SELF ASSESSMENT SECTION (1)
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Question 1
The following statements about suxamethonium are true A. It is the muscle relaxant most frequently implicated in allergic reactions B. It is metabolised to two molecules of acetylcholine by the action of plasma pseudocholinesterase C. The rise in intraocular pressure caused by its administration lasts for up to half an hour D. It may cause a bradycardia due to stimulation of nicotinic receptors E. The Phase II block seen after repeated administration or infusion is reliably reversed using neostigmine
Question 15
The following are true regarding breathing systems
A. The Bain circuit is an example of a Mapleson A system
B. The Bain circuit is more efficient than the Lack circuit during spontaneous breathing
C. In the Bain circuit, fresh gas flow occurs through the outer tube
D. During spontaneous breathing, the Lack circuit requires a fresh gas flow rate of twice the alveolar minute ventilation to prevent rebreathing
E. The Lack circuit may be used to ventilate the patient's lungs with the Penlon Nuffield 200 ventilator
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Answer 1
A. true B. false C. false D. false E. false
It is composed of two molecules of acetylcholine, but is metabolised to the relatively inactive succinyl monocholine. The rise in intraocular pressure caused by suxamethonium alone is brief, lasting for a few minutes. The bradycardia is caused by activation of muscarinic receptors. Phase II block does exhibit the characteristics of non-depolarising block but is not reversed by anticholinesterases.
Answer 15 A. false B. false C. false D. false E. false
The Bain circuit is the coaxial version of the Mapleson D system. Fresh gas flow (FGF) is supplied through a narrow inner tube. The patient's expired gases pass through the outer tube and are vented to atmosphere. This sytem is inefficient during spontaneous breathing but efficient during controlled ventilation. A FGF rate of between two to three times minute volume (200- 250 ml/kg/min) may be required during spontaneous ventilation to prevent rebreathing. FGF of between 70 and 80 ml/kg/min is required during controlled ventilation to prevent rebreathing.
The Lack circuit is the coaxial version of the Mapleson A system. The outer tube supplies inspired gas from the reservoir bag and the patient exhales through the inner tube. This system is inefficient during controlled ventilation but efficient during spontaneous breathing. During controlled ventilation, the FGF rate must be at least three times alveolar minute volume to prevent rebreathing. If the system is functioning correctly and no leaks are present, a FGF rate equal to the patient's alveolar minute ventilation is sufficient to prevent rebreathing. In practice, a higher FGF rate (equal to the minute volume) is selected to compensate for leaks. Unlike the Bain circuit, the Lack circuit does not permit the use of ventilators to provide controlled ventilation.
Ref: A R Aitkenhead, G Smith. Textbook of Anaesthesia,
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(ที่มา : http://www.nda.ox.ac.uk/wfsa/html/u17/u1716_01.htm )
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