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Anaesthetics / peri op care Flashcards

(92 cards)

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1
Q

How many days before surgery should Warfarin be stopped?

5 days
7 days
14 days

A

5 days

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2
Q

How many days before surgery should Clopidogrel be stopped?

5 days
7 days
14 days

A

7 days

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3
Q

How long before surgery should oral contraceptive pills/ HRT be stopped?

7 days
14 days
4 weeks

A

4 weeks

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4
Q

How long before surgery should patients stop eating and drinking for?

A

Stop eating 6 hrs before

Stop clear fluids 2 hrs before

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5
Q

Donor blood can be issued after which blood test- group and save or crossmatch?

A

Cross match

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6
Q

Which anti-emetics are best for opiod induced nausea and vomiting?

A

Ondansetron

Cyclizine

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7
Q

Which anti-emetics are best for gastric stasis/ impaired gastric emptying?

A

Metoclopramide

Domperidone

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8
Q

Which anti-emetics are dopamine antagonists?

A

Metoclopramide

Domperidone

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9
Q

Which anti-emetics are 5-HT3 antagonists?

A

Ondansetron

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10
Q

Which anti-emetics are H1 Histamine antagonists?

A

Cyclizine

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11
Q

Name 5 or more risks associated with anaesthesia.

A
  1. Eye damage (corneal abrasion)
  2. Teeth and mouth damage
  3. Pneumonia
  4. Nausea and vomiting
  5. Post op delirium/ cognitive dysfunction
  6. Accidental awareness
  7. Sore throat
  8. Anaphylaxis
  9. Malignant hyperpyrexia
  10. Death/ brain damage
  11. Nerve damage
  12. Urinary retention
  13. Post spinal/epidural headache
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12
Q

Normal urine output is >___ml/hr.

A

> 30ml/ hour

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13
Q

What is a normal urine output in ml/kg/hr?

A

> 0.5 ml/kg/hr

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14
Q

What two groups do local anaesthetics normally have?

A 
Aromatic group (hydrophobic)
Amine group (hydrophilic)
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15
Q

Give examples of Amide local anaesthetics?

A

Lidocaine
Bupivicaine
Prilocaine

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16
Q

Give examples of Ester local anaesthetics?

A

Cocaine
Procaine
Tetracaine

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17
Q

Local anaesthetics work by inhibiting influx of which ion through voltage gated channels?

A

Sodium

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18
Q

Local and regional anaesthetics work by…

A

Blocking voltage gated Na channels

Preventing transmission of pain signals so they don’t reach the CNS

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19
Q

General anaesthetics work by…

A

Preventing pain generated peripherally from being interpretted as pain by the CNS

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20
Q

Local anaesthetics can cause side effects when injected accidentally into plasma, such as…

A
  1. Light headedness
  2. Tinnitus
  3. Tongue numbness
  4. Convulsions
  5. CNS collapse
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21
Q

What is the maximum safe dose of Lidocaine (mg/kg)?

A

3mg/kg

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22
Q

What is the maximum safe dose of Bupivicaine (mg/kg)

A

2mg/kg

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23
Q

What is the maximum safe dose of Prilocaine (mg/kg)

A

6mg/kg

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24
Q

Give 2 examples of topical local anaesthetics?

A

EMLA cream (eutectic mixture of LA)- usually lidocaine and prilocaine

Lidocaine spray

Benzocaine lozenges

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25
Where is a spinal anaesthetic injected?
L3/4 Below end of spinal cord Into CSF- pass needle through all dura layers
26
Where is epidural anaesthetic injected?
Into the epidural space Outside of the dura, just passes through ligaments L2-4 for lower limb surgery, but can be given higher
27
What causes the plasma concentration of an anaesthetic to drop to "wake up concentration"?
Redistribution of the drug into tissues- mainly into fat
28
The more potent the inhaled anaesthetic, the ________ the MAC.
Lower
29
Entenox is a 50:50 mix of....
``` Nitrous oxide (N2O) Oxygen ```
30
Enflurane and isoflurane both cause vaso__-
Vasodilation
31
Sevoflurane is a widely used inhaled anaesthetic and has a rapid induction due to its ____ solubility.
Low
32
_______ is an inhaled anaesthetic that has a low boiling point so must be given with a heated vaporiser. Dantrolene Sevoflurance Desflurane
Desflurane
33
How many neurons do most pain pathways have?
3 1st order- receptor to spinal cord 2nd order- spinothalamic tract to thalamus 3rd order- thalamus to cortex
34
What are the 2 main pain neurons?
a delta- nociception and mechanoreception C- nociception and mechanoreception
35
Which neurotransmitter is implicated in acute pain? Glutamate Dopamine Substance P
Glutamate
36
Which neurotransmitter is implicated in chronic pain? Glutamate Dopamine Substance P
Substance P
37
Opiods are best used as analgesia for which type of pain?
Visceral pain
38
Give 3 examples of side effects of NSAIDs.
Gastric ulcers Renal failure Bronchospasm
39
Give 3 examples of side effects of opiods.
``` Respiratory depression Nausea and vomitting Constipation Depressed cough reflex Dysphoria Tolerance and dependence ```
40
A hudson face mask is typically used to deliver what percentage of O2?
30-40%
41
With a reservoir mask (emergency non rebreath mask), oxygen flows into the bag during ________.
Expiration
42
Venturi masks are used to provide oxygen at which concentrations?
``` Blue- 24 % White -28% Yellow- 35% Red- 40% Green- 60% ```
43
How is MAP (Mean arterial pressure) calculated?
Diastolic + 1/3 (Systolic-Diastolic)
44
When the oscillations in cuff pressure are at a maximum, this represents what blood pressure?
MAP
45
When the oscillations in cuff begin increasing, this represents what blood pressure?
Systolic
46
Oxyhaemoglobin absorbs light of what colour?
Blue light (narrow wavelength)
47
Deoxyhaemoglobin absorbs light of what colour?
Red light (wider wavelength)
48
Pulse oximetry uses how many light sources? 1 2 3
2: red light and infrared light
49
What can cause a false high reading in pulse oximetry?
Carbon monoxide poisoning
50
Peak Inspiratory Flow Rate (PIFR) is usually between....
25- 30 l/ min
51
Peak Expiratory Flow Rate (PEFR) is usually between....
300-600 l/min
52
The average human has how many litres of total body water?
42 litres
53
Two thirds of total body water is stored where? Intracellularly Extracellularly
Intracellular
54
One third of total body water is stored where? Intracellularly Extracellularly
Extracellular
55
The average human has approx how many litres of intravascular fluid?
4.7 liters
56
Which ions are mainly found intracellularly?
Potassium Magnesium Phosphate Protein
57
Which ions are mainly found extracellularly?
Sodium Chloride Bicarbonate
58
Osmolality is the number of osmoles per __
kg
59
Osmolarity is the number of osmoles per __
litre
60
The normal value of plasma osmolality is ......
290mosm/kg
61
Give 2 examples of isotonic fluids which can be given IV.
0.9% saline | 5% dextrose glucose
62
Give 3 examples of crystalloid fluids.
1. 0.9% saline 2. 5% dextrose 3. Hartmann's (sodium lactate)
63
Give 3 examples of colloid fluids.
Albumin Starch Dextran Gelatin
64
Which body compartment does 0.9% saline go into?
Remains in the ECF, does NOT enter cells Has a short half life as will be excreted by the kidneys
65
Which body compartment does 5% dextrose go into?
Is distributed into cells once the glucose is metabolised
66
Which body compartment does Hartmann's (sodium lactate) go into?
Stays in the ECF | for as long as 0.9% saline does
67
Give 3 examples of problems caused by using colloids.
Pruritis Renal function affected Anaphylaxis Anti-thrombotic
68
How do hypertonic sollutions affect cells?
Cause them to shrink
69
How do hypotonic sollutions affect cells?
Cause them to swell and lyse
70
What happens to the U&Es when a person is dehydrated?
Urea increases Urea to creatinine ratio rises Sodium increases
71
A 1000ml bag of 0.9% saline causes an increase in blood volume of _____mls.
333mls
72
A 1000ml bag of 5% dextrose causes an increase in blood volume of _____mls.
100mls
73
For maintenance requirements a person needs _____mls/kg/hr of fluid.
1.5 ml/kg/hr
74
First line urgent fluid therapy should involve ________mls of 0.9% saline OR ________mls of colloid.
2000mls 0.9% saline 1000mls colloid
75
Which blood group is the most common in the UK?
O positive
76
Which blood type can be given as donation to anyone?
O negative
77
Which blood type can receive any blood group as a donation?
AB
78
What are the 3 most serious risks of blood transfusion?
1. Anaphylaxis 2. ABO incompatibility 3. Bacterial contamination
79
Should a massive transfusion be given via a central line?
No Can cause overload to the heart
80
How should platelets be stored?
22 degrees <7 days Agitated
81
How should RBCs be stored?
4 degrees | <35 days
82
Which local anaesthetic is cardiotoxic so can not be used in regional anaesthesia nerve blocks?
Bupivicaine
83
Which local anaesthetic is used for regional anaethesia commonly?
Prilocaine
84
What can be given to reverse the effects of local anaesthetic (lidocaine) overdose?
IV 20% lipid emulsion
85
Which 2 drugs are key triggers for Malignant hyperpyrexia?
1. Halothane | 2. Suxamethonium
86
Dantrolene is used to treat which rare dangerous condition that can occur following induction of anaesthesia?
Malignant hyperpyrexia
87
Name 1 or more drug used for SEDATION in anaesthesia.
1. Midazolam 2. Propofol (+morhpine) 3. Ketamine
88
Which IV anaesthetic commonly has pain on injection? Etomidate Propofol Ketamine Sodium thiopentone
Propofol
89
Which IV anaesthetic can cause adrenal suppression and post op nausea? Etomidate Propofol Ketamine Sodium thiopentone
Etomidate
90
Which IV anaesthetic can be used for Rapid Sequence Induction and in status epilepticus? Etomidate Propofol Ketamine Sodium thiopentone
Sodium thiopentone
91
How may you know if a patient has aspirated?
1. Vomiting 2. Coughing 3. Laryngospasm/ bronchospasm 4. Decreasing Oxygen sats 5. Tachypnoea 6. Wheeze or crepitations on auscultation 7. Direct visualisation on laryngoscopy
92
Name 3 or more factors that may increase the risk of aspiration.
1. Emergency surgery 2. Patient eaten or drank within close time of operation 3. Pregnancy 4. Diabetes 5. Hiatus hernia

Surg (6 decks)

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