Name: Fabian liteta

ID: pmp/15/02/0000312

Course: Anesthesia quiz

Q1. Muscle relaxants used in anaesthesia,indications, effects and reversal agents.

Ans: Muscle relaxants work by inhibiting the interaction between acetylcholine and the postsynaptic
(nicotinic) receptors on the motor end plate on the skeletal muscle membrane.

They are divided into two groups:

a. Depolarizing neuromuscular blockers: e.g. suxamethonium

b. Non-depolarizing neuromuscular blockers: e.g. Atracurium and pancuronium.

(i) Suxamethonium:

 Indications: In general anesthesia – aids tracheal intubation, provides muscle relaxation for
general surgery and aids mechanical ventilation.
 Effects: Action on nicotinic receptors produces a maintained depolarization of the muscle
membrane. This inactivates the Na+ channels, which propagate the action potential throughout
the muscle. Action potentials fail to spread along the muscle fibers preventing muscle
contraction in response to motor nerve activity.
 Reversal agent(s): Recovery occurs spontaneously as suxamethonium is hydrolyzed by the
enzyme plasma (pseudo-) cholinesterase and normal neuromuscular transmission is restored
after 4-6 minutes.

(ii) Pancuronium:

 Indication: Adjunct to General anaesthesia, Endotracheal intubation, Mechanical ventilation

 Effects: Reversible competitive antagonism at muscle-type nicotinic receptors. Inhibits binding
of Ach to the receptors at the muscle end-plate. End-plate potential fails to reach threshold for
initiation and propagation of the action potential along the muscle.
 Reversal agents: Neostigmine

(iii) Atracurium:

 Indication: in General anesthesia- Tracheal intubation, Mechanical ventilation

 Effects: Reversible competitive antagonism at muscle-type nicotinic receptors. Inhibits binding
of Ach to the receptors at the muscle end-plate. End-plate potential fails to reach threshold for
initiation and propagation of the action potential along the muscle.
 Reversal agent(s): Neostigmine

Q2. Steps and indication for rapid sequence induction

Ans: Rapid sequence induction is used in an event where a patient requiring general anesthesia has
been identified as having the risk for gastric aspiration.
Steps:

 Preparation of equipment
 Preparation of patient: positioning, monitoring and Iv fluids.
 Pre-oxygenation
 Cricoid pressure application with loss of consciousness
 Tracheal intubation with cuffed endotracheal tube.

Indications:

 Non-fasted emergency cases

 Acute abdomen
 Pregnant women >20 weeks
 Diabetic autonomic dysfunction
 Delayed gastric emptying (opioids, alcohol)
 Gastric outlet obstruction
 Large hiatus hernia
 Active positional gastro-esophageal reflux
 Obese patients