Anaesthetics

Question 1

What is pre oxygenation?

Answer 1

Patients breathe 100% oxygen for several minutes to give them a reserve of oxygen for intubation

Question 2

What premedication is given?

Answer 2

Benzodiazepines to relax muscles, reduce anxiety and cause amnesia
Opiates to reduce pain and reduce the hypertensive response to the laryngoscope
Alpha-2-adrenergic agonists (e.g. clonidine) to help with sedation and pain

Question 3

What is RSI?

Answer 3

Rapid sequence induction/intubation

Question 4

What is the triad of general anaesthesia?

Answer 4

Hypnosis
Muscle relaxation
Analgesia

Question 5

What are examples of intravenous hypnotic agents?

Answer 5

Propofol
Ketamine
Thiopental sodium
Etomidate

Question 6

What are examples of inhaled hypnotic agents?

Answer 6

Sevoflurane
Desflurane
Isoflurane
Nitrous oxide

Question 7

What does volatile agents mean?

Answer 7

They are liquid at room temp and so need to be vaporised into a gas to be inhaled
Sevoflurane, desflurane and isoflurane are examples

Question 8

What are the two categories of muscle relaxants?

Answer 8

Depolarising (e.g. suxamethonium)
Non-depolarising (e.g. rocuronium and atracurium)

Question 9

What can reverse the effects of the neuromuscular blocking medications?

Answer 9

Cholinesterase inhibitors (e.g. neostigmine)
Sugammadex - specifically to reverse non-depolarising muscle relaxants

Question 10

What opiates are commonly used in anaesthetics?

Answer 10

Fentanyl
Alfentanil
Remifentanil
Morphine

Question 11

When are antiemetics given?

Answer 11

At the end of the procedure to prevent post-op nausea and vomiting

Question 12

What are common antiemetics given?

Answer 12

Ondansetron - avoid in long QT
Dexamethasone - caution in diabetic or immnocompromised
Cyclizine - caution with heart failure or elderly

Question 13

What needs to happen in emergence?

Answer 13

Muscle relaxant needs to have worn off before patient regains consciousness
Use nerve stimulator to test - train of four stimulation - needs to remain strong response for all four otherwise it has not fully worn off
Can use medication to reverse effects

Question 14

What is malignant hyperthermia

Answer 14

Rare but potentially fatal hyper metabolic response to anaesthesia
Risk is mainly with volatile anaesthetics and suxamethonium
Often genetic, in an autosomal dominant pattern

Question 15

What are the features of malignant hyperthermia

Answer 15

Increased body temp
Increased CO2 production
Tachycardia
Muscle rigidity
Acidosis
Hyperkalaemia

Question 16

What is malignant hyperthermia treated with?

Answer 16

Dantrolene - interferes with the movement of calcium ions

Question 17

What is an arterial line used for?

Answer 17

Accurately monitoring blood pressure and for ABG monitoring
NEVER for medication

Question 18

When are central lines used?

Answer 18

Giving medications that are too irritating for peripheral cannula: e.g. inotropes, amiodarone, fluids with a high potassium concentration
Taking blood samples

Question 19

What is a PICC line?

Answer 19

Peripherally inserted central catheter
Low risk of infection

Question 20

What is a Hickman line?

Answer 20

Tunnelled central venous catheter
Enters the skin on the chest, through the subcutaneous tissue into the subclavian or jugular vein
Cuff that surrounds the Cather near skin insertion, promoting adhesion.
More permanent and reduced risk of infection

Question 21

What are pulmonary artery catheters used for?

Answer 21

Specialist cardia centres for close monitoring of cardiac function and response to treatment
To measure pulmonary artery pressure

Question 22

What is a Portacath?

Answer 22

Small camber under the skin used to access the device.
Most long term

Question 23

What are the key side effects of NSAIDs?

Answer 23

Gastritis with dyspepsia
Stomach ulcers
Exacerbation of asthma
Hypertension
Renal impairment
CVS disease

Question 24

Opioids for breakthrough pain should be what fraction of background dose?

Answer 24

1/6

Question 25

Why is nutritional support so important for patients in ICU?

Answer 25

Their bodies are in hyper metabolic states, at high risk of malnutrition

Question 26

Why does TPN have to be given through a central line rather than peripherally?

Answer 26

It is very irritant to veins and can cause thrombophlebitis

Question 27

What are some complications of intensive care?

Answer 27

Ventilator can cause lung injury or pneumonia
Catheter can cause UTI
Central venous catheters can cause bloodstream infections
Stress-related mucosal disease (erosion of the upper GI tract)
Delirium
VTE
Critical illness myopathy
Critical illness neuropathy

Question 28

What is something that reduces risk of ventilator induced pneumonia?

Answer 28

Elevation of bed to 30 degrees
Reduces risk of aspiration of secretions from stomach
Regular mouth care

Question 29

What is a way to reduce risk of venous catheter related bloodstream infections?

Answer 29

Antibiotic impregnated or silver impregnated catheters

Question 30

What is the pathophysiology of stress-related mucosal disease?

Answer 30

Impaired blood flow
Can be prevented by NG feeding early just to keep stomach active

Question 31

What is a medication used in ICU to sedate agitated patients?

Answer 31

Dexmedetomidine

Question 32

What is an important cause of critical illness myopathy?

Answer 32

Corticosteroids or muscle relaxants

Question 33

What is key in reducing the risk of critical illness polyneuropathy?

Answer 33

Good glycemic control

Question 34

What does raised bicarbonate on an ABG indicate?

Answer 34

That the patient chronically retains CO2

Question 35

Apart from an anxiety attack, what is the other common cause of respiratory alkalosis?

Answer 35

PE

Question 36

What causes metabolic alkalosis?

Answer 36

Loss of hydrogen ions
GI vomiting
Kidneys - usually due to increased activity of aldosterone (e.g. Conn’s, liver cirrhosis, heart failure loop diuretics, thiazide diuretics)