Operations Flashcards

Question

BCIS

Answer 1

Pathophys: Embolisationa dn inflammatory reaction Grades: 94%/SBP 20%, 88%/40%, CVS collapse Risk: age, male, Cardioresp disease, diuretics Prevent - Surgeon: only use cement prn, comminicate, retrograde cement, avoid vigorous pressurisaiton - anaest: presuscitation, communicated, art line/vigilance, vasopressors/fluid

Answer 2

Medications: Hypnotic, paralytic, pressor, ACLS OT/other destination: aware/ready Patient: A-E, tubes/lines, monitoring Equipment: A/B, O2, Fluid Debrief: expected issues, patient handling

Answer 3

Helium escape: cold, hypoxia Magnetic Field: - FB: heating/movement/malfunction - Induced current: VF/limb movement Remote anaesthesia Contrast Hearing loss ECG/SpO2/ETCO2/Temp Monitoring artefacts Staff safety- pregnancy -hyperthermia

Answer 4

Airway management difficult VQ mismatch BP cuff placement upper arm best Radial nerve on superior arm CPN/saphenous nerve Axillary roll- avoid brachial plexus compression Ear folding Eye compression

Answer 5

<100 mL/ 8 hours output Minimal swing No air leak CXR- full expansion Consider 6 hour clamp then CXR prior to removal if high risk- IPPV, Hx of air leak

Answer 6

Post pneumoniectomy Pulmonary oedema Cardiac herniation Pulmonary Torsion Persistent Air Leak Arrhythmia Bleeding/Nerve Damage/PTx

Answer 7

Dissection: Bleeding/CVP, ascites drainage, prepare for clamp Anhepatic: Low VR- vasopressors, hypoglycaemia, acidosis, coagulopathy. Steroid just prior to reperfusion Reperfusion: K, acid, CO/SVR suppression, pHTN

Answer 8

1- MRI and stereotactic frame- Scalp block/sedation 2. Burr hole electrodes- sedation/responsive 3. Connect electrodes to wires, tunnel to IPG GA LMA

Answer 9

Indications: tumour, vascular, cyst, CN lesion, Craniocervical abnormality Sitting CIs: cerebral ischaemia upright, ventriculoatrial shunt, R to L shunt, PFO Issues: CVS instability (pooling), VAE, Pneumocephalus, Macroglossia, Quadriplegia, CPR/airway access Complications: obstructive hydrocephalus, CSF leak, CN dysfunction, Posterior fossa syndrome

Answer 10

Airway- access, oedema, bite, C spine B- compression C- Arterial and venous compression, prone CPR D- ICP/IOP E- Abdominal organ compression, other soft tissue compression Monitoring- risk of loss Turning staff/patient risk

Answer 11

Thrombolysis <4.5 h, EVT <6..<24 SBP 140 - 180 SpO2 ≥92 PCO2 normal T 35 - 37 BSL 4 - 8

Answer 12

Goals - Facilitate proximal control of rupture - Minimise cerebral ischaemia - Minimise ICP (if closed dura) - Prevent hypovolaemic shock Mx- in discussion with surgeon - FiO2 1.0 - Induced hypotension for surgical exposure/control (PPF/Thio 5 -10 mg/kg/Adenosine) then hypertension once proximal clip on (20% + baseline) - 3% saline if closed dura - MTP activation/fluid bolus

Answer 13

- Call surgeons/theatre hold, EVD ready, SMO care - FiO2 1.0, hyperventilate - ?protamine - 3NS - Euglycaemia/normothermia/control seizures -BP at baseline, increase to maintain CPP once bleed controlled - Decrease CMRO2- PPF/Thio - G+ H

Answer 14

Altitude - Low PbO2 --> hypoxaemia - Expansion of air filled spaces- Cuff, PTx, pneuoceph, BO - Worsening DCS/air embolism - Heat/humidity extremes Plane/Helo - Remote +++ - Vibration/turbulence - Noise - Radiation - Lighting/space Patient - Motion sickness - Agitation- danger to self/staff

Answer 15

Patient - Nature/severity of injury - Urgency - Size/weight Hospital receiving - Location - Distance - Intervening geography - Aircraft landing facilities - Staff and equipment able to deal with situation Logistics - Availability of methods- vehicles, staff -Weather - Cost

Answer 16

- Category - Quality of care - Staffing - Training - Responsibility - Communication - Organisational- training/insurance/PPE -QS- audit, peer review, risk management

Answer 17

Peri - Procedural General - Haemorrhage ○ Surgical wound ○ Anterior jugular vein ○ Thyroid ○ Inverior thyroid artery/vein - SC emphysema ○ ?PTx ○ ?pneumomediastinum- through and through ○ Usually just a brief leak of airway gas occuring during the procedure either from coughing or PPV - Loss of airway/depressurisation ○ Airway failure § Inadvertent extubation/decannulation § Loss of airway ○ Depressurisation § Derecruit/oedena/hypoxia/die ○ Aspiration/Bronchospasm - Neurovascular structure injury ○ Vagus, RLN, carotids - Thyroid injury Percutaneous only - Loss, kinking, fracture, or knotting of guidewire - False passage - Lateral stomal placement- ulceration/tracheomalacia/tracheal stenosis risk - Tracheal ring fracture --> tracheomalcia - Cricoid fracture - Posterior tracheal wall injury - Oesophageal injury - Conversion to open Surgical tracheostomy - Airway fire Early - Poor secretion Mx ○ Can be life threatening ○ Swap out inner cannula ○ Good humidification key - Dislodgement of previously well placed tube ○ Obesity- main risk factor, poor tube selection - Infection, tracheitis, mediastinitis, sternal wound infection - Dysphagia - Tracheal ulceration - Bleeding ○ Periop site infeciton ○ Granulation tissue ○ Erosion of tracheal wall ○ Erosion of paratracheal vessels ○ Tracheoinnominate fisutla Later - Tracheal stenosis - Tracheomalacia - Tracheosophageal fisutla - Persistent stoma - Sternoclavicular OM - Pneumonia - Aspiraiton

Answer 18

Pt Cardiac ?not open/Open Lie flat Anaes Remote Radiation Surg Access Heparin/reversal TOE Complications- bleed, dissection, CVA, arrhythmia, MI/coronary occlusion, tamponade, oesophageal perf

Answer 19

Feeding Analgesia Sedation Thromboprophylaxis Head up Urine/bowels Glucose Spont vent trial

Answer 20

Minimally invasive procedure to lower portal pressure. Indications: refractory ascites, variceal bleed CI: HF, severe TR/pHTN, biliary obstruciton, plt <20 Patient- -Extrahepatic liver disease: lungs, Cirrhotic CM, coags, renal, ascites, enephalopathy, anaemia/thrombocytopenia -Risk stratify, ?Transplant candidate - Optimise- lactulose/rifaximin, TEG, ascites 8g alb per 2.5L, hydrothorax Intraop - ETT, a line - TIVA RemiComplications- IJ access/arrhythmia, Bleed/HF/encephalopathy Postop - Paracetamol reduced dose + fetnanyl HDU

Answer 21

Facial flushing Bronchospasm Vaso up and down- propofol remi good Carcinoid heart disease- PV/TV PHT Dehydration Avoid histamine releasing agents, premedicate antihidtamines Somatostatin analogues, ocreotide 50 -200 mcg/hr 12 h preop- 1 week postop

Answer 22

Airway- Size 4 -5 LMA or 8.5 - 9 ETT, bronchoscope mount TIVA remi roc Backups- 14G cannula/ICC/DLT if PTx occurs Remote Shared AW

Answer 23

Poor patient access Fixed instrument position Steep head down Long surgery

Answer 24

Preop: - Arterial pressure (a/DHP) control <130/80 - arrhythmia (B) control - Reversal of volume depletion- hct normal - Cardiac funciton assess and optimise -Optimise electrolyte/glucose control- glucose, CKD, Ca Intraop - Avoid HTN from secondary to mediator release - Drug- indirects SNS, SCh, histamine, droperidol - Laryng, pneumo, handling Prevent HD collapse after ligation Drugs - Remi, Mg, GTN/SNP, phento, Dexmed, labetalol, esmolol, nicardipine - NAd/Adr, vasopressin, hydrocortisone Postop - art line 24h - Hypoglycaemia - steroids if bilateral

Answer 25

Haller index : Transverse/AP Diameter of chest (>3.25 severe) Preop: Associated disease e.g. Marfans/Scoli/MVP RLD/pHTN/RHF- ECG/Echo/PFTs Intraop: PTx/cardiac injury/sternal erosion/arrhythmias/vascular injury. 2 Large IV. Deep Extubation as cough --> Tension Multimodal analgesia - T5 Epidural (Even for thoracoscopic) 3-4/7 - PCA - NSAID - Muscle spasms- methocarbamol/Diaz

Answer 26

Bleeding CPP maintenance ?syndromes

Answer 27

Vasopressin starting dose is 0.03 units/minute = 1.8 u/h titrate 0.6 - 2.4 units per hour. >2.4 u/h associated with organ ischaemia and arrhythmias, (TdP) Dobutamine: 1 -10 mcg/kg/min Isoprenaline 1 -10 mcg/min- better chronotrope than adrenaline Milrinone 0.25-0.75 ug/kg/min, but lower doses are often used in clinical practice (0.125-0.37 ug/kg/min). Consider a 25-50 mcg/kg loading dose infused over 10 minutes. Nebulized milrinone appears to have a potency similar to nitroglycerine but with a longer duration of action. This could allow intermittent nebulized therapies to be used as maintenance therapy (e.g., 5 mg milrinone nebulized Q4 hours). Nitroglycerine: 5 mg nebulized over 15 minutes, repeat PRN (lasts ~30 min). A continuous neb using 200-400 mcg/ml solution may be reasonable until nitric oxide or Epoprostenol is available (this utilizes the nitroglycerine solution for IV administration that is pre-mixed in large glass bottles). Nitric oxide (NO): Intubated or via high-flow cannula: Start at 20 parts per million. Administered via nasal prongs: Start at 20-50 parts per million. May wean down gradually as the patient improves. Epoprostenol: Start at 50 ng/kg/min (max dose). May wean down gradually as the patient improves. Iloprost: IV 0.5 - 2 ng/kg/min for 30 minutes.

Answer 28

- Comorbid patient workup/optimisation - Surgical technique - One lung ventilation - Fluid management - Analgesia - Postoperative care/complications