How long to fast for?
6hours
clear fluids
crico pressure for what?
may occlude oesphagus
why paralyze and muscle relaxants?
ease of intubation
for delicate procedures like neurosurg
Aiway assessment?
Dentition: crowding Open mouth: 3 cm needed Mandibular protrusion Mallenpatti thyromental junction
desirables in Anaesthesia
asleep amnesia analgesia wakeful (day of surgery, neurosurg) anxiolysis muscle relaxation less PONV airway aspiration risk temperature mx
advantage of plexus and nerve blocks to general?
post-operative analgesia
to kinds of neuraxial blocks?
spinal
epidural
where does a spinal block go?
sub-arachnoid space
epidural get good coverage?
Nope: about 3-4 above and below
how much fluid needed for spinal block?
only 2-3 mls because it circulates in the CSF
how much fluid needed for epidural block?
10-15ml to get appropriate spread
why epidural for labour?
duration is longer due to infusion
post-op analgesia
what kind of block for caeserian section?
spinal usually
3 things to achieve General Anaesthesia?
hypnosis
analgesia
muscle relaxation
2 kinds of general anaesthesia?
- spontaneous ventilation
2. muscle relaxation (absolute - including diaphragm)
what kind of airway device for spontaneously ventilation?
laryngeal mask
what kind of airway device for muscle relaxant GA?
intubation
why a cuff for the intubation?
prevent aspiration
who is at risk for aspiration in anaesthesia?
non-fasting
trauma/emerg
GORD
preg for >20 weeks to >6weeks post partum
why preg increase GORD?
increased intrabdominal pressure
progesterone relaxes esophageal sphincter
3 phases of anaesthesia:
Induction
maintenance
reversal/emergence
drugs for induction?
propofol
benzos: midazolan
fentanyl
drugs for maintenance?
sevofluorane
morphine for analgesia
fentanyl for what in induction?
ablate the sympathetic response for intubation process
sevoflurane, isofluorane, desfluorane is what?
inhaled gas
green dream/green whistle is what analgesia?
penthane
who gets propofol infusion for maintenance?
PONV strong history
neurosurg
TIVA is what?
total intravenous analgesia
paralyzing agents?
Rocuronium
veccuronium
atracurium
suxamathonium
Non depolarizing muscle relaxants work how? how long do they work for?
competitive antagonist to the muscle side receptor
works for 3-45 mins
what to use to reverse muscle paralysis?
acetyl choline esterase inhibitor
neostigmine
neostigmine side effects?
bradycardia
antimuscarinic for reversal?
glycopyrorate
how to prevent bradycardia in reversal after neostigmine admin?
give antimuscarinic
suxamethasone lasts how long?
1-3 minutes
rapid sequence induction (RSI)
ketamine is what? when used? where used?
dissociative drug
preserves some airway reflexes
used in developing countries, low resource settings