1. James Holding

2. Green for Danger - Rank Films 1946

7. 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

8. Propofol

11. Maintenance

12. 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

13. MAC = minimum alveolar concentration

14. Muscle Paralysis

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

16. Nicotinic ACh Receptor

18. 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

19. 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

20. 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

21. Opiates Morphine Fentanyl Alfentanil Remifentanil Morphine Fentanyl Alfentanil Remifentanil

22. Antiemetics

23. 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)