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Phase 3B > Anaesthetics > Flashcards

Anaesthetics Flashcards

(61 cards)

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1
Q

What factors make a patient high-risk for surgery

A 
Age
Severity of surgical disease
Severity of proposed procedure
Medical co-morbidities
Exercise tolerance
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2
Q

Why is exercise tolerance important

A

Inflammatory stress response after surgery leads to an increased oxygen demand and therefore an increased cardiac output

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3
Q

What is a good way to assess physiological reserve

A

Can you climb a flight of stairs without getting breathless (consider alternate questions in those with joint pathology)

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4
Q

Hypertension target for surgery

A

> 180/100

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5
Q

When to do an ECG before surgery

A

> 55yrs - risk of silent MI
Anyone with cardiac signs/symptoms
Hypertension
Diabetes

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6
Q

Blood pressure medicines advice pre-operative

A

Continue all and take on day of surgery - especially beta blockers
ACE inhibitors/ARB should NOT be taken on day of surgery

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7
Q

What type of surgery should respiratory investigations be carried out

A

Upper abdominal

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8
Q

When is CXR require pre-operatively

A

Clinical indication or having thoracic surgery

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9
Q

How should hiatus hernia patients be managed for anaesthesia

A

PPI/H2 receptor antagonist and metoclopramide

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10
Q

Important LFTs pre-operatively

A

Clotting screen!

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11
Q

How should diabetic patients be managed pre-operatively

A

2-hourly blood glucose, ECG and U&Es. Scheduled at start of list (to minimize fasting)

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12
Q

How long prior to surgery can solids be taken

A

6 hours

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13
Q

How long prior to surgery can fluids be taken

A

2 hours

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14
Q

How long prior to surgery can breast milk be taken

A

4 hours

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15
Q

List medications that should be stopped prior to surgery

A 
Aspirin
Warfarin
Clopidogrel
ACEi/ARB
OCP
HRT
MAOIs
Sulfonylureas
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16
Q

Which drugs should be stopped 4 weeks prior to surgery

A

OCP

HRT

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17
Q

Which drugs should be stopped 1 week before surgery

A

Aspirin

Clopidogrel

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18
Q

Which drugs should be stopped 5 days before surgery

A

Warfarin

may required LMWH as replacement

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19
Q

Which drugs should be omitted on the day of surgery

A

ACEi
ARB
Sulfonylureas

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20
Q

How should airway be managed in suspected c-spine injury

A

Head in neutral position

Jaw thrust ONLY

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21
Q

Main causes of hypotension post-operatively

A

Residual anaesthesia
Hypovolaemia
Sepsis

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22
Q

What is the first line management of hypotension

A

Oxygen therapy and IV fluid challenge

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23
Q

Main causes of hypertension post-operatively

A 
Pain
Anxiety
CO2 retention
Pre-existing hypertension
Withdrawal from anti-hypertensives (omission for surgery)
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24
Q

What obs are measured post-operatively

A 
Resp rate
Pulse
Oxygen sats
Blood pressure
Urine output
Temperature
Mental sate
Pain
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25
Causes of hypoxaemia post-operatively
``` Airway obstruction Respiratory depression Respiratory faialure Hypostatic pneumonia Pulmonary atelectasis Aspiration pneumonia Pulmonary embolism ```
26
Causes of oliguria post-operatively
Dehydration/hypovolaemia AKI/acute renal failure Urinary retention/obstruction
27
Causes of confusion post-operatively
Hypoxaemia Alcohol withdrawal Opiods/sedative drugs Sepsis/infection
28
What might cause pain after surgery
Pressure sores
29
Risk factors for post-operative nausea and vomiting
``` Pain/anxiety Young Female Breast/bowel/uterus/middle ear surgery Use of opiods drugs History of pprevious post-op N&V History of motion sickness Dehydration ```
30
Name some groups of drugs used to treat post-operative nausea and vomiting
Antihistamines 5-hydroxytryptamine antagonists Dopamine antagonist Steroids
31
Antihistamines used to treat nausea
Cyclizine
32
5-hydroxytryptamine antagonists used to treat nausea (serotonin antagonist)
Ondansetron
33
Dopamine antagonists used to treat nausea
Metoclopramide, prochlorperazine
34
Steroids used to treat nausea
Dexamethasone (single dose only)
35
Guideline for treating post-operative nausea
1. Cyclizine 2. If no response in 30 mins give 5-HT antagonist 3. Dopamine antagonist if no response in 30 minutes
36
Systemic analgesic ladder
Simple analgesia NSAID Weak opiod Strong opiod
37
How is post operative pain manaed
Reversed analgesic ladder as pain usually starts worse and gets better
38
Give some examples of simple analgesia
Paracetamol
39
Give examples of NSAIDs
ibuprofen diclofenac keterolac
40
Give examples of weak opiods
dihydrocodeine | tramadol
41
Give examples of strong opiods
Morphine Diamorphine Fentanyl Oxycodone
42
How does codeine work
Metabolised to morphine in the liver. | 25% of people don't have the enzyme to metabolise codeine and it is ineffective in this population
43
What are colloids
Fluids containing large suspended molecules such as gelatin which do not leak out of the intravascular compartment and hence act as plasma expanders. Maintain oncotic pressure before blood can be given
44
Name some crystalloids
Hartmanns, saline, glucose and dextrose saline
45
Which blood can be given in extreme emergencies
O negative blood
46
How much to give in resuscitation fluids
Bolus of 500ml crystalloid containing sodium over less than 15 minutes
47
Routine maintenance fluids
25-30 ml/kg/day water 1 mmol/kg/day sodium, potassium,chloride 50-100g/day glucose
48
When to consider nasogastric or enteral feeding when giving fluids
If maintenance fluids needed for more than 3 days
49
What is the average fluid intake of the 70kg male
2-2.5 litres a day
50
What signs may appear if too much fluid is given
Right heart failure - tachycardia, peripheral oedema, raised JVP Left heart failure - tachycardia, breathlessness, wheeze, pulmonary oedema Electrolyte imbalance
51
What are the changes to the airway in an unconscious patient
Reduced/no protective reflexes Increased airway obstruction Absent cough reflex
52
What are the changes to breathing in an unconscious patient
Respiratory depression
53
What are the changes to circulation in an unconscious patient
Reduced peripheral vascular tone (BP=COxSVR)
54
What are the changes to disability in an unconscious patient
Reduced oesophageal sphincter tone & gastric motility Inability to swallow Reduced pain response Reduced corneal reflexes Decreased ability to regulate body temperature
55
What are the signs of airway obstruction
``` Increased respiratory effort tracheal tug intercostal recession cyanosis (later) stridor tachycardia initially leading to a terminal bradycardia cardiac arrest ```
56
Signs of apnoea
Absent chest movements no breath sounds no evidence of airflow
57
Signs of respiratory distress
Increased respiratory rate increased heart rate signs of CO2 retention (sweating, tremor, increased BP) abnormal respiratory pattern
58
What are the basic airway manoeuvres
Head tilt Chin lift Jaw thrust
59
How to manage the airway in a trauma patient
Risk of c-spine injury so ONLY perform jaw thrust! Keep the head and neck isolated
60
What level of oxygen do patients receive during anaesthesia
Minimum of 30%
61
Which patients may need several days of oxygen therapy post-operatively
``` Prolonged abdo/thoracic surgery obese patients sepsis or hypovolaemic shock pre-existing respiratory compromise receiving IV opiods ```

Phase 3B (3 decks)

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