4th Year Exam > Anaesthetics > Flashcards

Anaesthetics Flashcards

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1
Q

Name the 4 key features of an anaesthetic

A
  1. Lack of awareness
  2. Analgesia
  3. Optimise surgical conditions
  4. Patient safety
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2
Q

Name 3 considerations for the airway section of A-E assessment in surgery

A
  1. Intubation?
  2. Face mask with spontaneous breathing?
  3. NP airway?
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3
Q

Name 2 considerations for the breathing section of A-E assessment in surgery

A
  1. Spontaneous?

2. Baseline O2 saturations and any changes to this

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4
Q

Name 2 considerations for the circulation section of A-E assessment in surgery

A
  1. Normal BP

2. Target BP for operation

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5
Q

Name 1 consideration for the disability section of A-E assessment in surgery

A

Are any nerves under pressure (e.g. is pt. lying in difficult position)

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6
Q

Name 1 consideration for the exposure section of A-E assessment in surgery

A

Is pt. at risk of pressure ulcers (are they lying on something they shouldn’t be)

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7
Q

Name 3 respiratory conditions to be considered in a pre-operative assessment

A
  1. COPD/asthma
  2. Obstructive sleep apnoea
  3. Recent LRTI
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8
Q

Name 3 cardiovascular conditions to be considered in a pre-operative assessment

A
  1. Ischaemic heart disease (MI in last 3 months)
  2. Valvular disease
  3. Pacemaker
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9
Q

Name 3 GI conditions to be considered in a pre-operative assessment

A
  1. Aspiration pneumonitis
  2. GORD
  3. Hiatus hernia
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10
Q

Name 3 general aspects to be considered in a pre-operative assessment

A
  1. PMH/PSH
  2. Social history
  3. Height and weight
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11
Q

Name 4 drugs to be specifically considered during a pre-operative assessment (e.g. is patient regularly taking any of these)

A
  1. Anticoagulants
  2. Anti-hypertensives
  3. Steroids
  4. Normal analgesia/opiate
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12
Q

Name 5 key aspects of an airway assessment pre-operatively

A
  1. Mouth opening
  2. Teeth (e.g. crowded teeth)
  3. Jaw protrusion
  4. Neck protrusion
  5. Obesity and neck shape
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13
Q

What does the Mallampati score predict?

A

A predictor of obstructive sleep apnoea

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14
Q

What is the ASA grading?

A

A measure of pre-operative health

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15
Q

Give an example of an IV induction agent

A

Propofol

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16
Q

What is the broad mechanism by which general anaesthetic works?

A

Balance of excitatory and inhibitory effects to put pt. to sleep

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17
Q

How do inhaled anaesthetics generally work?

A

Work on GABA receptor to increase inhibitory effects

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18
Q

What is thought to be the MOA of ketamine?

A

Inhibit excitatory effects by inhibiting NMDA receptors

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19
Q

Name three main IV anaesthetic agents

A
  1. Propofol
  2. Thiopentone
  3. Ketamine
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20
Q

Name one inhaled anaesthetic

A

Sevoflurane

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21
Q

Name one depolarising neuromuscular blocker

A

Suxamethonium

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22
Q

Name one non-depolarising neuromuscular blocker

A

Rocuronium

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23
Q

Give an example of a drug used to reverse a neuromuscular blocker

A

Sugamadex (mops up NM blocker)

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24
Q

Name the two major classes of emergency drugs used in anaesthetics

A
  1. Vasopressors

2. Vagolytics

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25
Give the MOA of vasopressors
Increase BP by: 1. Act on Alpha 1 to vasoconstrict vessel 2. Act on beta 1 to increase HR and myocardial activity
26
Give the MOA of vagolytics
Increase HR by: - Inhibit effects of vagus nerve to increase SNS and decrease PNS
27
Name 4 modifiable risk factors considered at pre-operative assessment
Alcohol Smoking Diet Activity
28
What peri-operative risk scoring system is most commonly used but cannot be used for risk prediction due to variables like blood loss?
POSSUM
29
What is SORT and what is it used for?
Data entry of 6 pre-operative variables to give % mortality risk estimate for patients (non-cardiac, non-neurological surgery)
30
Name 3 components of assessment of functional capacity
6 min walk test Timed up and go test Frailty scoring
31
Name 3 components of pre-optimisation of chronic illnesses
Prehabilitation Pulmonary rehab for COPD Diabetes control
32
What is the main reason for fasting surgical patients?
To prevent pulmonary aspiration under anaesthesia
33
Name 3 normal anatomical and physiological barriers to aspiration in a conscious patient
- Gastro-oesophageal junction (at T10) - Upper oesophageal sphincter - Protective laryngeal reflexes
34
Name 3 risks of aspiration under anaesthesia
Full stomach Delayed gastric emptying Incompetent LOS
35
What are the fasting guidelines for food and clear fluid?
Food = 6 hours | Clear Fluid = 2 hours
36
Name 3 ways to protect an unfasted patient under anaesthesia
Reduce gastric volume (NG aspiration) Avoid GA (regional anaesthesia) Increase pH of gastric contents (antacids)
37
Name the 3 sections of the WHO surgical checklist
1. Before induction of anaesthesia 2. Before skin incision 3. Before pt. leaves operating room
38
What is the greatest risk involved in peri-operative blood transfusion?
Human error
39
Name 3 situations when blood should be given
1. Cardiovascular instability 2. Poor end organ perfusion 3. Estimated blood loss
40
What is defined as major haemorrhage?
Rate of loss >150ml/min
41
Name 3 things that should be ensured after activating a major haemorrhage protocol
1. Good IV access (2 wide bore) 2. 100% oxygen 3. Warmed clear IV fluids
42
Name 3 complications of massive transfusion
1. Impaired O2 delivery to tissues 2. Coagulopathy 3. Fluid overload
43
What is the definition of a surgical site infection?
Infection near or in the incisional site within 30 days (90 if prosthesis involved)
44
What type of wound is uninfected?
Clean wound
45
What is a clean-contaminated wound?
Operation has involved a viscus but no unusual contamination has occurred
46
What type of wound is an old traumatic one with retained devitalized tissue or foreign body?
Dirty wound
47
Define a contaminated wound
An open accidental wound with breaks in sterile technique
48
Give 2 patient and surgical risk factors for surgical site infection
Patient: Immunocompromised and age Surgical: Haematoma formation and increased length of procedure
49
How does giving peri-operative prophylactic antibiotics benefit the patient?
Reduces the chance of surgical site infection by reducing burden of micro-organisms at the site
50
Name 3 risks of peri-operative prophylactic ABX
1. Adverse effects 2. Drug resistance 3. C. Diff
51
How and when are prophylactic antibiotics used?
Single IV dose in: - Clean surgery (with prosthesis) - Clean-contaminated - Contaminated
52
Within what time period does post-operative nausea and vomiting usually occur?
24 hours
53
Name three general categories of trigger for N&V
1. Pain 2. Motion 3. Endogenous toxins
54
Name 4 neurotransmitters involved in N&V
1. 5HT 2. Dopamine 3. Histamine 4. Acetylcholine
55
What type of drug is ondansetron?
Antiemetic - 5HT antagonist
56
What type of drug is droperidol?
Antiemetic - dopamine antagonist
57
Define acute pain
Nociceptive or neuropathic pain lasting up to three months
58
Define chronic pain
Neuropathic pain lasting over 3 months due to changes in pain signalling
59
In the assessment of pain, what are the grades used to define functional pain?
A - no limitation B - mild limitation C - significant limitation
60
What is the 1st step on the WHO pain ladder?
Non-opioid +/- adjuvant
61
What is the 2nd step on the WHO pain ladder?
Weak opioid or multimodal +/- non-opioid +/- adjuvant
62
What is the 3rd step on the WHO pain ladder?
Strong opioid +/- non-opioid +/- adjuvant
63
What is the 4th step on the WHO pain ladder?
Interventional treatment +/- non-opioid +/- adjuvant
64
Name 3 possible causes of airway compromise
1. Inhaled foreign object 2. Laryngospasm 3. Secretions
65
Name 3 management options for airway compromise
1. Head tilt, chin lift 2. Jaw thrust 3. Airway adjuncts
66
Below what GCS score is airway compromise a significant risk?
GCS <8
67
What management should be immediately implemented if ACS is suspected?
MONA Morphine and antiemetic Oxygen Nitrites Aspirin
68
What management should be implemented if a pt. has suspected fluid overload?
Diuretics and call a senior
69
What is the normal range for blood glucose?
4-11mmol/L
70
Which drug can be given to counteract opioid toxicity?
Naloxone
71
Name 4 things to be inspected at in E of A-E assessment?
Rashes Abnormal bruising Calves Surgical wounds
72
Name 2 variable oxygen delivery devices
Nasal oxygen | Hudson Mask
73
Name 3 fixed oxygen delivery devices
Venturi mask Trauma mask High flow nasal O2
74
How does NIV work?
High flow device creates positive pressure to ventilate pt. via tight fitting mask instead of invasive ventilation
75
How does CPAP work?
Keeps small airways open to decrease work of breathing
76
Name 2 ways standard post-operative O2 may be delivered
4-6L via Hudson | 35-50% via Venturi
77
Give 2 examples of crystalloid fluids
Hartmann's solution | 4% dextrose 0.18% saline
78
Name 3 main reasons for fluid prescription in adults
Resuscitation Maintenance Replacement
79
What is the process of fluid administration in resuscitation?
500ml boluses of crystalloids for 2L, looking for response after each bag If nothing, call senior
80
What is the maximum fluid dose in maintenance?
Never more than 100ml/hr
81
Which type of fluids are typically used in replacement of losses?
Crystalloids | e.g. Hartmann's or 0.9% saline
82
Name 3 risks of ventilation
1. Lung injury 2. Intubation associated pneumonia 3. Cardiovascular effects
83
What does each letter of the SPIKES model for breaking bad news stand for?
``` Setting up Perception Invitation Knowledge Empathy Summarise ```
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