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Anaesthetics Flashcards

(68 cards)

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1
Q

Positional manoeuvre to open airway:

A
  • head tilt
  • chin lift
  • jaw thrust
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2
Q

What is an oropharyngeal airway used for?

A
  • easy to insert and use
  • no paralysis
  • ideal for very short procedures
  • often bridge to more definitive airway
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3
Q

What is a laryngeal mask used for?

A
  • very easy
  • sits on pharynx and aligns to cover airway
  • poor control against reflux of gastric contents
  • paralysis not required
  • especially day surgery
  • not suitable high pressure ventilation
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4
Q

What is a tracheostomy used for?

A
  • reduces work of breathing
  • useful in slow weaning
  • percutaneous in ITU
  • dries secretions, humidified air required
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5
Q

What is an endotracheal tube used for?

A
  • optimal control of airway once cuff inflated
  • short or long term
  • errors in insertion may result in oesophageal intubation
  • paralysis required
  • higher ventilation pressures used
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6
Q

ASA I:

A
  • normal healthy patient

- non-smoking, no/minimal alcohol use

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7
Q

ASA II:

A
  • mild systemic disease

- e.g. current smoker, social drinker, pregnancy, obesity, well controlled diabetes/HTN, mild lung disease

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8
Q

ASA III:

A
  • severe systemic disease
  • substantial limitations
  • poorly controlled diabetes, morbid obesity, hepatitis, alcohol abuse, pacemaker, ESRD, regular dialysis, MI, cerebrovascular
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9
Q

ASA IV:

A
  • severe systemic disease that is constant threat to life

- e.g. recent MI, cerebrovascular, ongoing ischaemia of heart, valve dysfunction, sepsis, DIC, ARD, ESRD

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10
Q

ASA V:

A
  • moribund patient not expected to survive without operation

- e.g. rupture aneurysm, massive trauma, ischaemic bowel, multiple organ dysfunction

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11
Q

ASA VI:

A
  • brain dead

- organs being removed for donor purposes

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12
Q

How is propofol used as an anaesthetic agent?

A
  • GABA receptor agonist
  • rapid onset
  • pain on IV injection
  • rapidly metabolised with little metabolite accumulation
  • anti emetic
  • moderate myocardial depression
  • maintaining sedation in ITU, total IV anaesthetic and daycare surgery
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13
Q

How is sodium thiopentone used as an anaesthetic agent?

A
  • very rapid onset
  • marked myocardial depression
  • metabolites build quickly
  • unsuitable for maintenance
  • little analgesic
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14
Q

How is ketamine used as an anaesthetic agent?

A
  • NMDA receptor antagonist
  • induction of anaesthesia
  • moderate to strong analgesic properties
  • little myocardial depression so suitable for haemodynamically unstable
  • dissociative anaesthesia resulting in nightmares
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15
Q

How is etomidate used as an anaesthetic agent?

A
  • favourable cardiac safety profile - haemodynamic instability
  • no analgesia
  • unsuitable for maintaining sedation as prolonged use can cause adrenal suppression
  • post operative vomiting is common
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16
Q

What to do if blood loss in surgery where transfusion is unlikely?

A

group and save

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17
Q

What to do if blood loss in surgery where transfusion is likely?

A

cross match 2 units

salpingectomy for ruptured ectopic pregnancy, total hip replacement

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18
Q

What to do if blood loss in surgery where transfusion is definite?

A

cross match 4-6 units

total gastrectomy, oophorectomy, oesophagectomy, elective AAA repair, cystectomy, hepatectomy

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19
Q

Inhaled anaesthetic:

A
  • halothane

- ADR: hepatotoxicity, myocardial depression, malignant hyperthermia

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20
Q

What are peripheral venous cannulas unsuitable for?

A
  • vasoactive drugs
  • e.g. inotropes and irritant drugs e.g. TPN
  • unless very short setting
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21
Q

How should central lines be inserted?

A
  • using US
  • femoral lines easier to insert but high infection rates
  • internal jugular preferred - multiple lumens
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22
Q

How should intraosseous access be inserted and what is it used for?

A
  • anteromedial aspect of proximal tibia
  • access to marrow cavity and circulatory
  • preferred in paediatric
  • may be used in adults
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23
Q

What are tunnelled lines?

A
  • Groshong and Hickman
  • popular for long term therapeutic
  • inserted using US into internal jugular vein and then tunnelled under skin
  • can be linked to injection ports under skin
  • popular in paediatric
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24
Q

What is a peripherally inserted central cannula?

A
  • picc lines popular for central venous access

- inserted peripherally so less major complications than conventional central lines

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25
Orange cannula size and flow rate:
- 14g | - 270ml/min
26
Grey cannula size and flow rate:
- 16g | - 180ml/min
27
Green cannula size and flow rate:
- 18g | - 80ml/min
28
Pink cannula size and flow rate:
- 20g | - 54ml/min
29
Blue cannula size and flow rate:
- 22g | - 33ml/min
30
What kind of drug is lidocaine?
- amide - LA and anti arrhythmic - affects sodium channels - hepatic metabolism, protein bound, renal excreted
31
Lidocaine toxicity:
- due to IV or excess administration - increased risk in liver dysfunction or low protein - treat with IV 20% lipid emulsion - initial CNS over activity and then depression - blocks inhibitory pathways and then activating pathways as well - cardiac arrhythmias - increased doses combined with adrenaline
32
What does lidocaine interact with?
- beta blockers - ciprofloxacin - phenytoin
33
What kind of drug is cocaine and what is it used for?
- salt - cocaine hydrochloride - LA paste - 4 and 10% conc - nasal mucosa -ENT - vasoconstriction - lipophilic so readily crosses BBB - can cause arrhythmias and tachycardia
34
What kind of drug is bupivacaine:
- binds to intracellular portion of sodium channels and blocks sodium influx into nerves - prevents depolarisation - longer action than lidocaine - topical wound infiltration at conclusion of surgical procedures - cardiotoxic so contra in regional blockage - levopbupivicaine less cardiotoxic and causes less vasodilation
35
What is prilocaine used for:
- less cardiotoxic | - intravenous regional anaesthesia
36
Dose of lignocaine plain and with adrenaline:
- 3mg/kg | - 7mg/kg
37
Dose of bupivacaine plain and with adrenaline:
- 2mg/kg | - 2mg/kg
38
Dose of prilocaine plain and with adrenaline:
- 6mg/kg | - 9mg/kg
39
Max dose lignocaine:
200mg
40
Max dose lignocaine:
500mg
41
Max dose bupivicaine:
150mg
42
What is malignant hyperthermia?
- often seen after anaesthetics - hyperpyrexia and muscle rigidity - excessive release of calcium from sarcoplasmic reticulum - associated with defect chromosome 19 encoding ryan-done receptor - autosomal dominant
43
Causative agents malignant hyperthermia:
- halothane - suxamethonium - antipsychotics (NMS)
44
Investigations and management malignant hyperthermia:
- CK raised - contracture tests with halothane and caffeine - manage with dantrolene - prevents calcium release from SR
45
When are nasopharyngeal airways used and contraindicated?
- decreased GCS - ideal for seizures - NOT in base skull fractures
46
What is suxamethonium?
- muscle relaxant - depolarising neuromuscular blocker - inhibits Ach at NM junction - fastest onset and shortest duration - generalised muscular contraction prior to paralysis - ADR: hyperkalaemia, malignant hyperthermia, lack of acetylcholinesterase
47
What is atracurium?
- muscle relaxant - non depolarising neuromuscular blocking drug - 20-45 minutes action - generalised histamine release on administration may produce facial flushing, tachycardia and hypotension - not excreted by liver or kidney, broken down in tissue by hydrolysis - reversed by neostigmine
48
What is vecuronium?
- muscle relaxant - non depolarising neuromuscular blocking drug - 30-40 minutes action - degraded by liver and kidney and effects prolonged in organ dysfunction - reversed by neostigmine
49
What is pancuronium?
- muscle relaxant - non depolarising neuromuscular blocekr - 2-3 minutes for onset - duration 2 hours - partially reversed with neostigmine
50
What are the depolarising and non-depolarising neuromuscular blocking drugs?
- depolarising: suxamehtonium (succinylcholine) | - non-depolairisng: tubocurarine, atracurium, veruconium, pancuronium
51
How do depolarising neuromuscular blocking drugs work and ADR?
- bind to nicotinic ach receptors so persistent depolarising of motor end plate - ADR: malignant hyperthermia, hyperkalaemia
52
CONTRA of depolarising neuromuscular blocking drugs:
-penetrating eye injuries -acute narrow angle glaucoma (suxamethonium increases intra-ocular pressure)
53
How do non-depolarising neuromuscular blocking drugs work and ADR?
- competitive antagonist of nicotinic ach receptors | - ADR: hypotension
54
How do you reverse non-depolarising neuromuscular blocking drugs?
acetylcholinesterase inhibitors e.g. neostigmine
55
What is paralytic ileus?
- common complication after bowel surgery especially - no peristalsis results in pseudo-obstruction - also in association with chest infections, myocardial infarction, stroke and AKI - deranged electrolytes can contribute
56
Early causes of post-op pyrexia (0-5 days):
- blood transfusion - cellulitis - UTI - physiological systemic inflammatory reaction - pulmonary atelectasis
57
Late causes of post-op pyrexia:
-VTE pneumonia -wound infection -anastomotic leak
58
3 phases of operation on checklist:
- before induction of anaesthesia - before incision of skin - before patient leaves room
59
What needs to be checked before induction of anaesthesia?
- patient identify confirmed - site marked - anaesthesia safety check completed - pulse oximeter on patient and functioning - allergies - any aspiration or airway risk - risk of >500ml blood loss?
60
When should women stop taking the pill/hormone replacement before surgery?
4 weeks
61
What are the stages of wound healing?
- haemostasis - inflammation - regeneration - remodeling
62
What is the haemostats stage of wound healing?
- minutes to hours after | - vasospasm in adjacent vessels, platelet plug formation and generation of fibrin rich clot
63
What is the inflammation stage of wound healing?
- days 1-5 - neutrophils migrate into wound - growth factors released (basic fibroblast growth factor and VEGF) - fibroblasts replicate within adjacent matrix and migrate into wound - macrophages and fibroblasts couple matrix regeneration and clot substitution
64
What is the regeneration stage of wound healing?
- days 7-56 - platelet derived GF and transformation GF stimulate fibroblasts and epithelial cells - fibroblasts produce collagen network - angiogenesis occurs and wound resembles granulation tissue
65
What is the remodelling stage of wound healing?
- week 6-1 year - longest phase of healing process may last up to 1 year - fibroblasts differentiate (myofibroblasts) and these facilitate wound contraction - collagen fibres remodelled - microvessels regress leaving pale scar
66
What is a hypertrophic scar?
- excess collagen | - nodules with randomly arranged fibrils and parallel fibrils
67
What is a keloid scar?
- excess collagen in scar - beyond boundaries of original injury - no nodules - do not regress over time and may recur following removal
68
Drugs impairing wound healing:
- NSAID - steroid - immunosuppressive - anti-neoplastic

Surgery (10 decks)

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