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CP3 Crit Care > Anaesthetics - Pre-Operative Assessment > Flashcards

Anaesthetics - Pre-Operative Assessment Flashcards

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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

in which patients is inhalation induction used?

A

Used in needle phobics/difficult intubation expected

Maintains spontaneous respiration

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7
Q

In which patients is TIVA used in?

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?

A

ECG
BP
RR
SpO2

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21
Q

What is the main complication of spinal anaesthesia?

A

Hypotension

-vasoconstrictors & fluids

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22
Q

What are the contraindications to spinal anaesthesia?

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

What is epidural anaesthesia?

A

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

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24
Q

What are the features of epidural anaesthesia?

Study These Flashcards
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?
``` 6-4-2: solid food, breast feeding, 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
49
What is the purpose of cricoid pressure
reduce risk of regurgitation
50
What is malignant hyperthermia?
condition often seen following administration of anaesthetic agents
51
What are the characteristics of malignant hyperthermia?
characterised by hyperpyrexia and muscle rigidity
52
What are the causes of malignant hyperthermia?
halothane | suxamethonium
53
What is the treatment of malignant hyperthermia?
Dantrolene
54
What are the benefits of an oropharyngeal airway?
Easy to insert and use No paralysis required Ideal for very short procedures Most often used as bridge to more definitive airway
55
What are the benefits of a laryngeal mask airway?
Widely used Very easy to insert Device sits in pharynx and aligns to cover the airway Paralysis not usually required Commonly used for wide range of anaesthetic uses, especially in day surgery
56
What are the drawbacks of a laryngeal mask airway?
Poor control against reflux of gastric contents | Not suitable for high pressure ventilation (small amount of PEEP often possible)
57
What are the benefits of a tracheostomy?
Reduces the work of breathing (and dead space) May be useful in slow weaning Percutaneous tracheostomy widely used in ITU
58
What are the benefits of endotracheal tube?
Provides optimal control of the airway once cuff inflated May be used for long or short term ventilation Higher ventilation pressures can be used
59
What are the drawbacks of endotracheal tubes?
Errors in insertion may result in oesophageal intubation (therefore end tidal CO2 usually measured) Paralysis often required

CP3 Crit Care (11 decks)

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