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Anaesthesia > OT > Flashcards

OT Flashcards

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1
Q

Monitoring the patient in order of preference of system

A

1) CNS
2) CVS
3) respiratory
4) neuromuscular junction
5) urine output & kidney function
6) body temperature

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2
Q

CNS monitoring

A

Depth of anaesthesia

EEG and bisectural index

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3
Q

Bi spectral index range

A

0 to 100
Zero deeply anaestised
100 fully awake

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4
Q

Adequate depth of anaesthesia

A

40- 60

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5
Q

Balanced anaesthesia

A

John lundy

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6
Q

John lundy

A 
4 A
Analgesia
 abolition of reflex 
amnesia 
adequate relaxation
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7
Q

Cvs monitoring

A

HR and PR

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8
Q

Invasive BP monitoring

A

Radial(m/c) femoral and dorselis pedis artery is used

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9
Q

Mean arterial pressure in curve

A

Area under the curve

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10
Q

Highest and lowest points in curve

A

Highest-SBP lowest-DBP

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11
Q

Advantage of invasive BP monitoring

A

Beat to beat BP monitoring in major surgeries transplant or vascular surgery
TO take repeated ABG sampling in major surgeries like bypass or any vascular surgery

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12
Q

Disadvantage of invasive BP monitoring

A

Ellen test

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13
Q

Allan test

A

Inference presence of adequate collaterals
normally < 7-pink
border line 7 to 14 seconds more than 14-no collateral

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14
Q

Complications of invasive BP monitoring

A

Ischemia thrombus or fistula

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15
Q

CVP monitoring

A

Technique seldinger

7F 20cm cannula

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16
Q

Advantage of cvp monitoring

A

To know fluid status ( in hypovolemia cvp low )
Shows functioning of right heart
if it is known functioning then cvp raised ( mitral stenosis rvf increased intra thoracic pressure cardiac tamponade)

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17
Q

Cvp normal value

A

0-5 cm

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18
Q

Monitoring fluid status methods

A

Serum lactate levels
urine output monitoring
goal directed fluid therapy
Cvp monitoring

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19
Q

Vein used in cvp

A

Internal jugular right vein

Subclavian vein for long term use

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20
Q

Why left internal jugular is not used

A

Cupula of lung-pneumothorax

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21
Q

Time interval for removal of Cannula

A

Peripheral IV line- 2 to 3 days
cvp catheter- 5 to 6 days
PICC (PERIPHERLY INSERTED CENTRAL CANNULA) - 21 to 30 days

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22
Q

Respiratory system monitoring

A

Pulse oximeter principle beer 🍻🍺 lambert’s law

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23
Q

Normal spo2 level

A

98-100%

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24
Q

Falsely elevated spo2

A

Co poisoning

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25
Falsely low spo2
Methemoglobinemia nail polish Henna dye jaundice
26
Neuromuscular monitoring advantage
Identify whether muscles are relaxed or not during intubation if they are not relaxed BP and HR increase Identify whether the muscles are have recovered from effect of muscle relaxant during post op period or else respiratory failure and shallow respiration
27
Most common nerve use to monitor neuromuscular
Ulnar nerve
28
Most common muscle used to monitor neuromuscular
Adductor policies
29
Common monitoring sites
Facial nerve orbicularis occuli corrugated supercilii ---furrows Brow Posterior tibial nerve--- flexor hallucis brevis--- flexes big toe
30
Pattern of application of current
Single twitch train of 4 tetaNY double burst stimulation
31
Train of 4 ratio
Current applied at interval of 0.5 second muscle contract graph is made... 🚆 Train of 4 ratio measured by taking amplitude of 4th impulse by 1st impulse
32
Train of 4 ratio non-depolarising blocker
Amplitude decreases each stimulus subsequently
33
Normal TOF for non depolarizing blockers
<1 But during recovery top should be > 0.9 otherwise breathing becomes shallow and patient going to hypoxia and post operative period
34
Tof in depolarizing blockers
Equal to 1
35
High dose depolarising blockers
Behave like non-depolarising blockers in phase 2
36
Tetany Hertz
50-100 Hz in 5 sec
37
Fade phenomenon
Seen in non depolarizing blockers | And phase 2 Depolarising blockers
38
Post Tetanic count
Whenever we apply Tetanic stimulus to a muscle, post that even if we apply a supra maximal stimulus the amount of contraction will be reduced because all the acetylcholine will be depleted by previous Tetanic contraction
39
Relation of PTC with depth of anesthesia
Inversely proportional
40
Double burst stimulation
Similar to Tetany but non painful
41
Temp monitoring
Hypothermia BMR reduced | Ffor everyone degree Celsius decrease 7 to 10% decrease in BMR
42
Types of temperature monitoring
Surface/ superficial temperature | core temperature depending on site of surgery
43
Neurosurgery mein
Nesopharyngeal /tympanic membrane
44
In cardiac/ GI surgery
Mid oesophageal/pulmonary artery
45
Temperature monitoring rectal
Not usually measured dependent on amount of faecal matter
46
Hyperthermia
Dependent on hypermetabolic States fever sepsis malignant hyperthermia
47
Temperature monitoring advantage
To find out thyroid storm, malignant hyperthermia ,hypothermia leading to delayed recovery
48
Airway monitoring
``` History Congenital anomalies predictors TMJ fxn Mallampatti scoring Atlanto occipital movement Neck circumference Thyro mental distance Sterno mental distance ```
49
Congenital anomalies predictors airway
Perry Robin turn down klip after he got failed | Perry Robinson syndrome,klippel feil ,Turner ,down syndrome
50
Difficult intubation in
``` OBESE Obesity Bearded Edentulous Snorers Elderly ```
51
Finger breath technique
3 fingers
52
Mallampatti scoring
``` 4 grades Grade 1 uvula freely hanging Grade 2 tip of uvula not seen Grade 3 half of uvula not seen Grade 4 only hard palate seen ```
53
Atlanto occipital movement angle
Normal 12-35 degree | Ankylosing spondylitis... difficult intubation
54
Neck circumference
>40 cm difficult
55
Sterno mental distance
12-13cm normal | <12 difficult intubation
56
Thyro mental distance
Normal 6.5 cm | <6 difficult
57
Preoxygenation
Due to administration of muscle relaxents there is a period of apnea before intubation this helps in reducing the period of apnea and increases the oxygen reserves. Done with 100% o2 for 3 minute duration
58
Emergency preoxygenation
8 vital capacities of breath in emergency | 4 vital capacities of breath in cases of extreme emergencies
59
Gudel airway
Measured from tragus to the angle of mouth or from the angle of mouth to angle of mandible
60
Nasopharyngeal airway contraindications
Base of skull fracture (raccoon eyes aur panda eyes) | coagulapathy
61
Curved laryngoscope
Adults M a g i l l / m i l l e r s blade Epiglottis is not included
62
Straight blade
Macintosh children epiglottis is included
63
Cuffed tube
Adults Cuff prevent aspiration Lumen-2 called murphy's eye
64
Most commonly used cuff
Low pressure high volume cuffs
65
Uncuffed tube
Children | narrowest region is subglottic region
66
ETT size
Adult male 8, 8.5, 9 | Adult female 7, 7.5, 8
67
Children formula ETT
<6 : (age/3)+3.5 >6 : (age/4)+4.5 Length of ETT (age/2)+12
68
Preterm ETT Size
2.5 no
69
Term ETT size
3no.
70
Upto 6 mths/1 year
3.5 no
71
Attenuation of laryngoscopy and endotrachel intubation sympathetic stimulation is by using
``` lignocaine IV or spray NTG IV or spray CCB Short acting opioids like alfentanil Short acting beta blockers like esmolol ```
72
OBESE pt
RAMP position head up
73
Contradication for ETT insertion
Pneumothorax
74
Spine surgery
Reinforced tube /armoured/ flexometallic ett
75
Emergency incubation manoeuvre
Sellick manoeuvre 40 Newton pressure on cricoid process
76
Oral surgery
RAE ETT (For north pole tube direction should be upward and downward for south pole tube)

Anaesthesia (2 decks)

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