemifentanil
MorphineFentanylAlfentanilRemifentanil
AntiemeticsAntiemetics
AntiemeticsAntiemetics
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)
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)