Anaesthesia for emergency surgery Flashcards
(19 cards)
What is emergency surgery?
When an operation has to be done as soon as possible in a response to a sudden condition that threatens patient’s life and its considered life – saving.
What is urgent surgery?
Urgent cases require surgery within 24 hours
What is the aim of emergency surgery?
To allow correction of the surgical pathology with minimum risk to the patient
Give 5 examples of orthopedic emergencies that require emergency surgery.
- Open fractures
- Dislocations
- Multiple long bone #s and Unstable pelvic #s
- Compartment syndrome
- Wet gangrene
- Septic joint
- Osteomyelitis
Give 5 examples of general surgery emergencies that require emergency surgery.
- Penetrating abdominal injury
- Perforated viscus
- Generalized peritonitis
- Intestinal obstruction
- Acute appendicitis
- Massive upper G.I. Bleeding
- Massive lower G.I bleeding
Give 4 examples of obstetric and gynaecological emergencies that require emergency surgery.
- Obstetric hemorrhages
- Ruptured uterus
- Prolonged obstructed labor
- Ruptured ectopic pregnancy
- Twisted ovarian cyst
- Some C/S
Give 5 factors that increase perioperative risk.
Limited time to assess and prepare patient
Uncertain diagnoses
Risk of aspiration
Body fluid, electrolyte and acid base derangements
Anemia and coagulation abnormalities
Coexisting diseases and poorly controlled chronic medical problems
Pain ands its physiological effects
After hours surgery
What history would you take pre-op?
History taking; (AMPLE HISTORY)
Indication for the surgery
Traumatic
Non traumatic
History of cardiopulmonary symptoms
History of intercurrent medical illness
Previous history of anesthesia
Drug history
Social history
History of last meal
What would you do for physical exam?
General examination: features of painful/respiratory distress, dehydration, pallor, presence or absence of tubes (N.G tube, urethral catheter)
Airways
Cardiopulmonary
Name 3 investigations you would carry out.
FBC - Hb
U&Es
Clotting profile
Chest x-ray and cardiac echo
How to you optimize a patient (make them fit for surgery)?
- Two large bore cannulas
- Oxygen should be made available
- Correction of fluid and electrolyte
- Provision of blood/blood products
- Monitoring of tissue perfusion
- Treatment of medical conditions
Name 3 anaesthetic techniques that can be used intra-op.
GA+ETT
Spinal Anesthesia
Epidural
P.N.B
L.A
How do you prepare for GA + ETT?
Checking machines and monitors
Various sizes of ETT
Suction catheter
Drugs drawn up in to labelled syringes
Pre induction base line vital signs
What method is used on induction?
Rapid Sequence Induction (RSI)
What does RSI involve?
Pre oxygenation
Breathing 100% oxygen for at least 3 minutes before induction
In breathing oxygen only, the lungs de-nitrogenate rapidly and after 3 minutes contains only oxygen and carbon dioxide
Cricoid pressure
Identifying the cricoid cartilage on the patient before induction of anesthesia
Intubation
A paralyzing dose of succinylcholine is administered immediately.
As soon as the jaw begins to relax, laryngoscopy is performed and the trachea intubated.
Cricoid pressure is maintained until the cuff of the tracheal tube is inflated and correct placement of the tube ascertained by auscultation of both lungs.
When can cricoid pressure be released?
The trachea is intubated
The cuff inflated
The correct position of the tube is confirmed
The lungs are not ventilated during RSI; because it will further reduces barrier pressure and predisposes patient to risk of regurgitation and aspiration.
How is the patient managed intra-op?
Maintenance of anesthesia
Fluid therapy
Blood transfusion
Intra operative monitoring
Blood pressure
Pulse rate
Central venous pressure monitoring
Urine out put
Capnograph
Reversal and emergence from anesthesia
How is aspiration treated?
Suction
Oxygen
Antibiotics (at the end)
What the post anaesthetic care?
Extubating of the trachea should not be performed until protective airway reflexes are intact
ICU /HDU care depending on the condition
Continued resuscitation and medical care
