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Phase 4 - Katherine > Anaesthetics COPY > Flashcards

Anaesthetics COPY Flashcards

1
Q

Name some anti emetics ?

Which is best for post op nausea / vomiting?

vertigo?

travel sickness ?

A

ondansetron
cyclizine
domperidone
metoclopramide
prochlorperazine

ondansetron
prochlorperazine
cyclizine

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2
Q

what things do you need to do pre op?

A

Optimise medical conditions
Adjust medication
Check investigations
Check weight
EXPLAIN AND CONSENT

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3
Q

parts of relevant anaesthetic Hx ?

A

previous anaesthetics, FHx
Airway problems
PONV

Malignant hyperpyrexia - this is a dangerous complication of anaesthesia due to an underlying muscular disorder.
(Inherited skeletal muscle disorder. May reverse with Dantralene. Triggered by volatiles and suxamethonium.Hyperkalaemia, hypoxia, temperature, rhabdomyolysis)

Suxamethonium apnea
(Patient does not have enzyme to break down therefore use propofol (Inherited disorder of acetylcholinesterase)

Allergies
Anaesthetic agents, analgesics, antibiotics, latex and eggs (propofol)

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4
Q

What to do for pt on warfarin for AF for operation

A

Stop and use LMWH

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5
Q

What features could make a difficult airway?

A

Anatomical
small mouth, small chin, large tounge, big neck

Lack of movement in neck / mouth

poor dentition

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6
Q

What 3 tests can be used to assess airway for intubation

A

mallampati (oropharynx) - open mouth and see differing amounts of the airway

extention of upper cervical spine
(<90 degrees)

thyromental test
(Distance from tip of thyroid to tip of mandible at gull extension Normal > 6.5cm, under 6cm = difficult laryngoscopy)

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7
Q

3 parts of anaesthetic triad

A

anaesthesia
analgesia
muscle relaxation

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8
Q

With GA what 2 options of route are there?

A

IV - propofol

Inhaled (iso/sevo/desfluorane) @young children/ needle phobics

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9
Q

During induction of GA what should you do?

A

pre oxygenate / oxygenate

secure / manage airway

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10
Q

What drug is usually given with propofol for maintenance of GA

A

Remifentanil

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11
Q

What level of GCS do you need to provide airway control

A

Under 8

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12
Q

Physical manoeuvres for airway control

A

head tilt
chin lift
jaw thrust

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13
Q

When would be cautious using a nasopharyngeal tube?

A

base of skull fracture

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14
Q

3 ways to determine correct placement of ET tube?

A

Chest movement
Misting of mask
Trace on capnography

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15
Q

2 places an ET tube can go thats wrong

A

oesophagus
1 bronchus (too far in)

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16
Q

which local anaesthetic only lasts for a short period of time?

A

lidocaine

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17
Q

which local anaesthetic can provide 2 hours anaestheia and 12 hours of analgesia

A

bupivocaine

use for regional blocks

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18
Q

advantages of regional anaestheisa over GA

A

Avoids GA
Can be awake
Avoid airway problems
Less nausea and vomiting
Better peri-operative pain control

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19
Q

Where does an epidural go? spinal ?

A

between ligaments and dura

through dura

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20
Q

3 reasons muscle relaxants are used for surgery ?

A

Relax opening to trachea (glottis)

Relax muscles for surgery

Patients do not fight ventilators

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21
Q

Egs of muscle relaxants

A

suxamethonium - used for emergencies

Atracurium, rocuronium, vecuronium

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22
Q

Reversal of muscle relaxants

A

neostigmine

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23
Q

How do NSAIDS work ?

A

Inhibit cyclo-oxygenase

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24
Q

Side effects of opiodss

A

CNS - sedation, miosis
CVS- bradycardia, hypotension
Resp - brady / apnoea
GI - N+V, constipation
Urinary - retention
Skin - itching

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25
Q

Egs of weak opiods

A

codeine
tramadol

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26
Q

rule of 1/3s for fluids

A

2/3 intracellular (28L)
(Na/Cl poor, K rich)

1/3 extracellular (14L)
(Na/cl rich, K poor)
- 2/3 interstitial
- 1/3 intravascular

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27
Q

Egs of crystaloid fluids

A

NaCl
dextrose
hartmanns

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28
Q

What is a crystaloid fluid? colloid?

A

Ions or small molecules dissolved in water

Larger insoluble molecules retained within plasma for longer

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29
Q

Egs of synthetic colloid fluids

A

blood, albumin

Synthetic
(starch
gelatin - these are never used)

risk of anaphylaxis!

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30
Q

Difference between t1/2 resp failure and mx with NIV

A

1
Hypoxia without hypercapnia
CPAP continuous

2
Hypoxia with hypercapnia
NPPV (BiPAP biphasic)

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31
Q

CPAP vs NPPV

A

CPAP
Increases intrathoracic pressure by maintaining a positive end expiratory pressure allowing the alveoli to stay open rather than collapse.

improves FRC and oxygenation
reverse resp acid

NPPV
increase tidal volume by giving the breath an extra push whilst also painting PEEP. This increased breath allows for better CO2 clearance

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32
Q

What happens in T1 resp failure - how does CPAP help

A

V/Q missmatch

Inadequate oxygenation
-Alveolar collapse (pneumonia
-Fluid in alveoli (L heart failure)

CPAP - maintains minimum airway pressure alveolus held open fluid forced from lung

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33
Q

Eg of 2 causes of t2 resp faulure ?

How does BiPAP help

A

COPD, Muscular dystrophy

Inadequate ventilation(effect of dead space)
-> limited alveolar expansion

at inspiration adds inspiratory pressure (IPAP)
and EPAP at expiration
(further expands lung holds open collapsing increases ventilation airway)

34
Q

DDx for resp failure - Name a couple

A

Pneumonia

Atelectasis (collapsed units), pneumothorax

Pulmonary oedema

Thromboembolic disease

Bronchospasm/obstruction, pre-existing, ARDS, increased metabolic demand

Central respiratory depression

35
Q

Complications of invasive ventilation

A

VAP (ventilator associated pneum)

VALI (lung injury)

Need sedation and muscle relaxant

Immobility + TED stocking

Oxygen toxicity

36
Q

What is involved in the pre-op assessment?

A

History of presenting compaint
Surgical, anaesthetic and medical history
Systems review
Drug history and allergies
Social history

ASA SCORE

37
Q

ASA score

A

1 - normal
2 - mild systemic disease with no limitation of activity
3 - severe systemic disease with limitation of activity
4 - incapacitating
5
6

38
Q

NCEPOD - how quickly you have to do surgery

A

1 - minutes
2 - hours
3 - days
4 - planned

39
Q

Pre-op drug changes

A

Steroids - continue
Diuretics - drop say before
ACEi - stop if major surgery or if blood loss anticipated
BBs - always continue
Diabetic meds - sliding scale over night
Warfarin - stop 4 days before and monitor INR
cOCP - supposed to stop 4 weeks before and re-start 2 weeks after

40
Q

Cancelation reasons

A

URTI
recent MI
poor control of drugs
poor bloodworm - electrolyte abnormalities
inadequate prep - consent, fasting
uncontrolled AF

41
Q

CHECKLIST FOR SAFETY

A

IDENTITY
PROCEDURE
CONSENT
EQUIPTMENT
SITE MARKED
ALLERGIES
ASPIRATION RISK

42
Q

Post op

A

stop vapours
give o2
throat suction
reverse muscle relaxation - neostigmine

43
Q

Causes of post-op N&V

A

Patient - female, previous post-op n&v, anxious

Anaesthetic - opioids, NO2, dehydration

Surgery - laparotomy, gynaecology, abdo neuro, ENT, eye

44
Q

Intra and post op antiemetics

A

intra - dex, ond
post- cyclizine
wrist thing

45
Q

Dose of lidocaine

SEs of toxicity and management

A

3mg/kg, 7 with adrenaline

Toxicity –> numbness of tongue, lightheadedness, visual and auditory disturbances —> go on to really bad ones

Management
Stop injecting LA
A-E

REVERSAL –> intralipid

46
Q

Differences between spinal and epidural

A

Spinal
- subdural space
- less amount
- 5-10 min onset

epidural
- into epidural potential space
- larger volume
- 15-30 min headache

Contraindications:
- neuro disease
- hypovolaemia
- anticoagulants

47
Q

Resp acidosis cause

A

severe asthma, COPD, hypoventilation

48
Q

Resp alkalosis cause

A

hyperventilation, panic attack

49
Q

Met acidosis cause

A

DKA, lactic acidosis

50
Q

Met alkalosis cause

A

loss of acid (severe vomiting), NG drain

51
Q

RISK OF FLUIDS

A

pulmonary oedema

52
Q

Sx of raised ICP

A

headache - worse in morning, coughing, bending down
vomiting - without nausea
papilloedema
Cushing’s triad - increased systolic BP, bradycardia, Cheyne-Stoke respiration

53
Q

Treatment of malignant hyperthermia?

How does it work?

A

It is treated with dantrolene.

Dantrolene interrupts the muscle rigidity and hypermetabolism by interfering with the movement of calcium ions in skeletal muscle.

54
Q

How is malignant hyperthermia inherited?

A

Autosomal dominant

55
Q

What are the 2 main categories of anaesthesia?

A

General
Regional

56
Q

What does fasting for an operation involve?

A

6 hrs no food
2 hrs no clear fluids

57
Q

Give an example of premedication before general anaesthesia- post oxygenation

A

Benzodiazepines e.g. midazolam - relax muscles and reduce anxiety
Opiates e.g. fentanyl - reduce pain and reduce hypertensive response to laryngoscope
Alpha-2-adrenergic agonists e.g. clonidine - helps sedation and pain

58
Q

When is RSI used? (2)

A

Emergency - preplanning not possible and pt not fasted

Pts with GORD or Pregnancy to avoid aspiration

59
Q

Give 4 examples of IV options for general anaesthetic

A

Propofol (the most commonly used)
Ketamine
Thiopental sodium (less common)
Etomidate (rarely used)

60
Q

Give 4 examples of inhaled GA

A

Sevoflurane (the most commonly used)
Desflurane (less favourable as bad for the environment)
Isoflurane (very rarely used)
Nitrous oxide (combined with other anaesthetic medications – may be used for gas induction in children)

61
Q

What is generally used to induce GA

A

IV medication e.g. propofol

62
Q

What is generally used to maintain GA

A

Inhaled medications as it takes longer for them to diffuse through the lungs

63
Q

What is usually used in TIVA? What is the advantage of this?

A

Propofol. Nicer recovery compared to inhaled options.

64
Q

What is the one contraindication of propafol

A

Shock

65
Q

What are the 2 categories of muscle relaxation

A

Depolarising e.g. suxamethonium
Non-depolarising e.g. rocuronium

66
Q

What can be used to reverse muscle relaxants

A

Cholinesterase inhibitors e.g. neostigmine

67
Q

How do you test the muscle relaxant has worn off before the patient becomes conscious?

A

Nerve stimularor at ulnar nerve, facial nerve and temple (4 times each)

68
Q

What is malignant hyperthermia?

A

A rare hypermetabolic response to anaesthesia

Risks include:
Volatile anaesthetcs
Suxamethonium

69
Q

Symptoms of malignant hyperthermia

A

Increased body temperature (hyperthermia)
Increased carbon dioxide production
Tachycardia
Muscle rigidity
Acidosis
Hyperkalaemia

70
Q

What is ASA 1

A

A normal healthy pt

71
Q

What is ASA II

A

A patient with mild systemic disease

(Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (BMI 30 - 40), well-controlled Diabetes Mellitus/Hypertension, mild lung disease)

72
Q

What is ASA III

A

A patient with server systemic disease

(Substantive functional limitations; One or more moderate to severe diseases. Examples include (but not limited to): poorly controlled Diabetes Mellitus/Hypertension, 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 (>3 months) of Myocardial infarction, Cerebrovascular accidents)

73
Q

What is ASA IV

A

A patient with severe systemic disease that is a constant threat to life

74
Q

What is ASA 5

A

A moribund patient who is not expected to survive without the operation

75
Q

What is ASA 6

A

A declared brain-dead patient whose organs are being removed for donor purposes

76
Q

How should once daily long acting insulin be taken on the day before, of and day after surgery?

A

20% reduction in dose

77
Q

For elective total hip replacement surgery NICE recommend commencing a low molecular weight heparin when?

A

6-12 hours after surgery

78
Q

What induction agent is useful in haemodynamically unstable pts?

A

Ketamine

79
Q

What kind of airway is contraindicated in basal skull fracture

A

Nasopharyngeal

80
Q

When should COCP or HRT be stopped prior to surgery

A

4 weeks before

Phase 4 - Katherine (26 decks)

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