anaesthetics

Question 1

reversal agent for lidocaine

Answer 1

lipid emulsion

Question 2

side effect of volatile liquid anaesthetics (isoflurane, desflurane, sevoflurane)

(these are inhaled)

Answer 2

-malignant hyperthermia
-myocardial depression

Question 3

what are volatile liquid anaesthetics (isoflurane, desflurane, sevoflurane) used for

(these are inhaled0

Answer 3

induction + maintenance of anaesthesia

Question 4

what is propofol used for

(injected)

Answer 4

induction + maintenance of anaesthesia

Question 5

SE propofol

Answer 5

hypotension

Question 6

when is ketamine usedful in anaesthesia

Answer 6

major trauma

as it does not cause a drop in BP

Question 7

mofa propofol

Answer 7

potentiates GABA

Question 8

role of etomidate?

Answer 8

Causes less hypotension than propofol and thiopental during induction

often used in cases of haemodynamic instability

Question 9

ketamine mofa?

Answer 9

NMDA antagonist

Question 10

ASA I

normal healthy patient

Answer 10

Healthy
Non-smoking
No or minimal alcohol use

Question 11

ASA II

patient with mild systemic disease

Answer 11

Mild diseases only without substantive functional limitations.
Examples include (but not limited to): -current smoker
-social alcohol drinker
-pregnancy
-obesity (BMI 30 - 40)
-well-controlled Diabetes Mellitus/Hypertension
-mild lung disease

Question 12

ASA III

patient with severe systemic disease

Answer 12

Substantive functional limitations; One or more moderate to severe diseases.

Examples include (but not limited to): -poorly controlled Diabetes Mellitus/Hypertension
-COPD
-morbid obesity (BMI > 40)
-active hepatitis
-alcohol dependence or abuse
-implanted pacemaker
-moderate reduction of ejection fraction
-End-Stage Renal Disease (ESRD) undergoing regularly scheduled dialysis
-history (>3 months) of Myocardial infarction
-Cerebrovascular accidents

Question 13

ASA IV

patient with severe/ systemic disease that is a constant threat to life

Answer 13

Examples include (but not limited to):
-recent (< 3 months) of Myocardial infarction
-Cerebrovascular accidents
-Ongoing cardiac ischaemia or severe valve dysfunction
-Severe reduction of ejection fraction
-Sepsis
-SDIC
-ARD or ESRD not undergoing regularly scheduled dialysis

Question 14

ASA V

morbid patient not expected to survive operation

Answer 14

Examples include (but not limited to): -ruptured abdominal/thoracic aneurysm
-massive trauma
-intra-cranial bleed with mass effect
-ischaemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction

Question 15

ASA VI

Answer 15

A declared brain-dead patient whose organs are being removed for donor purposes

Question 16

can women continue HRT for surgery

Answer 16

no should be stopped 4 weeks prior

Question 17

Dropping sats following intubation → ?

Answer 17

oesophageal intubation

Question 18

what is required prior surgery for someone taking prednisolone?

Answer 18

hydrocortisone

Question 19

can you take ACEI/ ARBs before surgery

Answer 19

no, stop 24 hours before

Question 20

when to stop antiplatelets before surgeruy

Answer 20

7 days before surgery

Question 21

when to stop DOACs before surgery

Answer 21

stop 24 hours before low/moderate bleeding risk surgery (e.g. hernia repair)

stop 48 hours before high bleeding risk surgery (e.g. cardiothoracic surgery)

Question 22

when to stop warfarin before surgery

Answer 22

stop 5 days before surgery

check INR the day before; give oral vitamin K if INR ≥ 1.5.

Question 23

how long before surgery should patient fast

Answer 23

6 hours food
2 hours water/ clear liquid

Question 24

diabetic on once a day long acting insulin
-how should it be adjusted prior to surgery

Answer 24

once-daily insulin dose should generally be reduced by 20% on the day before and the day of surgery