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Systems: Specialities AB > Anaesthetics: Conduct of General Anaesthesia > Flashcards

Anaesthetics: Conduct of General Anaesthesia Flashcards

(40 cards)

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1
Q

What roles are anaesthetists involved in?

A
  • Pre-op Assessment & Care
  • Critical Care / Intensive Care
  • Pain Management
  • Anaesthesia
  • Post-operative care
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2
Q

What are the stages in the process of anaesthesia?

A
  • Pre-operative Assessment
  • Preparation
  • Induction
  • Maintenance
  • Emergence
  • Recovery
  • Post-operative Care and Pain Management
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3
Q

What preparation is required for anaesthesia?

A
  • Planning
  • Right patient, right operation
  • Right (or left) side…..
  • Pre-medication
  • Right equipment, right personnel
  • Drugs drawn up
  • IV access
  • Monitoring
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4
Q

How is anaesthesia induced?

A

Gas or IV agent

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5
Q

What drugs are used in IV induction?

A
  • Propofol
  • Thiopentone
  • others
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6
Q

What are the general features of IV induction?

A
  • Rapid (One “arm-brain” circulation ~ 20s)
  • No obvious planes
  • Easy to overdose
  • Generally rapid loss of airway reflexes
  • Apnoea is very common
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7
Q

What agent is used in gas induction?

A

Sevoflurane (halothane)

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8
Q

Who is gas induction commonly used in?

A

Young children

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9
Q

What are the general features of gas induction?

A
  • Slow

- Considerably more obvious ‘planes’ of anaesthesia

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10
Q

List the planes of anaesthesia.

A
  • Analgesia / Sedation
  • Excitation
  • Anaesthesia: Light —> Deep
  • Overdose
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11
Q

What are the 4 components of induction?

A
  • Quietness
  • Gas or IV Agent
  • Careful monitoring of conscious level
  • Airway maintenance
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12
Q

How is conscious level monitored?

A
  • Loss of Verbal Contact
  • Movement
  • Respiratory Pattern
  • Processed EEG
  • “Stages” or “planes” of anaesthesia
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13
Q

What happens to the airway as someone loses consciousness

A

The epiglottis falls back and obstructs the airway

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14
Q

When is airway maintenance required in GA?

A

Always

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15
Q

What is the triple airway manoeuvre?

A
  • Head tilt
  • Chin lift
  • Jaw thrust
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16
Q

What simple apparatus can be used in airway maintenance?

A
  • Face mask
  • Guedel
  • NP airway
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17
Q

What are the features of the anaesthetic face mask?

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A
  • Identical to those used in Resuscitation
  • Contoured to face to allow a gas-tight seal
  • Sizes from neonatal - large adult
  • Technique involves lifting the face into
  • Standard connector
18
Q

Who tolerates placement of a Guedel?

Study These Flashcards
A

Only unconscious patients

19
Q

What can insertion of a guedel into a ‘light’ patient cause/

Study These Flashcards
A

Vomiting or laryngospasm

20
Q

How should a guedel be inserted?

Study These Flashcards
A

Adult
-Upside down and then rotated 180 once in the mouth

Children
-Can be inserted directly

21
Q

What are the features of a LMA?

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A
  • Cuffed tube with ‘mask’ sitting over glottis
  • Maintains, but DOES NOT PROTECT the airway
  • Sizes for adults and children
22
Q

How should a LMA be inserted?

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A
  • Direct insertion

- Inflation of cuff

23
Q

What are the features of an I-gel?

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A
  • 2nd generation” LMA
  • (Relatively) Easy insertion
  • Does NOT protect from aspiration
  • Can use suctioning when inserted
24
Q

How should an I-gel be inserted?

Study These Flashcards
A
  • Direct insertion

- No cuff inflation required

25
What obstructive airway complications may occur?
- Ineffective Triple Airway Manoeuvre - Airway Device malposition or kinking - Laryngospasm = Laryngeal spasm
26
What is laryngospasm?
- Forced reflex adduction of the vocal cords - May result in complete airway obstruction - Caused by airway (or other) stimulation in light planes of anaesthesia - Often unrelieved by simple manoeuvres
27
What aspiration airway complications may occur?
Loss of protective airway reflexes (gag, swallow, cough) can lead to foreign material entering the lower airway (gastric contents, blood, surgical debris)
28
What is a maintained airway?
One which is open and unobstructed
29
What is the only way to protect an airway from contamination?
Use of a cuffed ET tube
30
How is ET intubation carried out?
- Oral route most commonly used - Laryngeal reflexes must be abolished - Classic method uses laryngoscope, muscle relaxant, “sniffing the morning air” position - Also possible in the awake patient using local anaesthesia and fibre-optic scope
31
Why do we intubate patients?
- Protect airway from gastric contents - Need for muscle relation and therefore artificial ventilation - Shared airway with risk of blood contamination (tonsillectomy) - Need for tight control of blood gases - Restricted access to airway
32
What are the risks to an unconscious patient?
- “Airway, Airway, Airway” - Temperature - Loss of other protective reflexes eg corneal, joint position - Venous thromboembolism risk - Consent & Identification - Pressure areas
33
How can a patient be positioned when anaesthetised?
- Supine - Lithotomy - Prone - Lying on side - Sitting
34
How should a patient be cared for following anaesthesia?
- Care of the unconscious patient - Muscle relaxation, analgesia - Monitoring and physiological support - Fluid management - Documentation and recording
35
What happens after the administration of the induction agent?
- Induction agents wear - Maintenance: IV / Inhalational or both - Self- or Artificial Ventilation - “Balanced” (multi-modal) technique - Analgesia - Gas supply from anaesthetic “machine”
36
What monitoring should be take place whilst a patient is anaesthetised?
- Minimum monitoring (SpO2, ECG, NIBP,FiO2, ETCO2) - Respiratory parameters - Agent monitoring - Temperature, urine output, NMJ - Invasive venous/arterial monitoring - Processed EEG - Watch for VENTILATOR DISCONNECT
37
What are the risk factors for awareness during anaesthesia?
- Paralysed and ventilated - Previous episode of awareness - Chronic CNS depressant use - Cardiac surgery - Major trauma - GA c/section
38
What happens as someone awakens from anaesthetic?
- Muscle relaxation reversed - Anaesthetic agents off - Resumption of spontaneous respiration - Return of airway reflexes / control - Extubation
39
How are local (regional) anaesthetics administed?
- Same care as GA - IV access required - Monitoring - Presence of anaesthetist - Spinal, epidural, plexus block, nerve block - Each technique has its own indications, benefits, hazards and complications
40
What is involved in the recovery area following anaesthetic?
- A dedicated area with trained staff - Many patients have not yet regained consciousness or AIRWAY CONTROL - Continuing responsibility of anaesthetist - Problems with A, B, C - Pain control - Post-operative Nausea & Vomiting may occur - Set criteria for discharge back to ward

Systems: Specialities AB (19 decks)

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