Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FLASH FINALS > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

Propofol.
MoA:
Adverse effects:
Extra effect:

A

Potentiates GABA
Pain on injection, HYPOTENSION
Anti-emetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Thiopental
MoA:
Adverse effects:
Extra effect:

A

Barbiturate (potentiates GABA)
Laryngospasm
High soluble = quick effect on the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Etomidate
MoA:
Adverse effects:
Extra effect:

A

Potentiates GABA
Primary ADRENAL SUPPRESSION Myoclonus
Causes less hypotension than propofol and thiopental and therefore used in cases of haemodynamic instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ketamine
MoA:
Adverse effects:
Extra effect:

A

Blocks NMDA receptors
Disorientation, hallucinations
Acts as a DISSOCIATIVE ANAESTHETIC
No drop in BLOOD PRESSURE so useful in trauma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q 
Duration of time of cessation before surgery: 
ACEi 
LMWH
Warfarin 
Anti-platelet
A 
ACEi = 24 hours 
LMWH = 24 hours 
Warfarin = 5 days 
Anti-platelet = 7 days (week)

Majority cardiac drugs do not need stopped apart from ACEi - risk of AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Anti-coagulation

Warfarin stopped 5 days before - what are high risk pts. bridged with

A

Heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pre-operative INR Mx.
INR < 1.5
INR 1.6-1.7
INR >1.8

A

proceed as normal
1 mg Vit K
2 mg Vit K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

General anaesthesia
Induction agent
Muscle relaxant

A

Propofol, thiopental

Muscle relaxants: rocuronium, vecuronium, suxamethonium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Class of drugs of muscle relaxant

A

nACH antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Reverse anaesthetic agent

A

Neostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mx. bradycardia

A

IV Atropine 500mcg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mx. Hypotension

A

Vasopressors:
Ephedrine -> A&B agonist
Metaraminol -> a1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Mx. Malignant hyperthermia

A

IV Dantrolene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Mendelson syndrome

A

Aspiration of stomach acid causing inflammation of the lungs
Mx. Pre-operative RANITIDINE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Local anaesthetics
Long acting
Short acting

A

Lidocaine

Bupivacaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Local anaesthetics use as epidural anaesthesia SE?

A

Hypotension, CVS collapse if given IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Adrenaline with local anaesthetics - areas of the body where these cannot be used:

A

Fingers
Ears
Nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Opioid overdose
Px.
Antidote.

A

Pin point pupils.
Respiratory depression
Reduced LOC drowsiness, coma.

Naloxone
400mcg bolus for OD
titred infusion for toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

BDZ overdose
Px.
Antidote.

A

Ataxia.
Dysarthria
Reduced LOC  drowsiness, coma

Flumazenil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Aspirin overdose
Px.
Antidote.

A

Tinnitus.
Vomiting.
Dehydration.
Hyperventilation  respiratory alkalosis (early) and (later) metabolic acidosis (anion gap)

Nil. 
Activated charcoal 
Supportive care +
fluids. 
Bicarbonante infusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

B Blocker overdose

A

GLUCAGON

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Salbutamol overdose

A

Agitation.
Tremor.
Tachycardia, palpitations.
Bloods: hypokalemia.

Nil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tricyclics overdose
Px.
Mx.

A 
Dilated pupils. 
Urinary retention.
Dry mouth / skin. 
Ataxia w/ jerky movements and increased tone. 
ECG: sinus tachycardia.

Nil.
Supportive care +
• fluids.
Bicarbonante infusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Anti-freeze
Px.
Mx.

A

Ataxia, dysarthria, nausea, vomiting, convulsions, coma.
Diagnostic test: osmol gap on serum osmolality.

Mx. Fomepizole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Paracetamol overdose
Toxic dose.
Mx:
tx threshold: mg

A

> 150mg / kg.

N-Acetylcysteine should be given if:
there is a staggered overdose (not taken within 1 hour) or there is doubt over the time of paracetamol ingestion, regardless of the plasma paracetamol concentration; or
the plasma paracetamol concentration is on or above a single treatment line joining points of 100 mg/L at 4 hours and 15 mg/L at 15 hours, regardless of risk factors of hepatotoxicity.

100 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cardiac arrest - 4Hs and 4Ts

A

Hypothermia
Hypovolaemia
Hypoxia
Hypo/hyperkalemia

Toxins
Tension pneumothorax
Tamponade
Thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Cardiac arrest - drugs

A

10 ml 1:10000 Adrenaline IV -> every 3-5 minutes

300 mg Amiodarone - after every 3 shocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Cardiac arrest - bloods

A

FBC, U&E, LFTs, CRP, Magnesium, coagulation, ABG (or venous gas if this not possible)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Pathophysiology of shock (general)

A

• Shock is generalized tissue hypo perfusion and hypoxia due to acute circulatory failure.
• Blood pressure: TPR X CO.
• Failure to maintain MAP results in slow flow of blood through vessels which causes:
o Thrombus formation.
o Inadequate tissue perfusion, leading to a switch from aerobic to anaerobic respiration -> lactic acid accumulation and acidosis.
o Lactic acidosis reduces tissue function leading to injury, necrosis and multi-organ failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Lactate level in shock

A

> 2.2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Cardiogenic shock px

A

chest pain, palpitations + cold, clammy peripheries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Obstructive shock causes and px.

A

Causes: PE, tension pneumothorax, cardiac tamponade.

Cold clammy peripheries, distended neck veins, Raised JVP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Hypovolaemic shock px. and mx.

A

Cold peripheries, dry mucous membranes, thready pulse, LOW JVP

Initial management = fluid challenge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Distributive shock cause and px.

A

Sepsis, anaphylaxis, neurogenic or spinal cord damage.

FEVER, warm flushed peripheries with increased capillary refill time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Adult anaphylaxis - drug doses

A

Adrenaline 0.5ml/mg 1:1000 IM -> repeat every 5 minutes
Hydrocortisone: 200 mg slow IV
Chlorphenamine: 10 mg slow IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Adult bradycardia

A 
•Main drug: 500mcg Atropine IV. 
•If initial atropine doesn’t work, can give either of the following:
-Repeat Atropine up to 6 times (3mg). 
-Isoprenaline 5mcg IV. 
-Adrenaline 2 – 10mcg IV. 
-Transcutaneous wiring.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Adult tachycardia w/ pulse:

A 
•Amiodarone: 
o300mg IV over 10 – 20 minutes. 
o900mg IV over 24 hours. 
oIndications:
Three failed DC shocks in unstable patient.
Regular broad complex tachycardia.

•Adenosine:
oInitial: 6mg IV bolus.
o can give up to two further 12mg boluses if no effect.
oIndications: failed vagal maneuvers in regular narrow complex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q 
Cushings reflex (3)
Bodys natural way to overcome raised ICP by increasing blood pressure.
A

Bradycardia + hypertension + irregular breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

GCS =

A

MVE 6,5,4

Obeys commands.	6
Localizes to pain. 	5
Flexion & withdrawal to pain. 	4
Abnormal flexion to pain. 	3
Extension to pain. 	2
No response. 	1
Orientated and talking. 5
Confused and disoriented - 4
Inappropriate words	3
Incomprehensible sounds	2
No verbal response 	1

Opens spontaneously. 4
Opens to command. 3
Opens to pain. 2
No response. 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

GCS < 14 px.

A

Confused and disorientated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

GCS < 8

A

Comatose

42
Q

GCS 3

A

Completely unresponsive

43
Q

Head injury bruising: what causes ‘panda eyes’ appearance

A

Anterior fossa fracture: Bilateral periorbital

44
Q

‘Battle sign’

A

Middle fossa

Mastoid bruising behind the ear

45
Q

What bone do middle fossa fractures encompass and how can this present -

A

Temporal bone
SNHL, facial nerve palsies
Think about the course of cranial nerves

46
Q

Head injury initial assessment

A

ABCDE, GCS, ALWAYS DO A BLOOD GLUCOSE

Examination: cranial, upper/lower limb neuro

47
Q

Head injury investigations

A

Bloods: FBC, U&E, LFT, coagulation, cross match, glucose.

CSF sample: positive for glucose / B2 tau protein.

48
Q

CT head indications:

A

o GCS < 13 on initial assessment.
o GCS < 15 at 2 hours on assessment in ED.
o Suspected skull fracture.
o Posttraumatic seizure.
o Focal neurological deficit.
o More than one episode of vomiting since injury.
o LOC or amnesia if >65, risk of bleeding or >30 minutes of memory loss.

49
Q

Raised ICP tx.

A

Usually neurosurgical

Holding measures: Mannitol, Sedation, intubation, hyperventilation

50
Q

Facial trauma - blow out fracture px.

A

Inferior rectus entrapment =
Red eye, recessed eye, double vision - reduced eye movements -> cannot look up
ipsilateral nose bleed
loss of sensation of CNV2

51
Q

X-ray blow out fracture appearance:

A

Tear-drop sign on X-ray

52
Q

American society of Anaesthetics classifications (I-VI)

A 
I = normal healthy pt. 
II = A patient with MILD systemic disease 
III = A patient with severe systemic disease 
IV = severe systemic disease which is a constant threat to life
V = Moribund pt. who is not expected to survive 
VI =  DEAD
53
Q

Blood transfusion - action
Unlikely (Hysterectomy, appendicectomy, thyroidectomy, lap cholecystectomy) =
Likely (salpingectomy for ruptured ectopic pregnancy, THR) =
Definite (Total gastrectomy, oophorectomy, oesophagectomy, elective AAA repair, cystectomy, hepatectomy) =

A

Group and save
Cross match 2 units
Cross-match 4-6 units

54
Q

Nitrous oxide - MoA, Adverse effects, Notes

A

MoA = Unknown
Adverse effects = may diffuse into gas-filled compartments - to be avoided in pneumothorax
Notes = used for maintenance analgesia and anaesthesia

55
Q

Volatile liquid anaesthetics (Isoflurane, Desflurane, Sevoflurane) adverse effects

A

Myocardial depression
Malignant hyperthermia
Halothane (not common now = hepatotoxic)

56
Q

Peripheral venous cannulas - pros and cons

A 
Pros = easy to insert, wide lumen can provide rapid infusion. 
Cons = problems with peripheral sites for vasoactive drugs - such as inotropes and irritant drugs.
57
Q

Central line Ps and Cs

Preferred route - IJV or Femoral ?

A

Multiple lumens for allowing multiple infusions -
Lumens are narrow though so do not allow for rapid infusion
IJV (femoral lines have higher infection rates).

58
Q

Tunnelled lines (Hickman, Groshong)

A

Devices inserted using US guidance into IJV then tunnelled. For long term therapeutic requirements.

59
Q

PICC (peripherally inserted central cannula) - Ps and CS

A

Less prone to major complications relating to device insertion than conventional central lines.

60
Q

Lidocaine toxicity features and tx.

A

Features = initial CNS over activity followed by depression as lidocaine blocks inhibitory pathways. Cardiac arrhythmias.
Local anaesthetic toxicity is treated with IV 20% lipid emulsion

61
Q

Bupivacaine - duration of action relative to Lidocaine, SE, CI

A

Longer, cardiotoxic, contraindicated in regional blockage in case the tourniquet fails

62
Q

Malignant hyperthermia: causative drugs

Treatment?

A

Halothane
Suxamethonium
Anti-psychotics (Neuroepileptic malignant syndrome)
Dantrolene

63
Q

Muscle relaxants - Suxamethonium MOA and adverse effects, onset and duration?

A

DEpolarizing neuromuscular blocker - cannot be reversed consequently.
produces generalised contraction prior to paralysis
Adverse effects = Hyperkalaemia, malignant hyperthermia and lack of acetylcholinesterase.
FASTEST ONSET AND SHORTEST DURATION OF ALL MUSCLE RELAXANTS

64
Q

Muscle relaxants - Atracurium MOA and adverse effects, reversed by?

A

NON-depolarizing neuromuscular blocker
May cause facial flushing, tachycardia and hypotension due to generalised histamine release.
reversed by neostigmine

65
Q

Muscle relaxants - Vecuronium MOA and adverse effects, reversed by?

A

NON-depolarizing neuromuscular blocker
Degraded by liver and kidney and effects prolonged in organ dysfunction.
reversed by neostigmine

66
Q

Muscle relaxants - Pancuronium MOA and adverse effects, reversed by

A

NON-depolarizing neuromuscular blocker
Onset = 2-3 minutes
PARTIALLY reversed by neostigmine

67
Q

Suxamethonium contraindication - (EYE)

A

Patients with penetrating eye injuries or acute closed angle glaucoma as suxamethonium increases intra ocular pressure.

68
Q

TPN long term associations

A

Fatty liver and derranged LFTs

69
Q

Feeding Jejunostomy - can this be used for long term feeding? Risk of aspiration? Main risks?

A

Yes, low, main risks are tube displacement and leaking carrying as risk of peritonitis

70
Q

Naso-gastric feeding contraindication

A

Head injury - risks associated with tube insertion

71
Q

Post-operative pyrexia
Early (0-5 days) causes :
Late (>5 days) causes :

A

Early (0-5 days) causes : Blood transfusion, cellulitis, UTI, Physiological systemic inflammatory reaction, pulmonary atelectasis
Late (>5 days) causes : VTE, Pneumonia, wound infection, anastamotic leak.

72
Q

Post-operative illeus cause and mx -

A

Causes = deranged electrolytes can contribute to the development of post-operative ileus - important to check potassium, magnesium and phosphate.

mx = NBM initially, NG tube if vomiting, IV fluids to maintain normovolaemia - additives to correct electrolyte imbalances
TPN occasionally for severe/ prolonged cases.

73
Q

Preparation for surgery - oral fluids and fasting rules

A

Pts. may drink CLEAR (water, fruit juices without pulp, coffee/tea without milk) fluids until 2 hours before their operation. (can help reduce headaches etc. post-operatively)
Pts. Generally advised to fast from foods and non-clear fluids from 6 hours before surgery

74
Q

Post-operative risks for diabetic pts. (3)

A

Increased wound and respiratory infections
Increased risk of post-operative AKI
Increased length of hospital stay

75
Q

Do patients <69 HbA1c (good diabetic control) require anything more than adjustment of usual insulin regimen post-surgery

A

NO

76
Q

Can most oral-therapy diabetics (T2) be managed by manipulating medication on the day of surgery?
What are exceptions to this ?
What should be used in this case ?

A

Yes
Exceptions: If more than one meal is to be missed
Poor glycaemic control
Risk of renal injury (low eGFR, Contrast)
in which case VRIII (variable release intravenous insulin infusion should be used)

77
Q

Rules for metformin:
Day prior to admission
Day of surgery (morning op) :
Day of surgery (afternoon op) :

A

Day prior to admission : Take as normal
Day of surgery (morning op) : if taken once/twice a day - take as normal -> If taken 3/day - omit lunch dose.
Day of surgery (afternoon op) : if taken once/twice a day - take as normal -> If taken 3/day - omit lunch dose.

78
Q

Rules for Sulphonylureas (Gliclazide):
Day prior to admission
Day of surgery (morning op) :
Day of surgery (afternoon op) :

A

Rules for Sulphonylureas (Gliclazide)
Day prior to admission : Take as normal
Day of surgery (morning op) : If taken once daily, omit dose that day - if 2/day omit morning dose
Day of surgery (afternoon op) : If taken once daily, omit dose that day - if 2/day omit BOTH doses that day.

79
Q

Rules for DDP IV Inhibitors (GLIPTINS)
Day prior to admission
Day of surgery (morning op) :
Day of surgery (afternoon op) :

A

Take as normal

80
Q

Rules for GLP-1 analogues (-tides)
Day prior to admission
Day of surgery (morning op) :
Day of surgery (afternoon op) :

A

Take as normal

81
Q

Rules for SGLT-2 inhibitors
Day prior to admission
Day of surgery (morning op) :
Day of surgery (afternoon op) :

A

Day prior to admission: take as normal
Day of surgery (morning op) : omit on day
Day of surgery (afternoon op) : omit on day

82
Q

Rules for once daily insulins (Lantus, Levemir)
Day prior to admission
Day of surgery (morning op) :
Day of surgery (afternoon op) :

A

Day prior to admission: REDUCE BY 20%
Day of surgery (morning op) : REDUCE BY 20%
Day of surgery (afternoon op) : REDUCE BY 20%

83
Q

Twice-daily biphasic

A

Day prior to admission: No dose change
Day of surgery (morning op) : Reduce morning dose by half, evening unchanged (50%).
Day of surgery (afternoon op) : Reduce morning dose by half, evening unchanged (50%).

84
Q 
Special preparations: 
PTH surgery - 
Sentinel node biopsy 
Surgery of thoracic duct 
Phaeochromocytoma surgery 
Surgery for carcinoid tumours 
colorectal cases 
Thyrotoxicosis
A

Thyroid surgery; vocal cord check.
Parathyroid surgery; consider methylene blue to identify gland.
Sentinel node biopsy; radioactive marker/ patent blue dye.
Surgery involving the thoracic duct; consider administration of cream.
Pheochromocytoma surgery; will need alpha and beta blockade.
Surgery for carcinoid tumours; will need covering with octreotide.
Colorectal cases; bowel preparation (especially left sided surgery)
Thyrotoxicosis; lugols iodine/ medical therapy.

85
Q 
Surgical complications: 
Accessory:
Sciatic:	
Common peroneal:
Long thoracic:
Pelvic autonomic nerves:	
Recurrent laryngeal nerves:	
Hypoglossal nerve:	
Ulnar and median nerves:
A

Accessory Posterior triangle lymph node biopsy
Sciatic Posterior approach to hip
Common peroneal Legs in Lloyd Davies position
Long thoracic Axillary node clearance
Pelvic autonomic nerves Pelvic cancer surgery
Recurrent laryngeal nerves During thyroid surgery
Hypoglossal nerve During carotid endarterectomy
Ulnar and median nerves During upper limb fracture repairs

86
Q 
Surgical complications:
Thoracic duct	Pneumonectomy, Oesphagectomy
Parathyroid glands	
Ureters	
Bowel perforation	
Bile duct injury	
Facial nerve	
Tail of pancreas	
Testicular vessels	
Hepatic veins
A

Thoracic duct: During thoracic surgery e.g. Pneumonectomy, oesphagectomy
Parathyroid glands: During difficult thyroid surgery
Ureters: During colonic resections/ gynaecological surgery
Bowel perforation: Use of Verres Needle to establish pneumoperitoneum
Bile duct injury: Failure to delineate Calots triangle carefully and careless use of diathermy
Facial nerve: Always at risk during Parotidectomy
Tail of pancreas: When ligating splenic hilum
Testicular vessels:
During re-do open hernia surgery
Hepatic veins: During liver mobilisation

87
Q

Ix for intra-abdominal abscess, air and if luminal contrast is used, anastomotic leak?

A

CT scan

88
Q

Ix for rectal anastamotic leaks

A

Gastograffin enema

89
Q

Ix. Leg veins - for DVT

A

Doppler USS

90
Q

Ix. PE

A

CTPA

91
Q

Recent surgery - CI for thrombolysis? mx.

A

Yes, IV heparin preferable to heparin - easier to reverse.

92
Q

Complications of perioperative hypothermia

A

Coagulopathy: reduced ability to clot, increasing intra-operative blood loss.
Prolonged recovery from anaesthesia.
Reduced wound healing
infection
shivering= benign in healthy individuals but cab cause increase in metabolic rate which can result in myocardial ischaemia.

93
Q

Risk factors for peri-operative HYPOthermia

A
  • ASA 2 or above
  • Major surgery
  • low body weight
  • large volumes of unwarmed IV infusions
  • unwarmed blood transfusions
94
Q

Risks VTE

Medical and trauma patients

A

Significant reduction in mobility for 3 days or more
Hip/knee replacements
Hip fracture
Pelvic surgery
acute surgical admission for inflammatory/intra-abdominal condition

95
Q

general risk factors VTE

A
  • Active cancer/ chemotherapy
  • aged > 60
  • known clotting disorder
  • BMI > 35
  • Dehydration
  • HRT
  • COCP
  • varicose veins
  • pregnant/ less than 6 weeks post-partum
96
Q

VTE prophylaxis - medical

A

Fondaparinux (SC injection)
LMWH - reduced doses in pts. with severe renal impairment
Unfractioned heparin - alternative to LMWH in pts. with chronic kidney disease

97
Q

When should women on COCP stop pill before surgery?

A

4 weeks

98
Q

VTE prophylaxis for pts. with fragility fracture -

A

LMWH (6-12 hours post-op) or Fondaparinux for a month

99
Q

Hypertrophic vs keloid scars

A

Hypertrophic remains confined to the boundaries of the original wound.
Keloid = extend outwith boundaries - do not regress over time.

100
Q

Drugs impairing wound healing

A
  • Non-steroidal anti-inflammatory drugs
  • Steroids
  • immunosupressive agents
  • Anti-neoplastic drugs

FLASH FINALS (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions