Complications in Anaesthesia Flashcards

1
Q

List of minor complications in anaesthesia?

A
  1. Airway injuries
  2. Eye injuries: corneal ulceration if eyes not taped closed
  3. Positional injuries: nerve damage over bony prominences
  4. Regional anaesthesia complications: epidural abscess, meningitis, epidural haematomoa, nerve injuries, post-spinal headache
  5. Central venous cannulation complications
  6. PONV
  7. Awareness
  8. Mild Hypothermia
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2
Q

What are the complications of central venous cannulation?

A

Early:
Technical: pnuemothorax, haemothorax, nerve damage
Dysrhythmias from guide wire
Air embolism

Late:
Infection: sepsis or endocarditis
Thrombosis
Tamponade

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3
Q

What factors need to be considered for PONV?

A
  1. Patient factors: children, females, non-smoker, hx motion sickness, previous PONV, obesity
  2. Anaesthetic factors: prolonged pre-op starvation, hypotension (epidurals, spinals), emetic drugs (opiates, etomidate, ketamine, N20, volatiles)
  3. Surgical factors: eye and ear surgery, intra-abdominal surgery
  4. Post-op factors: pain, opiates, hypotension, forcing oral fluids too soon post-op
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4
Q

Prevention of PONV?

A

Avoid emetic drugs
Regional anaesthesia is an option
TIVA with propofol (intrinsic anti-emetic properties)
Administration of anti-emetic drugs in theatre for high risk PONV patients
Keep patient well hydrated with IV fluids

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5
Q

Anti-emetic drug examples?

A

Droperidol
Prochlorperazine
Ondansetron
Dexamethasone/betamethasone

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6
Q

List the major/life-threatening complications in anesthesia?

A
  1. Endotrachial intubation failure
  2. Aspiration
  3. Respiratory complications (laryngospasms, bronchospasm, obstruction, post-op respiratory depression, pneumothorax)
  4. Cardiovascular complications (hypotension, hypertension, dysrhythmias, cardiac arrest, MI)
  5. Equipment failure
  6. Anaphylaxis
  7. Pharmacogenetic diseases (malignant hyperthermia, halothane hepatitis, scoline apnoea, porphyria)
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7
Q

Clinical presentation of anaphylaxis?

A

Triad of skin reactions, respiratory and cardiac effects
Skin = wheal and flare, urticaria
Resp = angio-oedema, bronchospasm, hypoxia
CVS = hypotension, tachycardia, cardiovascular collapse

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8
Q

What drugs are most likely to cause anaphylaxis in anaesthesia?

A

Antibiotics

Muscle relaxants

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9
Q

Definition of malignant hyperthermia?

A

A rare inherited syndrome
Characterised by life-threatening acute hypermetabolic state
Triggered by exposure to a triggering agent

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10
Q

What are the triggering agents for malignant hyperthermia in anaesthesia?

A

All volatile vapours

Suxamethonium

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11
Q

Pathophysiology of MH?

A

Caused by a defect in a receptor in the sarcoplasmic reticulum
Ryanodine receptor - a calcium channel receptor
Oce the receptor is exposed to the trigger agent, the receptor stays open and floods the cell with calcium
Resultant persistant contractile state
Hyperthermia >38, is a late stage of MH

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12
Q

Clinical features of MH?

A
Tachycardia
Tachypnoea (if breathing spontaneously)
Increased O2 consumption
Eventually cyanosis
Hypercapnia
Masseter muscle spasm
Whole body skeletal muscle rigidity
Dysrhymias
Cardiovascular collapse
Metabolic and respiratory acidosis
Hyperkalaemia
Hyperthermia
Myoglobinuria
Untreated, will progress to ARF, heptic failure, coagulopathy, cerebral oedema and death
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13
Q

Management protocol for MH?

A

Discontinue triggering agent
Call for help
Hyperventilate with 100% 02 at high flows
Mix DANTROLENE SODIUM with sterile water, administer 2,5 mg/kg IV ASAP
Institute cooling measures
Treat associated complications (i.e. dysrhythmia)
Administer additional dantrolene doses as needed
Transfer to ICU

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14
Q

MH-safe anaesthesia?

A

Avoid GA if possible and use regional technique

If GA needed:
Patient should be first on the list
Use machine with no vapourisers on it
Machine should be flushed with high flow O2 for 20 minutes prior to use
Propofol TIVA technique
Non-deopolarising muscle relaxants
Know location of dantrolene
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15
Q

Risk factors for Halothane hepatits?

A
Repeat exposure to halothane within 6 months
Middle age
Females
Obesity
Existing hepatic disease
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16
Q

Porphyria in anaesthesia?

A

Family history must be ascertained
Variegate form common in SA (Dutch/Afrikaner descent)
Thiopentone implicated (barbiturate)
Acute attack resulting in paralysis, abdominal pain and even death

17
Q

Examples of nerve damage by positional injuries?

A

Radial nerve
ulnar nerve
brachial plexus from overextending arm
lateral popliteal nerve in lithotomy position
femoral nerve in extended lithotomy position