These questions relate to Prothrombinex.
Q. It is a recombinant product. TRUE/ FALSE
Q. Antagonizes the action of warfarin within minutes. TRUE/ FALSE
Q. Constitutes an infectious risk. TRUE/ FALSE
Q. Comes formulated as a clear, colourless liquid. TRUE/ FALSE
Q. Must always be given in combination with FFP. TRUE/ FALSE
The Laryngeal Mask Airway (LMA) was just one of numerous patents that Brain applied for. This is true. The LMA was the thirteenth patent he applied for. While not gifted in the sciences at school he had a flair for construction. He built his own guitar at the age of fourteen.
The first published study involving the LMA was a case series of women undergoing gynaecological laparoscopy. This is also true. The paper was published in the BJA in 1983 and was titled “The laryngeal mask- a new concept in airway management”.
The LMA was first commercially available in 1983. False. The first commercial devices were available in the UK in 1988. Not all that long ago really! It took years for Brain to perfect his device and develop it as a medical device.
Australia was the first place to use the Proseal LMA. This is true and was again relatively recently in 2000. I don’t know why. Perhaps he knew he had a willing advocate down under in the person of Joe Brimacombe!
There are over twenty different methods described to insert a LMA. This is true and they are all described in Brimacombe’s book. You only need one, however.
Dr Brain was born on July 2, 1942. His father was a diplomat and was knighted. Surely his son deserves a knighthood also?
I hope I am not being presumptuous in assuming that all of you know who Archie Brain is. The next sentence will give you a rather substantial clue regardless. I reckon his invention of the laryngeal mask was worthy of the Nobel Prize for Medicine. His invention is certainly the most significant advance in the field of anaesthesia for my generation. It is very fortunate that propofol joined the arsenal at roughly the same time. White stuff + LMA is probably the commonest anaesthetic combo in the world today. Interestingly enough the first anaesthetics using the LMA were done with a combination of thiopentone and muscle relaxant. Trying to insert a LMA with just thiopentone is fraught with peril but the contemporary anaesthetic trainee has barely seen a vial of thiopentone these days let alone tried to insert a LMA under the influence of this venerable barbiturate. For a fascinating and comprehensive history about all things concerning Brain and his invention one should consult Joe Brimacombe’s definitive Laryngeal Mask Anesthesia: Principles and Practice. I would confidently assert that Brimacombe has inserted more LMAs than anyone else on the planet. Despite the American spelling of his textbook he is a pom who practices in Far North Queensland. To say he is an ardent fan of the Proseal LMA would be an understatement. LMAs are so popular in Cairns that they mandate intubating people each April so they don’t forget what to do with a laryngoscope.
The Laryngeal Mask Airway (LMA) was just one of numerous patents that Brain applied for. TRUE/ FALSE
The first published study involving the LMA was a case series of women undergoing gynaecological laparoscopy. TRUE/ FALSE
The LMA was first commercially available in 1983. TRUE/ FALSE
Australia was the first place to use the Proseal LMA. TRUE/ FALSE
There are over twenty different methods described to insert a LMA. TRUE/ FALSE
It is significantly more expensive than metoclopramide* T/F
It prolongs the QT period to a similar degree to that of droperidol T/F
A common adverse effect is constipation T/F
It doesn’t impair the analgesic efficacy of tramadol T/F
The wafer formulation has an intense bitter taste T/F
*At the time of writing, an amp of Maxolon costs about 40 cents in my hospital.
Admittedly, this is a rather dry topic. It is of unequivocal importance to anaesthetists however as our practice revolves around giving drugs that have potent pharmacodynamics effects with rapid onset and offset of action.
Regarding the time to peak effect (TTPE):
Is indicated on a plasma time curve for a bolus dose where the effect site curve crosses the plasma concentration curve TRUE/FALSE
Will be relatively short for any drug that rapidly redistributes TRUE/FALSE
Will be relatively short for drugs with a large keo TRUE/FALSE
Will always be longer than the t ½ keo TRUE/FALSE
Is considered to be a dose insensitive parameter TRUE/FALSE
Coming in an aesthetically pleasing little orange container, glucagon is a drug anaesthetists administer infrequently. Funnily enough the most common indication that we give glucagon for has nothing to do with hypoglycaemia. Rather it is given to treat suspected spasm of the sphincter of Oddi demonstrated on an intraoperative cholangiogram when performed during a lap chole. The second most common indication in our sphere of influence is probably the management of impacted food boluses. Both of these indications relate to the smooth muscle relaxant action of glucagon.
Glucagon is an anabolic hormone TRUE/FALSE
Glucagon is synthesized by the alpha cells of the islets of Langerhans TRUE/FALSE
Glucagon is effective in the management of beta blocker overdose because it firmly binds to adrenoceptors TRUE/FALSE
Glucagon is an inotrope and chronotrope TRUE/FALSE
Glucagon binds to a G protein coupled receptor and inhibits adenylate cyclase activity and thus reduces cAMP TRUE/FALSE
Insulin preparations are synthesized using recombinant technology TRUE/FALSE
If injected intravenously, long acting insulins will still have a long duration of action TRUE/FALSE
Insulins are metabolized by the liver TRUE/FALSE
Measurement of C-peptide levels can differentiate endogenous from exogenous insulin TRUE/FALSE
Glargine insulin (Lantus) forms microprecipitates when injected subcutaneously* TRUE/FALSE
* Lantus commonly stings when injected- my diabetic father will attest to this! This is related to its formulation. Can you hazard a guess at its pH and why it is formulated like that?
Although insulin will degrade at room temperature, it is similar to suxamethonium in that it will be retain adequate activity for well over a month if left out on your anaesthetic trolley.
A standard Mars bar (53g) contains 30g of glucose. They used to be given to pregnant women as a component of the glucose challenge test for gestational diabetes. I don’t know if this is still the case.
The glucose transporter, GLUT-4, is ubiquitous and found in most cells in the body TRUE/FALSE
Hepatic uptake of glucose is dependent on the presence of insulin TRUE/FALSE
Glucokinase phosphorylates glucose and is a pivotal enzyme in the glycolysis pathway TRUE/ FALSE
Alterations in glucose transport occur within seconds of insulin release TRUE/FALSE
Insulin has trophic and mitogenic actions TRUE/FALSE
A bonus question- are glucose and dextrose the same thing?
That’s the actual Ether Dome pictured above. You can visit it- I haven’t done so yet but it is on my bucket list. The picture on the back wall was commissioned after the 150th celebration of Ether Day. Although possibly not as famous as Robert Hinckley’s painting, ‘The First Operation with Ether’, it is certainly more historically accurate.
To the statements then regarding National Anaesthesia Day:
It has always been celebrated on this date in Australia. False, it has only been recently that Australia has deigned to celebrate it on the actual date.
Morton tried to patent ether calling his mystery drug ‘Letheon’. True, he and his mentor, a Professor of Chemistry named Charles Jackson, applied for and got a patent. This was withdrawn later- Morton was determined to get all the recognition (and profits) for himself. He and Jackson fought a bitter lifelong quarrel to be recognised as the sole true discoverer of anaesthesia.
Morton was running late on the momentous day setting an unfortunate precedent. True, he was having problems getting his inhaler device ready in time. Surgeons have been bemoaning ‘equipment issues’ on our part ever since.
Morton was the first person to administer ether successfully for a surgical procedure. False, we know at least one other person successfully used ether for surgery prior to October 16, 1846. A rural doctor called Crawford Long used ether in 1842. Idiot didn’t tell anyone about it and he didn’t publish his findings until 1849.
Morton killed himself by cutting his femoral artery at the age of 48 while imprisoned. He was incarcerated for throwing acid in a prostitute’s face. This is false. The details relate to the unfortunate demise of Morton’s partner, Horace Wells. He died at the age of 33, the other details are correct. He never recovered from being booed off ‘stage’ after his failed attempt to demonstrate anaesthesia with nitrous oxide. He was a victim of the pharmacokinetic properties of the agent more than a failing of the agent itself. Morton’s choice of ether, a highly soluble agent with a slower offset of action, was the key to his success. Morton died of a stroke.
Today is a very significant one particularly if you are an anaesthetist. On this day, 171 years ago, William Thomas Green Morton (pictured above) administered the first successful anaesthetic publically at what is now termed the ‘Ether Dome’ in Massachusetts General Hospital, Boston. I am biased but think this is the most significant medical discovery ever. What is perhaps surprising is that the demonstration didn’t happen many years earlier- ether is not a novel chemical nor is it difficult to synthesize. The analgesic and sedative properties of nitrous oxide had been known about for almost half a century but no one had bothered to apply this knowledge to the more expedient need of surgical anaesthesia. To be fair, Morton’s contemporary, Horace Wells, used nitrous oxide successfully for dental extractions before unfortunately ‘failing’ when he demonstrated it publically on the same stage as Morton would subsequently have success. I put the ‘failing’ in apostrophes because although Wells’ patient (he was a medical student with a toothache) groaned when under the influence- eliciting the derisory, “Bah humbug!” comment from the surgeon- the patient later stated that he did not recall the procedure and that it had caused him no pain. Surgeons have forever since equated movement or vocalisation from the patient as evidence of inadequate anaesthesia.
Although we commemorate this event with the respect that it deserves, the pioneering anaesthetists of the day were not the most respectable or reputable bunch. For the most part they were greedy, self-serving dentists out to make a quick buck. Nonetheless we are indebted to them.
The following statements relate to October 16, National Anaesthesia Day:
It has always been celebrated on this date in Australia TRUE/FALSE
Morton tried to patent ether calling his mystery drug ‘Letheon’ TRUE/FALSE
Morton was running late on the momentous day setting an unfortunate precedent TRUE/FALSE
Morton was the first person to administer ether successfully for a surgical procedure TRUE/FALSE
Morton killed himself by cutting his femoral artery at the age of 48 while imprisoned. He was incarcerated for throwing acid in a prostitute’s face TRUE/FALSE
Answers another time. Happy Anaesthesia Day!