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 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

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 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 Paralysis

Neuromuscular blockers Depolarising Suxamethonium Non-depolarising Atracurium Vecuronium Rocuronium Depolarising Suxamethonium Non-depolarising Atracurium Vecuronium Rocuronium

Nicotinic ACh Receptor

Reversal 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

Uppers 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

Downers 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 Morphine Fentanyl Alfentanil Remifentanil Morphine Fentanyl Alfentanil Remifentanil

Antiemetics

Cyclizine – an anti-histamine (SE – tachycardia and other anti-cholinergic effects) Granisetron and ondansatron – 5-HT 3 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-HT 3 receptor antagonists (SE – constipation) Prochlorperazine (stematil) – a dopamine and mACh receptor antagonist (SE – extrapyramidal) Dexamethasone – a glucocorticoid (SE – deranged glucose control)