Anaesthetics and Perioperative Care Flashcards
(41 cards)
What are the stages of wound healing?
Haematomesis
Inflammation
Regeneration
Remodelling
What are hypertrophic scars?
Excessive amounts of collagen within a scar
Nodules may be present histologically containing randomly arranged fibrils within and parallel fibres on the surface
The tissue itself is confined to the extent of the wound itself and is usually the result of a full thickness dermal injury
What is a Keloid scar?
Excessive amounts of collagen within a scar. Typically will pass beyond the boundaries of the original injury
They do not contain nodules and may occur following even trivial injury
What drugs can impair wound healing?
NSAIDS
Steroids
Immunosupressive agents
Anti neoplastic drugs
Describe ASA 1
A normal healthy patient
Healthy
Non-smoking
No or minimal alcohol use
Describe ASA 2
A patient with mild systemic disease
Current smoker
Social alcohol drinker
Pregnancy
Obesity (BMI 30 - 40)
Well-controlled Diabetes Mellitus/Hypertension
Mild lung disease
Describe ASA 3
A patient with severe systemic disease
Poorly controlled DM/HTN
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 of MI or cerebrovascular accidents
Describe ASA 4
A patient with severe systemic disease that is a constant threat to life
Recent Myocardial infarction
Cerebrovascular accidents
Ongoing cardiac ischaemia
Severe valve dysfunction
Severe reduction of ejection fraction
Sepsis
DIC
Describe ASA 5
A moribund patient who is not expected to survive without the operation
Ruptured abdominal/thoracic aneurysm
Massive trauma
Intra-cranial bleed with mass effect
Ischaemic bowel in the face of significant cardiac pathology
Multiple organ/system dysfunction
Describe ASA 6
A declared brain-dead patient whose organs are being removed for donor purposes
Name common IV induction/sedation agents
Propofol
Sodium thiopentone
Ketamine
Etomidate
Give properties of sodium thiopentone
Extremely rapid onset of action making it the agent of choice for rapid sequence of induction
Marked myocardial depression
Metabolites build up quickly
Little analgesic effects
Give properties of propofol
Rapid onset of anaesthesia
Pain on IV injection
Anti emetic properties
Moderate myocardial depression
Give properties of etomidate
Has favorable cardiac safety profile with very little haemodynamic instability
No analgesic properties
Adrenal suppression
Post operative vomiting is common
Give properties of ketamine
Has moderate to strong analgesic properties
Produces little myocardial depression making it a suitable agent for anaesthesia in those who are haemodynamically unstable
May induce state of dissociative anaesthesia resulting in nightmares
Name an inhaled general anaesthetic
Halothane
Name an IV general anaesthetic
Thiopental
Give side effects of thiopental
Laryngospasm
Give side effects of Halothane
Hepatotoxicity
Myocardial depression
Malignant hyperthermia
Give GA complications
Post op pain
Post op N&V
Post op confusion
Laryngospasm when removing the ventilation tube
Hypoxia if inability/delayed ventilation
Hypotension
Respiratory depression
Name common local anaesthetic agents
Lidocaine
Cocaine
Bupivacaine
Prilocaine
What is the most widely used local anaesthetic?
Lidocaine
How is local anesthetic toxicity managed?
IV 20% lipid emulsion
When should lidocaine and adrenalin preparations not be used?
Minor surgery involving the finger as can cause digital ischaemia
