Anaesthetics/Pre-Op Flashcards
(29 cards)
What are the positional manoeuvres which can be used to open airway?
- Head tilt/chin lift
- Jaw thrust (used when any concern of C spine injury)
What is the different airway adjuncts?
- Nasopharyngeal airway (good for seizures but cannot be used if basal skull fracture suspicion)
- Oropharyngeal airway (Guedel)
- Laryngeal airway (iGel)
- Endotracheal tube
What error can happen with Endotracheal tube insertion and what should be monitored to check this?
Oesophageal intubation - monitor end-tidal CO2 (capnography)
What are 2 types of inhaled anaesthetics?
- Volatile liquids e.g. isoflurane
- Nitrous oxide
What are the side effects of inhaled anaesthetics?
- Fluranes -> Malignant hyperthermia
- NO -> Avoid in pneumothorax as can cause increase in pressure in air compartments
What are the different IV anaesthetic options?
Propofol - commonly used - has anti-emetic properties so useful for high risk N+V patients
Thiopental - can cause laryngospasm but acts quickly on the brain as is fat-soluble
Ketamine - useful in trauma as does not cause drops in BP
What are the different local anaesthetic options?
Lidocaine
- Works by blocking sodium channels
- Can be toxic (treated with IV 20% lipid emulsion)
Other options include
- Bupivacaine
- Prilocaine
- Cocaine
What is malignant hyperthermia?
- Autosomal dominant
- Hyperpyrexia and muscle rigidity following anaesthetic agents, commonly suxamethonium
- Caused by excessive release of Ca2+ from skeletal muscle
- Bloods show raised CK
- Manage with Dantrolene
What are the types of muscle relaxants?
Suxamethonium
- Depolarising neuromuscular blocker
- Fastest onset and shortest duration
Others include
- Atracurium
- Vecuronium
What are causes of post-op pyrexia?
Early
- Blood transfusion
- Cellulitis
- UTI
Late
- VTE
- Pneumonia
- Wound infection
What is postoperative ileus?
- A common complication of bowel surgery
- Reduced bowel peristalsis resulting in pseudo obstruction
- Presents like obstruction
- Check potassium, magnesium and phosphate as can be caused by deranged electrolytes
- Managed conservatively with fluids, NG feeding
What are the rules regarding food and drink with surgery?
- Clear fluids until 2 hours before
- Food stopped 6 hours before
What complications are diabetic patients at higher risk of?
- Wound and resp infections
- Post-operative AKI
- Length of hospital stay
How can patients on metformin be managed?
- If taken 1 or 2 times a day, continue as normal
- If taken 3 times a day, omit lunchtime dose if prolonged surgery
How can patients on gliclazide be managed?
Omit doses on day of surgery BEFORE/DURING the operation (i.e. for morning surgery, if taken twice a day, just omit morning dose but if afternoon surgery, omit both morning and afternoon)
How should patients on DPP/GLP be managed?
Take as normal
How should patients on SGLT-2 inhibitors be managed?
Omit on day of surgery
How should patients on insulin be managed?
Once daily regime: reduce dose by 20%
Twice daily regime: half morning dose, do not change evening dose
Basal-bolus: Omit morning and lunchtime short acting insulins, reduce long acting by 20%
What is the surgical safety checklist?
- Before induction
- Before incision
- Before patient leaves the room
What needs to be on and functioning before anaesthesia?
Pulse oximeter is on and functioning
When should COCP/HRT be stopped before surgery?
4 weeks
What is cricoid pressure used for?
Prevent gastric contents entering the pharynx
Dropping sats following intubation?
Think oesophageal intubation
How should TPN be administered?
Central line
