General Surgery Flashcards
Pre-medication implications
-drowsy, impaired coordination, impaired memory and learning
General anaesthesia
Adverse effects
Impaired ventilation
- respiratory inhibition
- Reduced FRC
- Atelectasis
- V/Q mismatch –> hypoxaemia
Impaired airways clearance
- loss of cough reflex
- Drying of cilia–> impaired mucociliary function
- secretion retention
GA
-greater respiratory effects to MV, intubation and loss of cough
Epidural anaesthesia
-Blocks sensation but muscle power intact
Imps
-reduced risk of respiratory comp as intubation and mech vent not reqd
Spinal anaesthesia
- Catheter placed into subarachnoid space
- Blocks sensory, motor, pain input
Imps
- reduced risk of resp comps as intubation and mech vent not reqd
- dura is punctured, may get headache due to CFS
Nerve Block
-injection of local close to nerve
Imps
-may have residual analgesia and loss of sensation and motor function in the innervated area
PCA
- IV delivered
- Usually narcotic medications are used
Adverse effects narcotics
- Respiratory depression
- Postural hypotension
- Drowsiness
- Nausea, vomiting
- Paralytic ileus
- Pruritis/itchiness
- Urinary retention
Imps
- Encourage patient to bolus before treatment
- Monitor RR and SpO2 to ensure breathing is not depressed
- nausea, follow Post-op protocol and take vomit bag
- monitor responsiveness- notify staff med may need to be reviewed
Epidural Analgesia
Side effects
- hypotension
- sedation
- Resp depression
- Motor and Sensory loss of upper and LL limbs
- Bowel and bladder disturbances (urinary retention)
- Infection, haemorrhage, inflammation, displacement of catheter
- Epidural haematoma
Imps
-Bolus prior to treatment
-pain over epidural, sensorimotor changes in limb and bladder signs of epidural haematoma or infection
-check epidural: leaking, redness, swelling, hepatoma, muscle strength in LL prior to mob
Full epidural assessment
NSAIDS
-reduce inflame and limit mild to moderate levels pain
Adverse
- bronchospasm
- peptic ulcer
- renal impairment
- reduced platelet
Opioids
mod to severe
- same IV narcotics
- IV, orally, IM
Simple analgesic
mild levels reduce body temp
Nitrous oxide
short period relief
- inhaled via mask
- removal painful dressings, physio treatment
Oesophagectomy
- removal of part or all, stomach pulled up and reanatomosed to end
- Ivor Lewis: upper ab to mob stomach and R) post-lat thoracotomy for resection of lesion and construction of anastomosis
- thorascopic-assisted: one ab incision & 4 or 5 ports
Imps
- avoid head down due to gastric reflux may lead to aspiration or infection
- care with suction
- neck motion limited to limit stress on anastomosis
- post-op ICC
Gastric/ Duodenal surgery
- Pyloroplasty
- Nissen Fundoplication
- Gastrectomy
gastic or duodenal ulcers or gastric carcinoma
A) pyloric muscle divided and defect is sutured transversely leaving a large gastric outlet
B) anti reflux, fundus mob and loosely wrapped around lower oesophagus. Prevents acid reflux and heals oesophagitis
C) removal of all or part of stomach, closure of duodenum and anastomosis of oesophagus to jejunum
Cholecystectomy
- removal of gall bladder
- Open via Koshers incision or R) paramedian incision