Conduct of Anaesthesia

Question 1

Stages of anaesthesia

Answer 1

Preparation 
Induction 
Maintenance
Emergence
Recovery

Question 2

Roles of an anaesthetist

Answer 2

Pre-op assessment care
Critical care / intensive care
Pain management
Anaesthesia 
Post op care

Question 3

What does the preparation stage of anaesthesia involve?

Answer 3

Planning
Right patient, right operation 
Right or left side 
Pre medication 
Right equipment, right personnel 
Drugs drawn up 
IV access 
Monitoring

Question 4

What does the induction stage of anaesthesia involve?

Answer 4

Quietness
Gas or IV agent
Careful monitoring of conscious level
Airway maintenance

Question 5

Drugs used for IV induction

Answer 5

PROPOFOL
Thiopentone
Others

Question 6

Features of IV drug induction

Answer 6

Rapid - one arm brain circulation - approx. 20 secs 
Obvious planes 
Easy to overdose 
Generally rapid loss of airway reflexes 
Apnoea is common

Question 7

Drugs used in gas induction

Answer 7

Sevoflurane (halothane)

Question 8

Features of gas induction

Answer 8

Common in younger children
Slow
Considerably more obvious “planes” of anaesthesia

Question 9

How to monitor conscious level

Answer 9

Loss of verbal contact 
Movement
Resp pattern 
Processed ECG
stages and planes of anaesthesia

Question 10

When is airway maintenance always required?

Answer 10

In general anaesthesia

Question 11

What is the “triple airway manoeuvre”?

Answer 11

Head tilt
Chin lift
Jaw thrust

Question 12

Simple apparatus used in airway maintenance

Answer 12

Face mask 
Oropharyngeal ("Guedel") airway 
- unconscious patient 
Nasopharyngeal airway 
Laryngeal mask airway

Question 13

Features of a laryngeal mask airway

Answer 13

Cuffed tube with mask that sits over glottis

maintains, but does not protect the airway

Question 14

What is used for resuscitation?

Answer 14

I-gel

2nd generation LMA

Question 15

What does I-gel used in resuscitation NOT protect you from?

Answer 15

Aspiration

Question 16

Airway complications

Answer 16

Obstruction

Aspiration

Question 17

What causes obstruction of the airway in anaesthesia?

Answer 17

Ineffective triple airway manoeuvre
Airway device malposition or kinking
Laryngospasm = laryngeal spasm

Question 18

Features of laryngospasm

Answer 18

Forced reflex adduction of vocal cords
May result in complete airway obstruction
Caused by airway (or other) stimulation in light planes of anaesthesia
Often unrelieved by simple manoeuvres

Question 19

When is the airway maintained?

Answer 19

When it is open and not obstructed

Question 20

Why intubate?

Answer 20

Protect the airway from gastric contents
Need for muscle relaxation -> artificial ventilation
Shared airway with risk of blood contamination
Need for tight control of blood gases
Restricted access to airway

Question 21

What route is most commonly used for endotracheal intubation?

Answer 21

Oral route

Question 22

What must be abolished in endotracheal intubation?

Answer 22

Laryngeal reflexes

Question 23

Risks faced by the unconscious patient before the surgery even begins

Answer 23

AIRWAY
temperature
loss of protective reflexes e.g. corneal, joint position 
Venous thromboembolism risk 
Consent and identification 
Pressure areas

Question 24

What is the best monitor?

Answer 24

The anaesthetic

Question 25

How is monitoring done?

Answer 25

``` Basic "minimum" monitoring - SpO2, ECG, NIBP, FiO2, ETCO2 Respiratory parameters Agent monitoring Temperature, urine output, NMJ Invasive venous / arterial monitoring Processes ECG VENTILATOR DISCONNECT anaesthetic best monitor ```

Question 26

Anaesthetic complications

Answer 26

``` Airway Breathing Circulation Related to techniques or position Awareness ```

Question 27

Risk factors of anaesthesia awareness

Answer 27

``` Paralysed and ventilated Previous episode of awareness Chronic CNS depressant use Cardiac surgery Major trauma GA C/section ```

Question 28

What happens during emergence/awakening?

Answer 28

``` Muscle relaxation reversed Anaesthetic agents off Resumption of spontaneous resection Return of airway reflexes/control Extubation Can be very quick or very very slow ```

Question 29

Issues surrounding recovery

Answer 29

Problems with A, B and C Pain control Post op nausea and vomiting