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CP3 @ UoN - Critical Illness > Anaesthetics - Pre-Operative Assessment > Flashcards

Anaesthetics - Pre-Operative Assessment Flashcards

(48 cards)

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1
Q

What is general anaesthesia?

A

A state of total unconsciousness resulting from the use of centrally acting anaesthetic drugs

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2
Q

What are the three main types of GA?

A

IV induction w/ gas maintenance
Inhalation induction w/ gas maintenance
Total IV anaesthesia

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3
Q

Describe IV induction w/ gas maintenance

A

Pre-oxygenation/airway management
IV induction
Volatile gas maintenance

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4
Q

What are the most common IV induction agents?

A

Propofol

Thiopental

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5
Q

What are the most common volatile gas agents?

A

Sevoflurane

Isoflurane

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6
Q

Describe inhalation induction

A

Used in needle phobics/difficult intubation expected

Maintains spontaneous respiration

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7
Q

Describe Total IV anaesthesia (TIVA)

A

Used in pts w/ PMH/FH of malignant hyperthermia

-volatile agents contraindicated

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8
Q

What are the advantages of TIVA?

A

Reduced post-op N/V
Predictability in bariatric pts
More control over depth of anaesthesia

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9
Q

What is rapid sequence induction (RSI)?

A

Delivery of rapidly acting muscle relaxant immediately after induction agent
-w/o waiting to see if resp can be assisted

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10
Q

What is the main risk of RSI?

A

Unable to intubate/ventilate unconscious pt

-difficult airway equipment should always be available

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11
Q

What is the purpose of RSI?

A

To rapidly produce optimum conditions for intubation in emergency situation

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12
Q

What is the triad of GA?

A

Narcosis (pt rendered unconscious)
Analgesia (lack of pain/suppression of phys reflexes)
Relaxation (reduction/absence of muscle tone)

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13
Q

What is the MoA of local anaesthetic?

A

Blockage of conduction of nerve impulses along nerve axons w/ lignocaine +/- adren
-adren causes vasoconstriction inc potency/duration of anaesthesia

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14
Q

How can local anaesthetic be used?

A

Topically
Local infiltration
Regional anaesthesia
Spinal anaesthesia/epidural

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15
Q

What is regional anaesthesia?

A

Local anaesthetic injected directly into minor/major nerves OR epidural space/CSF

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16
Q

What is the maximum safe dose of lignocaine?

A

3mg/kg

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17
Q

What is spinal anaesthesia?

A

Local anaesthetic solutions introduced via needle directly into CSF

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18
Q

What are the features of spinal anaesthesia?

A 
Onset = Fast
Duration = 1-4hrs
Block = Complete block in affected area (T10-toes)
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19
Q

What is complete sensory block?

A

Loss of pain
Temperature
Positional sense

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20
Q

How should a pt be monitored when receiving spinal anaesthesia?

21
Q

What is the main complication of spinal anaesthesia?

Study These Flashcards
A

Hypotension

-vasoconstrictors & fluids

22
Q

What are the contraindications to spinal anaesthesia?

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A 
Raised ICP
Hypovolaemia
Surgery above thorax
Local/systemic infection
Procedures >2hrs duration
23
Q

What is epidural anaesthesia?

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A

Epidural catheter inserted into epidural space & local anaesthetic +/- analgesic delivered continuously via pump

24
Q

What are the features of epidural anaesthesia?

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A

Onset = 45mins
Duration = Longer, often combined w/ GA/spinal
Used as on demand pain relief

25
How should a patient be monitored when receiving epidural anaesthesia?
ECG BP RR SpO2
26
What are the potential complications of epidural anaesthesia?
``` Hypotension Resp depression CSF/dural puncture -headache -total spinal paralysis ```
27
What are the general benefits of regional anaesthesia?
Less risk of - chest infections - cardiovascular complications - PONV - post-op pain - DVT
28
What are the effects of GA on the cardiovascular system?
Decreased myocardial contractility -decreased CO -hypotension Arrhythmias
29
What are the effects of GA on the resp system?
Resp depression Decreased ventilator response to hypoxia/hypercapnia Laryngospasm
30
What are the effects of spinal anaesthesia on the cardiovascular system?
Blockage of sympathetic nerves -vasodilation -bradycardia Perioperative myocardial ischaemia/infarct
31
What are the effects of spinal anaesthesia on the respiratory system?
Resp depression | -if opiates used
32
What pre-op cardiovascular assessment should take place?
ECG +/- echo
33
What pre-op respiratory assessment should take place?
CXR ABG Pulmonary function
34
What are the common/major risks associated w/ GA?
``` PONV Anaphylaxis Awareness under GA Aspiration (use RSI if pt not starved) Cardio-respiratory issues ```
35
What are the common/major risks associated w/ spinal anaesthesia?
``` Neurological disorder (due to trauma) High spinal block (depression of brainstem) Urinary retention/bladder damage Cardio-resp issues Spinal headaches PONV ```
36
Describe the ASA classification
ASA 1 = normal healthy pt ASA 2 = pt w/ mild systemic disease ASA 3 = pt w/ severe systemic disease, restricting activity but not incapacitating ASA 4 = pt w/ severe systemic disease representing constant threat to life ASA 5 = moribund pt not expected to survive 24hrs w/o op ASA 6 = brain-dead pt, organs being harvested
37
How can operative urgency be classified?
Immediate Urgent Expedited Elective
38
Describe immediate operative urgency
To save life/limb/organ - resus & surgery simultaneous - pt in theatres w/i minutes
39
Describe urgent operative urgency
Acute onset/deterioration of condition threatening life/limb/organ - surgery when resus complete - w/i 6/24hrs
40
Describe expedited operative urgency
Stable pt requiring early intervention | -w/i days of decision to operate
41
Describe elective operative urgency
Surgery planned/booked in advance of admission
42
What investigations may be appropriate in pre-op assessment?
``` FBC, U&Es, LFTs, BM, clotting ECG, ECHO CXR Resp function tests C-spine XR ```
43
What is the purpose of pre-op starvation?
Minimise volume of gastric contents | -lowers risk of regurgitation & aspiration
44
What are the pre-op starvation times for food/clear fluids?
``` Solid food (inc milk) = 6hrs Breast fed infants = 4hrs Formula fed infants = 2hrs Clear fluids (inc black tea/coffee) = 2hrs ```
45
What are the risks of increased pre-op starvation?
Dehydration PONV Anxiety Discomfort
46
What are the principles of pre-op management of DM?
``` Minimise pre-op fasting times Comprehensive pre-op assessment Omit medication on day of surgery -if well controlled Sliding scale insulin infusion -if poorly controlled ```
47
What are the principles of peri-op management of DM?
Consider RSI (DM pts prone to aspiration) Regular BM monitoring -if >10mmol/L consider insulin/glucose
48
What are the principles of post-op management of DM?
Regular monitoring of BM & vital signs

CP3 @ UoN - Critical Illness (8 decks)

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