Anaesthetics

Question 1

At what level does the spinal cord end?

Answer 1

L2/3

Question 2

At what spinal level are spinal anaesthetics typically given?

Answer 2

L3/4

Question 3

What kind of anaesthetic agent are typically used in spinal anaesthetics?

Answer 3

Local anaesthetic (Lidocaine, tetracaine, and bupivacaine etc.)

Question 4

Into which space is spinal anaesthesia administed?

Answer 4

Sub-arachnoid space (between arachnoid and pia mater)

Question 5

Where is the spinal epidural space found?

Answer 5

Between the dura and arachnoid mater

Question 6

What are the major complications of spinal/epidural anaesthesia to be aware of?

Answer 6

Meningitis, post-puncture headache

Question 7

How long before general/regional anaesthesia should patients avoid food?

Answer 7

6 hours

Question 8

How long before general/regional anaesthesia should patients avoid water?

Answer 8

2 hours

Question 9

Which common medications should be withheld before anaesthesia?

Answer 9

Anti-hypertensives, esp. ACEIs and diuretics
NSAIDs
Anti-platelet agents
Anti-coagulants
Metformin
Insulin

Question 10

For how long before surgery should Aspirin be with-held?

Answer 10

7-10 days

Question 11

For how long before surgery should Warfarin be with-held?

Answer 11

5 days

Question 12

For how long before surgery should Clopidogrel be with-held?

Answer 12

7 days

Question 13

For how long before surgery should DOACs be with-held?

Answer 13

2 days

Question 14

Which classification is used to describe patient’s physical fitness for anaesthesia?

Answer 14

ASA

Question 15

What is the triad of general anaesthesia?

Answer 15

Hypnosis, paralysis, analgesia

Question 16

Give examples of volatile sedating agents.

Answer 16

Nitrous Oxide (Obs/Paeds), Sevoflurane

Question 17

Give examples of IV sedating agents.

Answer 17

Profolol, Etomidate, Ketamine

Question 18

What is the primary mechanism of profolol?

Answer 18

GABA-mediated

Question 19

What is the main side effect of profolol to be aware of?

Answer 19

Hypotension

Question 20

Which agents may be used during surgery to raise BP?

Answer 20

Metaraminol, ephedrine

Question 21

Nociceptive pain is relayed by which kind of nerve fibres?

Answer 21

A-delta and C fibres

Question 22

In which tract would pain signals travel up the spinal cord?

Answer 22

Spinothalamic tract

Question 23

Which part of the pain pathway influences your pain threshold?

Answer 23

Modulation

Question 24

What is meant by modulation in the pain pathway?

Answer 24

Inhibitory signal/descending inhibition to decrease pain

Question 25

Opioids in spinal anaesthesia can evoke which side effect?

Answer 25

Itch

Question 26

What are the main differences between epidural and spinal for patients?

Answer 26

Epidural takes 15 mins to work, spinal is instant. Epidural usually fitted with catheter to allow further administration

Question 27

How long before surgery should COCP/HRT be stopped?

Answer 27

4 weeks due to VTE risk

Question 28

Which rare but life-threatening side effect is associated with halogenated volatile agents?

Answer 28

Malignant hyperthermia

Question 29

Which IV sedating agent also contains anti-emetic properties?

Answer 29

Propofol

Question 30

Thiopental is contra-indicated in which group of patients?

Answer 30

Asthmatics (causes bronchoconstriction)

Question 31

Give a side effect of etomidate.

Answer 31

Adrenal suppression

Question 32

Which sedating agent may be favoured in trauma?

Answer 32

Ketamine (as does not cause hypotension)

Question 33

Depolarising agents such as suxamethonium may lead to which side effect?

Answer 33

Malignant hyperthermia

Question 34

What is the treatment for malignant hyperthermia?

Answer 34

Dantrolene

Question 35

What is the most common site for IO access?

Answer 35

Proximal tibia

Question 36

What should you do if a peri-operative transfusion is unlikely?

Answer 36

Group & save

Question 37

What should you do if a peri-operative transfusion is likely?

Answer 37

Cross-match 2 units

Question 38

What should you do if a peri-operative transfusion will definitely be needed?

Answer 38

Crossmatch 4-6 units

Question 39

What are the step-wise airway management steps?

Answer 39

``` Head tilt, chin lift Jaw thrust OPA NPA iGel Intubation Surgical airway ```

Question 40

How is an oropharyngeal (Guidel) airway sized?

Answer 40

Incisor to ear

Question 41

How is an oropharyngeal (Guidel) airway inserted?

Answer 41

Inserted upside down and turned round

Question 42

How is a nasopharyngeal airway measured?

Answer 42

Nostril to ear

Question 43

Nasopharyngeal airways are contra-indicated in...

Answer 43

Base of skull #

Question 44

What size of iGel will the average adult require?

Answer 44

4