Anaesthetics

Question 1

How long prior to surgery does the COCP need to be stopped? How long to wait after surgery before restarting?

Answer 1

4 weeks prior to surgery

Wait 2 weeks before restarting

Question 2

How long prior to surgery does Warfarin need to be stopped?

Answer 2

5 days prior to surgery

Question 3

How long prior to surgery does Clopidogrel need to be stopped?

Answer 3

7 days prior to surgery

Question 4

How do you treat anaemia detected in a peri-operative patient?

Answer 4

> 6 weeks to surgery – oral iron

<6 weeks to surgery – IV iron

Question 5

What should you do with a patient whose on oral prednisolone prior to surgery?

Answer 5

Switch to IV Hydrocortisone

If major surgery - continue IV hydrocortisone for 72 hours

If minor surgery - can go straight back to oral pred after surgery

Question 6

What to do with diabetic meds prior to surgery?

Answer 6

Metformin - if OD/BD - take as normal. IF TDS - omit lunchtime dose.

Gliclazide - omit morning dose.

Sliding scale insulin (if insulin dependent)

Question 7

Which muscle relaxant is used for rapid sequence intubation?

Answer 7

Suxamethonium (depolarising muscle relaxant)

Question 8

Which drugs are used to induce unconsciousness?

Answer 8

Propafol - anti-emetic, pain on injection

Ketamine - analgesic properties, does not cause hypotension (good in trauma)

Thiopentone

Etomidate - favourable cardiac safety profile

Question 9

Which drugs are used to maintain unconsciousness?

Answer 9

Isoflurane

Sevoflurane

Desflurane

Question 10

What is the risk associated with sevoflurane, desflurane and suxamethonium?

Answer 10

Malignant hyperthermia

Question 11

Which drugs are at risk of causing malignant hyperthermia?

Answer 11

Sevoflurane

Desflurane

Suxamethonium

Question 12

Which type of muscle relaxant is de-polarising?

Answer 12

Suxamethonium

Question 13

What is an example of a non-depolarising muscle relaxant and what drug can be used to reverse them?

Answer 13

Atracurium, vecuronium

Reversal agent = Neostigmine

Question 14

What are side effects of suxamethonium?

Answer 14

Hyperkalaemia

Malignant hyperthermia

Question 15

What are side effects of atracurium? (Non-depolarising muscle relaxant)

Answer 15

Facial flushing

Tachycardia

Hypotension

Question 16

What are contraindications to suxamethonium?

Answer 16

Penetrating eye injuries

Acute angle closure glaucoma

Pseudocholinesterase deficiency

Question 17

What are risks of general anaesthetic?

Answer 17

Sore throat

Nausea/vomiting

Aspiration

Anaphylaxis

Malignant hyperthermia

Death

Question 18

What is malignant hyperthermia? How does it present?

Answer 18

A rare but potentially fatal reaction to anaesthetic

Hyperthermia

Tachycardia

Muscle rigidity

Acidosis

Hyperkalaemia

Raised CK

Question 19

How is malignant hyperthermia treated?

Answer 19

IV Dantrolene

Question 20

Where does anaesthetic go in a spinal block?

Answer 20

Subarachnoid space

Question 21

Where is anaesthetic placed in an epidural?

Answer 21

Epidural space

Question 22

What are adverse effects of an epidural?

Answer 22

Headache

Hypotension

Motor weakness

Nerve damage

Infection

Haematoma

Question 23

How long must a patient fast prior to surgery?

Answer 23

Usually
Clear fluids only from 6 hours prior
Completely NBM from 2 hours prior

Question 24

Which diabetic drugs must be omitted on the day of surgery?

Answer 24

Sulfonylurea
SGLT-2 inhibitors
Metformin

Question 25

Which airway management is best used for a patient having seizures?

Answer 25

Nasopharyngeal airway

Question 26

Where can a central line be placed?

Answer 26

Internal jugular vein Subclavian vein Axillary vein Femoral vein

Question 27

Which general anaesthetic has anti-emetic properties?

Answer 27

Propofol

Question 28

Which general anaesthetic for inducing anaesthesia is better for trauma and why?

Answer 28

Ketamine - it doesn't cause a drop in BP but Propofol does

Question 29

What positional manoeuvres can open the airway?

Answer 29

1) Head tilt 2) Chin lift 3) Jaw thrust

Question 30

When do you use a nasopharyngeal airway over an oropharyngeal airway? When are nasopharyngeal airways contraindicated?

Answer 30

Nasopharyngeal airway = usually when patient is more conscious. tolerated better Contraindicated in base of skull fracture

Question 31

Which diabetes drugs should be stopped before surgery?

Answer 31

Metformin + Sulfonylurea + SGLT-2 Inhibitors Omit dose prior to surgery Can take as normal after surgery

Question 32

Which anaesthetic agent can cause hyperkalaemia?

Answer 32

Suxamethonium

Question 33

What is the ASA classification?

Answer 33

ASA I - completely healthy, non-smoker, normal BMI ASA II - mild systemic disease/smoker/drinker/pregnant/obese ASA III - severe systemic disease/COPD/alcohol abuse/pacemaker/end stage renal disease/CVA ASA IV - systemic illness which is a constant threat to life, MI <3 months ago, sepsis, DIC, ARD ASA V - patient not expected to live without surgery ASA IV - braindead

Question 34

Where can a central line be placed?

Answer 34

Internal jugular vein Subclavian vein Axillary vein Femoral vein

Question 35

Which types of anaesthetic can cause malignant hyperthermia?

Answer 35

Suxamethonium Isoflurane/Sumoflurane/Desflorane

Question 36

What kind of inherited condition can cause increased risk of malignant hyperthermia?

Answer 36

Autosomal dominant

Question 37

What can be used to treat lidocaine toxicity? E.g. if accidentally injected into vein

Answer 37

20% lipid emulsion

Question 38

How does a post-op ileus present?

Answer 38

Abdominal distension/bloating Abdominal pain Nausea/vomiting Inability to pass gas

Question 39

What is an anastomotic leak? How does it present and how is it diagnosed?

Answer 39

Contents of organ leaks through sutures into the peritoneum Leads to peritonitis and sepsis Presents with fever usually 5-7 days post surgery Diagnosis = CT abdo

Question 40

What is atelectasis and how is it managed?

Answer 40

Basal alveolar collapse leading to respiratory difficulty Presents with dyspnoea + hyperaemia approx 72 hours post op Management - position pt upright, chest physo

Question 41

What are causes of post-op pyrexia?

Answer 41

* Day 1-2: 'Wind' - Pneumonia, aspiration, pulmonary embolism * Day 3-5: 'Water' - Urinary tract infection (especially if the patient was catheterised) * Day 5-7: 'Wound' - Infection at the surgical site or abscess formation * Day 5+: 'Walking' - Deep vein thrombosis or pulmonary embolism * Any time: Drugs, transfusion reactions, sepsis, line contamination.

Question 42

How much should once dose daily insulin be reduced by on the morning of surgery?

Answer 42

20%

Question 43

Which anaesthetic causes adrenal suppression?

Answer 43

Etomidate