Anaes

Question 1

Causes of post-op hypoxia

Answer 1

tongue falling back
Benzos, opiates
Inhalationals
NMBAs
OSA
Shivering
Bronchospasm
Laryngospasm
Upper airway secretions

Question 2

Causes of post-op hypotension

Answer 2

Inhalationals, opiods, induction agents
Epidural anaes
Bleeding
Sepsis
Pneumothorax
Cardiac tamponade
MI, HF

Question 3

Causes of HTN

Answer 3

Pain
Distended bladder
Hypercapnia
Excessive IV fluids
Vasopressor use

Question 4

Causes of PONV

?

Answer 4

Inhalationals
Full stomach
Young females and children
non-smokers
Obese
Hx of PONV
Laparoscopic surgery
Upper GI surg
Middle ear surgery

Question 5

Causes of shivering post-op

Answer 5

Hypothermia
Use of volatile agents
Post-epidural anaes
Sepsis

Question 6

Stages of anaesthesia

Answer 6

1 = Relative anaes
2 = Excitement/delirium
3 = surgical anaes
4 = medullary depression

Question 7

what score for measure of physiologic recovery post-anaesthesia?

Answer 7

Aldrete score.
9 or above = safe discharge from PACU

Question 8

When is RSI usu done?

Answer 8

Usu for pts with high risk of aspiration e.g. IO, GOO, GERD, esophageal patho, achalasia, acute abdo scenarios.
There will be pre-oxygenation, but no bagging using inhalationals.

Question 9

ADR of opioids in intrathecal space?

Answer 9

Pruritus
Hypotension
N/V

Question 10

What to watch out for in RA?

Answer 10

Resus drugs (for LAST)
IV access
Monitoring
Assistance
Drugs - which to use
Equipment

Question 11

Factors that make spinal block difficult

Answer 11

Elderly, obesity

Question 12

Complications of spinal block?

Answer 12

Hematoma
Bleeding
Infection
Cauda equina
Persistent block

Question 13

Limitations of Pulse Oximeter?

Answer 13

• Less accurate at sats below 70
• Interference by ambient light
• Carboxyhemoglobinemia
• Loss of pulsatile component
• Movement artefact

Question 14

Causes of inaccurate BP reading?

Answer 14

Cuff should be at level of heart
Patient moving/shivering
Wrong cuff size

Question 15

When is NMJ monitoring used?

Answer 15

when NMBAs have been given.
Common one is “train of four”.

Question 16

When is Bispectral index used?

Answer 16

Only when propofol is used for maintenance.

Question 17

Risk factors for awareness intra-op?

Answer 17

Obese patient
Difficult intubation
Prior hx of intra-op awareness
Use of beta blockers
Use of low MAC agent
Cardiac, trauma, emergency and CSecs
Use of muscle relaxants
ASA status 4

Question 18

Advantages of regional anaes?

Answer 18

Consciousness preserved
Minimal respi depression
Attenuate stress response
Good early post-op pain relief
Simple to administer

Question 19

Disadvantages of regional anaes

Answer 19

Needs technical skill
Occasional inadequate blockade
Patient acceptance/cooperation

Question 20

Complications of Regional anaes (wo LAST)

Answer 20

Failed blockade
Hypotension
Pneumothorax - brachial plexus block
Urinary retention - spinal block
Post-dural puncture headache
Motor blockade

Question 21

Risk factors for post-dural puncture headache?

Answer 21

Young female
Pregnant
big needle

Question 22

Pre-op hx taking unique to anaes?

Answer 22

Last meal, fluids
URTI
Smoking
Pregnancy
Family hx of anaes
OSA

Question 23

Causes of HTN in op?

Answer 23

Light anaesthesia
Hypovolemia
Vasodilation
Hypercarbia
Hypoxia
Hyperthermia

Question 24

Characteristics of bronchospasm?

Answer 24

Prolonged expiration phase
Wheeze
Increased peak airway pressures

Shark-fin appearance in ETCO2, common in post-morphine wheeze

Question 25

Contraindications to Sux?

Answer 25

HyperK Burns Spinal cord injury Malignant Hyperthermia

Question 26

Contraindication to Etomidate?

Answer 26

Adrenal suppression ## Footnote etomidate works fast

Question 27

ADR of fentanyl?

Answer 27

chest wall rigidity bradycardia ## Footnote Cardiorespi depression is a given

Question 28

Indications for Central Venous Line insertion?

Answer 28

Expecting hemodynamic instability Access for TPN Risk of air embolism Conduit for pacing wires, pulmonary artery catheters, dialysis catheters ## Footnote And ofc to give drugs

Question 29

Pre-op in DM?

Answer 29

Postpone ops in poorly controlled DM. Stop all OHA and insulin when NBM 6hr before. Stop SGLT2 inhibitors 2 days pre-op. Give dextrose drip if insulin given or CBG <5 Half dose basal insulin for T1DM / T2DM on insulin

Question 30

Intra-op difficulty of DM?

Answer 30

Diabetic ANS dysfunction, cuz when intravascular vol changes, pt cant compensate with peripheral resistance as well. Higher risk of CVS instability + delayed gastric emptying. High risk of pulmonary aspiration Intubation might be difficult due to chronic hypergly causing glycosylation of tissue proteins. TMJ and cervical spine mobility can be limited

Question 31

Intra-op mx of HTN?

Answer 31

Arterial BP kept within 20% of pre-op. Do NOT allow hypotension. Can use short-acting HTN e.g. esmolol during intubation.

Question 32

Post-op mx of HTN?

Answer 32

Resume anti-HTN asap. Effective pain mx

Question 33

When to postpone elective surgery in Heart disease?

Answer 33

Recent ACS / decompensated CCF within 1/12 Bare-metal stent insertion within 1/12 Drug-eluting stent insertion within 6-12 months

Question 34

First sign of MH?

Answer 34

Tachy Raised ETCO2 Muscle rigidity

Question 35

Why is pain mx impt in COPD pts?

Answer 35

severe pain can cause atelectasis and opioids can cause respi depression in pts with alr low respi reserves

Question 36

Pre-op in COPD?

Answer 36

Pre-op chest physio Optimize inhalers Reduce secretions Stop smoking min 8/52