Anaesthetics Flashcards
(49 cards)
When should intraosseous access be considered
If attempts (usually >2 minutes) at IV are unsuccessful, or IV is not feasible
Sign in
Conducted prior to induction of anaesthesia
Patient confirms identity, nature of procedure, and reiterates consent
Sign out
Before patient or surgical team leaves OR
Inventory of surgical equipment, surgeon reports on procedure, and any concerns regarding recovery are recorded
Time out
Done before first skin incision is made
Equipment checked + concerns regarding intra-operative complications are recorded
Alternative to LMWH in patients with chronic kidney disease
Unfractionated heparin
Elective hip replacement VTE prophylaxis
LMWH for 10 days followed by aspirin (75 or 150 mg) for a further 28 days;
or LMWH for 28 days combined with anti-embolism stockings until discharge;
or Rivaroxaban
Elective knee replacement VTE prophylaxis
Aspirin (75 or 150 mg) for 14 days;
or LMWH for 14 days combined with anti-embolism stockings until discharge;
or Rivaroxaban
Management of local anaesthetic toxicity
IV 20% lipid emulsion e.g. intralipid
Risk factors/causes of local anaesthetic toxicity
IV administration
Excess usage
Liver dysfunction
Low protein state
Presentation of local anaesthetic toxicity
Initial overactivity of CNS
Then depression of CNS
Cardiac arrhythmias
One technique to reduce risk of local anaesthetic toxicity
Higher doses given with adrenaline to reduce systemic absorption - prolongs duration of action at site of injection (does not work with bupivicaine)
Maximum 1% lignocaine plain dose
3mg/kg - 200mg (20ml)
Based on ideal bodyweight
Maximum 1% lignocaine with 1 in 200,000 adrenaline
7mg/kg - 500mg (50mL)
Based on ideal bodyweight
Maximum bupivicaine 0.5% dose
2mg/kg - 150mg (30mL)
Based on ideal bodyweight
Substance used to clean surgical wounds in first 48 hours
Sterile saline
When can patients with surgical wounds shower safely
48 hours after surgery
Substance used to clean surgical wounds after 48 hours
If surgical wound separated, or opened to drain pus –> tap water
When is a tracheostomy useful
In facilitating long-term weaning
Often used in ITU
Early causes of post-operative pyrexia (0-5 days)
Blood transfusion
Cellulitis
UTI
Physiological systemic inflammatory reaction (usually within a day)
Pulmonary atelectasis
Late causes of post-operative pyrexia (>5 days)
VTE
Pneumonia
Wound infection
Anastomotic leak
When should drugs containing oestrogen be stopped prior to surgery
4 weeks
Name 5 muscle relaxant drugs
Suxamethonium
Atracurium
Vecuronium
Pancuronium
Rocuronium
Which of the muscle relaxants is depolarising
Suxamethonium
Action of suxamethonium
Competitively binds to ACh receptors in motor end plate –> paralysis
