TRAUMA from surgery can be from what? 4 examples
stress response
fluid shifts
blood loss
cardiovascular, respiratory, renal or metabolic stress
general Anaesthesia - is what in other terms?
drug induced reversible coma
what considerations are taken into place when administering ANA?
patient - co-morbidities and known pathologies
nature of surgery
post-op care
ANA techniques
ANA role pr-operatively? 5
assess identify high risk - high risk of getting those complications minimise risk consent inform and support patients decisions
pre-operative assessment inckudes what?
history
examination
investigations
history pre-operative assessment includes what info? 3
known co-morbidities
unknown co-morbidities
ability of withstand stress - exercise tolerance etc
history pre-operative assessment includes what info? 3
known co-morbidities
unknown co-morbidities
ability of withstand stress - exercise tolerance etc
potential ANA problems asssociated with what areas of body? 4
airway - issues with intubation
spine - any deformities
reflux - not fasted?
obesity - gaining access difficult
what grading systems are used to see what tests needed for patient pre-operatively? 3
ASA GRADE
SURGERY GRADE
ASA GRADING? FOR?
explain the levels
scale to see how fit healthy patient is pre-operatively
ASA1 = otherwise healthy patient ASA 2 = MILD to moderate systemic disturbance ASA3 = severe systemic disturbance ASA 4 = life threatning disease ASA 5 = moribund patient ASA 6 = ORGAN RETREIVAL
cardiac risk index includes what? 6
high risk surgery ischaemic heart disease congestive heart failure CVD diabetes renal failure
excericise tolerance - METS? why? explain levels?
indicator how well patient goes through surgery
list of which actviities patient can do without getting breathless
2mets to 9mets (healthy person)
why look at lifestyle of patient before surgery?
look at this pre-operatively too as increase risk of surgery complications
what happens in pre-operative medication provided by ANA?
most continue as normal
esp - inhalers, anti-anginals etc
might stop others that might hinder surgeyr - anti-coags.
IPS?
MDT trained for acute pain management
ANA
NURSES
etc
stages of an ANA?
INDUCTION - making patient sleep
MAINTENANCE - keeping patient asleep
EMERGENCE - process of waking up
RECOVERY - after ANA & recovery from surgery
end tidal co2 is?
measure of co2 in gas exhaled
mointoring standard in ANA when giving GA? 5
ECG NIBP - 3 leads SATURATIONS ETCO2 airway pressure
what is the effect of ANA on patient blood pressure?
vasodilation
so goes down
what access is needed prior to ANA?
need to find cannula before ANA - usually hands is where IV access is found
why does ANA reduce o2 saturation when given?
under ANA - muscles relax and lung volume decreases
why give pre-oxygenation?
to prevent reduction of gas to happen quickly - as muscles relax and lung volume decrease under ANA
affect of residual capacity under ANA?
reduced UNDER ANA
induction in patient given how and why?
gaseous - slow and in kids
IV cannula - used in fast and in adults
induction medications categories? 3
multi drugs usually used
analgesic
hynotic
muscle relaxant
analgesic drugs e/g 1
fentanyl
hypnotic drugs example ? 2
propofol
ketamine
planes of ANA describe?
not on/off = definite stages/levels of consciousness
planes of ANA - describe the 4 planes ?
1 analgyesia/ amnesia - relaxed/floaty
2 delirium to unconsciousness
3 surgical ANA ——— AIM (not move to surgical stimuli)
4 apnoea to death ——– AVOID
affect of ANA on airways? 2
loss of airway reflexes
relaxation of tissues
breathing monitored by what 3 ?
saturation probe
end tidal co2
airway pressure monitoring
3 types of breathing in ANA patient?
spontaneous venitlation - BREATHING on own
controlled ventilation - help on breathing
supported ventilation - can bretah but we help too
circulation affect under ANA?
haemodynamic instability common under ANA
changes in BP and heart rate
how circulation monitored under ANA? 2
control of haemodynamics - BP checked reguaraly
vasoactive drugs given - tighten bv to increase BP
SIGNS OF AWARENESS in ANA? 2
increase bp
sweaty
how to avoid awareness in ANA?
increase depth of AN monitoring
measure ANA in and out - tells how asleep patient is
body temp affect in ANA?
drop in temp - vasodilation
low temp consequences in ANA patient? 4
increase risk of surgical infection
increase risk of bleeding
increase pain after op
increase risk of needing transfusion
what type of injury common in ana patient?
pressure injury - from cables/equipment
VTE in ANA patients?
thromboembolism
keep them active in long surgeries - stockings/pumpers to pump blood in legs
what needs to be carefully done when placing patient in ANA?
positioning of patient
constant adjustment means in ANA?
of level of ANA given to patient throughout to keep asleep
chronic pain is classed as ?
longer than 3 months
nociceptive pain describe?
obvious tissue injury
inflammatory pain
protective function
neuropathic pain?
nervous system damage
tissue injury not as obvious
burning, shooting, numbness
painkillers classification? 2 and examples 2 each
analgesics - paracetamol, NSAIDS
opioids - morphine, codeine
tramadol ?
mixed opiate
tramadol ?
mixed opiate - pankiller - analgyesic
amitriptyline?
TCA
painkiller
increases descedning inhibitory signals - to reduce pain
examples of anti-convulsant drugs? 2
carbamazepine
sodium valproate
pain ladder used in where?
in acute pain NOT NEUROPATHIC PAIN
can use for nociceptive pain
PAIN LADDER EXPLAIN EACH STAGE
MILD/MODERATE PAIN = non-opioids - aspirins, NSAIDS, paracetemol
MODERATE/SEVER PAIN = mild opioids, codeine, eith/without non-opioids(nsaids)
SEVERE PAIN = strong opioids - morphine, with/without non-opioids(nsaids)
2 types of resp failure?
type 1 = oxygenation failure
type 2 = oxygenation & ventilation failure
CVS failure due to shock??
shock leads to inability to get o2 into bloodstream - leading to cellular hypoxia
fluid either cooloids or crystalloids mean?
colloids - fluid that has large active particles in it
crystalloids - fluid with small molecules in them
septic means?
unresposiveness to fluid intake
regional ANA?
prodcues insensbility in are/region of body
ANA produced distal site served by that nerve
general ana means?
insensibilty in whole body
local ana means?
produces insensibility in only the relevant part of body
ANA prodcued at site of injection
triad of ana?
analgesia
hypnosis
relaxation
opiates give what of triad of ANA?
analgesia
and hypnosis
local anaesthetics give what of triad of ANA?
analgesia
relaxation
no hypnosis
general ANA agents do what in the body?
supress neuron activity
and interfere with neuronal ion channels
by opening channels with alter neuron - hyperpolarise them
general ANA spare what function in the body?
reflexes - spinal/ autonomic
IV ANA - onset and recovery explained?
e/g
onset - rapid
rapid recivery
thiopentone/ propofol
IV ANA drugs are what type?
highly fat soluble drugs - high % in fat
inhaled ANA are what type of drugs ?
and their benefit?
halogenated hydrocarbons via lungs
minimum alveolar conc - produce affect with any agent
and low number also gives high potency - still gives same effect
maintenence of ANA in inhaled?
prologned duration - extends the time
GA common sequence?
general ANA is IV induction then inhaled maintenance
ana affect on sympathetic nerve actviity?
reduce it
muscle relaxants must be gIven with what? AND WHY
MUST BE GIVEN WITH HYPNOSIS DRUG
as not nice being awake and cant communicate as muscles relaxed
indication to use muscle relaxant? 2
ventilation/intubation
when need patient to be still
e/g of local ANA?
lignocaine
bupivacaine
ropivacaine
infusion technology for?
to find out right dose needed
TCI - target controlled infusion system
to achieve specific conc. of agents using pharmokinetics algorithms
