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Intensive care
Pain relief
Hospital at night teams
Education
Drugs in Anaesthesia
The Triad of anaesthesia- a convenient way of thinking about anaesthetic drugs
A person having an anaesthetic will often have a combination from 1 each.
Consider CVS RS (airway / gas exchange) GI (reflux) NEURO METABOLIC effects
1 Hypnosis = unconsciousness
Intravenous
Propofol / Thiopentone / Etomidate / Methohexitone vs Ketamine
Effect all organ systems to differing extents
CVS hypotension / dyrhythmias
RS Airway reflexes / respiratory depression (apnoea)
GI - oesophageal sphincter tone (regurgitation)
One off dose.. or infusions
Sedation vs anaesthesia
Metabolised by liver
Elderly, ill, hypovolaemic need less greater side effects (eg cardiac arrest)
Ketamine CVS stimulant, analgesia
Normal Physiology: at NMJ, ACh released from nerves crosses cleft- ACh, Ca++ release
Suxamethonium 30-60 secs on, 4-5 mins off, depolarises/non-competitive,
enzymes degrade (cholinesterase)
Vecuronium, atracurium, others etc longer onset minutes /offset 15-45mins: competitive
either fall off as more ACh is made (naturally) or cholinesterase inhibitors
Postoperative
Where should the patient go? (ward/HDU/ICU/other hospital)
Analgesia
Monitoring and observations
DVT prophylaxis
Fluid
Oxygen
Communication (surgeon, nurses, patient, relatives)
Could I have done anything different/better?