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finals > anaesthetics and preoperative care > Flashcards

anaesthetics and preoperative care Flashcards

1
Q

where dose a laryngeal mask sit

A

in pharynx and aligns to cover the airway

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2
Q

is laryngeal mask suitable for high pressure ventilation

A

no

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3
Q

what airway dries secretions

A

tracheostomy

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4
Q

what anaesthetic classification is a brain dead patient

A

VI

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5
Q

what is propofal mechanism of action

A

GABA receptor antagonist

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6
Q

is propofol an anti emetic

A

yes

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7
Q

onset of action of sodium thiopentone

A

rapid onset

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8
Q

mechanism of action of ketamine

A

NMDA receptor antagonist

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9
Q

does ketamine cause myocardial depression

A

slightly
best for those who are haemodynamically unstable

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10
Q

what is done if there is blood loss and chance of infusion is unlikely

A

group and save

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11
Q

examples of surgery where group and save is done

A

hysterectomy
appendectomy
thyroidectomy
c section

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12
Q

what is done if blood loss and transfusion is likely

A

cross match 2 units

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13
Q

blood loss if transfusion can occur

A

cross match 4-6 units

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14
Q

examples of inhaled general anaesthetics

A

volatile liquid anaesthetics
- isoflurane
- desflurane
- sevoflurane

nitrous oxide

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15
Q

side effects of volatile liquid anaesthetics

A
  • myocardial depression
  • malignant hyperthermia
  • halothane is hepatotoxic
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16
Q

when should nitrous oxide be avoided

A

pneumothorax

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17
Q

examples of IV general anaesthetics

A

propofol
thiopental
etomidate
ketamine

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18
Q

where is easiest place to insert a central line

A

femoral

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19
Q

which is preferred for central line

A

internal jugular

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20
Q

what is preferred route of access in paediatric

A

intraossesous access
- proximal tibia

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21
Q

size of orange cannula

A

14g
270ml/min

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22
Q

size of grey cannula

A

16g
180ml/min

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23
Q

size of green cannula

A

18g
80ml/min

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24
Q

size of pink cannula

A

20g
54ml/min

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25
Q

size of blue cannula

A

22g
33ml/min

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26
Q

can you give lidocaine during acidosis

A

no as it detaches from protein

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27
Q

drug interactions with lidocaine

A

beta blocker
ciprofloxacin
phenytoin

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28
Q

can cocaine cross blood brain barrier

A

yes

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29
Q

when is cocaine mostly used

A

ENT surgery

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30
Q

how does bupivacaine work

A

bind to intracellular sodium channels and blocks sodium influx into nerve cells
causes depolarisation

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31
Q

dosage of lignocaine

A

3mg/kg

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32
Q

what is maximum dose of lignocaine

A

200mg

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33
Q

why does adrenaline get added to local anaesthetic

A

to prolong duration of action at site of injection

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34
Q

when is adrenaline contraindicated

A

patient taking MAOIs or tricyclic antidepressants

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35
Q

what side effect can occur after administration of anaesthetic agents

A

malignant hyperthermia

36
Q

characteristics of malignant hyperthermia

A

hyperpyrexia and muscle rigidity

37
Q

why does malignant hyperthermia occur

A

excessive release of calcium form sarcoplasmic reticulum of skeletal muscle

38
Q

investigations for malignant hyperthermia

A

CK raised
contracture tests with halothane and caffeine

39
Q

management of malignant hyperthermia

A

dnatrolene - prevents calcium release from sarcoplasmic reticulum

40
Q

examples of muscle relaxants

A
  • suxamethonium
  • atrcurium
  • vecuronium
  • pancuronium
41
Q

when are nasopharyngeal airways contraindicated

A

base of skull fractures

42
Q

complications of naso gastric feeding

A

aspiration of feed or misplaced tube

43
Q

what is surgically sited feeding tube

A

feeding jejunostomy

44
Q

what can be used for long term feeding

A

feeding jejunostomy

45
Q

what is definitive option in patients in whom enteral feeding is contra indicated

A

total parenteral nutrition

46
Q

what is long term use of total parenteral nutrition associated with

A

fatty liver and deranged LFTs

47
Q

what are early causes of post-op pyrexia

A
  • blood transfusion
  • cellulitis
  • urinary tract infection
  • physiology systemic inflammatory reaction
  • pulmonary atelectasis
48
Q

late causes of post-op pyrexia

A
  • venous thromboembolism
  • pneumonia
  • wound infection
  • anastomotic leak
49
Q

what is post op ileus

A

aka paralytic ileus
common complication after surgery involving the bowel results in pseudo-obstruction

50
Q

features of postoperative ileus

A

abdominal distension/bloating
abdominal pain
nausea
inability to pass flatus
inability to tolerate an oral diet

51
Q

fluids before surgery

A

clear fluids until 2 hours before their operation

52
Q

when before surgery should you stop no clear fluids

A

6 hours before

53
Q

if surgery is long and diabetic will miss a meal or they have poorly controlled diabetes on insulin what is the management

A

variable rate intravenous insulin infusion

54
Q

metformin day prior to admission

A

take as normal

55
Q

metformin day of morning surgery

A

take as normal if taken twice a day
if have lunchtime dose - miss this out

56
Q

metformin day of afternoon surgery

A

take as normal if taken twice a day
if lunch time dose - miss it

57
Q

day before surgery sulfonylurea

A

take as normal

58
Q

sulfonylurea day of morning surgery

A

once daily in morning - miss dose
twice daily- omit morning dose

59
Q

sulfonylurea day of afternoon surgery

A

taken once daily in morning - omit dose
taken twice daily - omit both doses

60
Q

DPP IV inhibitor (-gliptins) day prior to surgery

A

take as normal

61
Q

DPP IV inhibitor (-gliptins) day of surgery morning or afternoon

A

take as normal

62
Q

GLP-1 analogues (-tides) day prior to surgery

A

take as normal

63
Q

GLP-1 analogues (-tides) day of surgery morning or afternoon

A

take as normal

64
Q

SGLT-2 inhibitors (-flozins) day before surgery

A

take as normal

65
Q

SGLT-2 inhibitors (-flozins) day or surgery if morning or afternoon

A

omit on day of surgery

66
Q

one daily insulins day prior to surgery

A

reduce dose by 20%

67
Q

once daily insulins day of surgery morning or afternoon

A

reduce dose by 20%

68
Q

long acting insulin day before surgery

A

no dose change

69
Q

long acting insulin day of surgery

A

halve the usual morning dose evening dose unchanged

70
Q

mechanism of injury accessory nerve

A

posterior triangle lymph node biopsy

71
Q

sciatic nerve mechanism of injury

A

posterior approach to hip

72
Q

common peroneal mechanism of injury

A

legs in Lloyd Davies position

73
Q

long thoracic nerve mechanism of injury

A

axillary node clearance

74
Q

arrhythmia following cardiac surgery can lead to

A

hypokalaemia

75
Q

what investigation for rectal anastomotic leaks

A

gatrograffin enema

76
Q

features that increase the risk of surgical site infection

A
  • shaving the wound using a razor
  • using non iodine impregnated incise drape if one necessary
  • tissue hypoxia
  • delayed administration of prophylactic antibiotics in tourniquet surgery
77
Q

perioperative period refers to

A

temperature management of patients from 1 hour prior to their surgery until 24 hours after the surgery has been completed

78
Q

risk factors of perioperative hypothermia

A
  • ASA grade 2 or above
  • major surgery
  • low body weight
  • large volumes of unarmed IV infusions
  • unwarmed blood transfusion
79
Q

complication of perioperative hypothermia

A
  • coagulopathy
  • prolonged recovery from anaesthesia
  • reduced wound healing
  • infection
  • shivering
80
Q

combined oral contraceptive pill prior to surgery

A

stop therapy 4 weeks before

81
Q

what is a hypertrophic scar

A

excessive amounts of collagen within a scar
contain nodules

82
Q

keloid scar

A

excessive amounts of collagen
pass beyond the boundaries or original injury
do not regress over time may recur

83
Q

drugs that impair wound healing

A
  • NSAIDs
  • steroids
  • immunosuppressive agents
  • anti neoplastic drugs
84
Q

lidocaine mechanism of action

A

blockage of sodium channels disrupting the action potential

85
Q

what is good anaesthetic agent for haemodynamically unstable patients

A

ketamine

86
Q

when is a nasopharyngeal airway contraindicated

A

base of skull fractures

finals (25 decks)

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