Conduct of GA and LA

Question 1

Example of 2 drugs used for IV induction

Answer 1

Propofol

Thiopentone

Question 2

Roughly how long does one ‘arm-brain’ circuit take

Answer 2

20 seconds

Rapid loss of airway reflexes

Question 3

Disadvantages of IV induction

Answer 3

Easy to overdose - slower circulation in older patients

Apnoea very common

Question 4

Example of drug used for gas induction

Answer 4

Sevoflurane (Halothane)

Question 5

Gas induction is most commonly used in which groups of patients?

Answer 5

Children

Adults with special needs

Question 6

Rate of gas induction

Answer 6

Slow

Question 7

Describe the planes/stages of anaesthesia

Answer 7

1- Analgesia/Sedation
2- Excitation/delirium
3- Anaesthesia Light to Deep
4- Overdose/Respiratory arrest

Question 8

On which plane does surgery take place?

Answer 8

3- surgical anaesthesia

Question 9

What signs/features are monitored when administering anaesthetic?

Answer 9

Loss of verbal contact
Movement
Respiratory pattern
Processed EEG
Stages/Planes

Question 10

Specifically monitored during induction?

Answer 10

 Quietness
 Gas/IV
 Monitor conscious level
 Airway maintenance

Question 11

What happens to the airway in supine unconscious patients?

Answer 11

Obstructed

Loss of muscle tone- tongue will rest on pharyngeal wall

Question 12

What is used to manage airway?

Answer 12

Simple manoeuvres
Triple Airway manoeuvre
Apparatus

Question 13

Apparatus used for oropharyngeal airway?

Answer 13

Guedel

Question 14

What occurs if guedel inserted in ‘light’ patient?

Answer 14

Vomiting or laryngospasm

Question 15

Examples of supraglottic airway devices

Answer 15

Laryngeal mask

Igel - developed after

Question 16

Benefit of Igel

Answer 16

Easy insertion

Question 17

Disadvantage of Igel

Answer 17

Doesn’t protect from aspiration

Question 18

Complications during induction

Answer 18

Obstruction

Aspiration

Question 19

Why might obstruction occur during induction?

Answer 19

Ineffective triple manoeuvre
Airway device malposition or kinking
Laryngospasm - airway stimulated in light patients

Question 20

In which group of patients is obstruction a more common complication?

Answer 20

Children - smaller airways

Question 21

What substances are commonly aspirated under GA?

Answer 21

Gastric contents
Blood
Surgical debris

Question 22

Indications to intubate

Answer 22

 Need muscle relaxation therefore artificial ventilation eg laparotomy
 Shared airway with risk of blood contamination eg tonsillectomy
 Tight control of blood gases – CO2 levels in neurosurgery
 Restricted access eg maxfax surgery

Question 23

What risks are known in the unconscious patient?

Answer 23

Airway
Temperature
Loss of protective reflexes - corneal, joint position
VTE
Pressure Areas
Consent and Identification

Question 24

Basic monitoring during maintenance

Answer 24

SpO2
ECG
Non-invasive Blood Pressure
FiO2
ET CO3

Question 25

Other features to monitor during maintenance

Answer 25

``` Respiratory parameters Agent Temperature, Urine output, NMJ Invasive venous/ Arterial monitoring Processed EEG Ventilator disconnection ```

Question 26

Complications - Maintenance

Answer 26

ABC Techniques, positions Dreaming Awareness

Question 27

Risk factors for complications

Answer 27

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

Question 28

Conduct of LA | Safety compared to GA?

Answer 28

Morbidity and mortality the same

Question 29

Key requirements during LA

Answer 29

IV access Anaesthetist present Monitoring

Question 30

Examples of LA procedures

Answer 30

Spinal Epidural Nerve block Plexus block

Question 31

Where would patient undergo recovery if complications after anaesthetic?

Answer 31

Post Anaesthesia Care Unit

Question 32

Indications for Post Anaesthesia Care Unit admission

Answer 32

o Patient not regained consciousness or airway control o Continuing responsibility of anaesthetist o ABC Problems o Pain control o Post op nausea and vomiting o Set criteria for discharge back to ward