Pac

Question 1

Hypertension

Answer 1

Continue except Ace inhibitor

Question 2

DM Drugs

Answer 2

Stop and skip on the day of surgery..if required insulin inj to maintain level between 120-200 mg/dl

Question 3

Epilepsy

Answer 3

Continue

Avoid enflurane and methohexital( inhalational and barbiturates with methyl group)

Question 4

Thyroid

Answer 4

Continue

Question 5

Psychiatry

Answer 5

Continue except MAO inhibitors
Interect with synthetic opioids meperidine cause cheese reaction
Skip 2-3 day before surgery

Question 6

Lithium

Answer 6

Continue..

If using newer anaesthetics ‘ curium’

Question 7

Effects of lithium on muscle relaxants

Answer 7

Prolongs duration

Question 8

Mgso4

Answer 8

Continue

Question 9

OC pills

Answer 9

Estrogen causes thromboembolism in DVT

Except that continue

Question 10

Steroids

Answer 10

Continue

Question 11

Herbal medicine

Answer 11

Stop 1>2 week before

LFT

Question 12

Tb medicine

Answer 12

Continue

LFT

Question 13

MI past history

Answer 13

Continue LD Aspirin
Stop all 5-7 days before
Cataract surgery on topical anaesthesia….. Continue

Question 14

NSAIDs

Answer 14

Stop 24-48 hrs before surgery

To avoid post op renal dysfunction

Question 15

Sildenafil

Answer 15

Stop 24 hrs before
PDE Inhibitor …
Use PAH
s/e hypotension

Question 16

Diuretic

Answer 16

Stop all loop diuretic

Hypotension and electrolyte imbalance

Question 17

Malignant hyperthermia

Answer 17

Family history sudden death on OT table cardiac arrest

Question 18

Susceptible pt to Malignant hyperthermia

Answer 18

Muscle disorders/ dystrophy

Question 19

Agent causing MH

Answer 19

Succinylcholine+/- any volatile agent

Question 20

Pathophysiology of MH

Answer 20

Ryanodine receptor mutation —->excessive release of calcium —->excessive muscle contraction —->causes release of potassium —->cause ventricular arrhythmia

Question 21

Symptoms of MH

Answer 21

Unexplained tachycardia with increased BP , Temp ,ETCO2,

Pt. Stiff ,lock 🔒 jaw ( d/t inadequate muscle relaxation)

Question 22

Treatment for MH

Answer 22

Stop all anaesthetic —>100% o2 —> 4-6 mg/kg dantrolene sodium in divided dose

Treat hyperkalemia —-> calcium gluconate inj or salbutamol nebulization or insulin+ glucagon infusion

Question 23

Complications of MH

Answer 23

Excessive muscle contraction —-> myoglobin release —-> acute tubular necrosis (renal failure)

Question 24

Smoking

Answer 24

6-8 wk before.
Bronchospasm (salbutamol nebulization or steroids inhalational) and laryngospasm (100% o2 , jaw thrust, propofol and succinylcholine)

Question 25

Alcohol

Answer 25

24-48 hrs before | LFT

Question 26

Tobacco

Answer 26

Difficult intubation | Submucosal fibrosis

Question 27

Allergy history (anaphylactic shock)

Answer 27

Antibiotics>latex>muscle relaxant>local anaesthetic

Question 28

Pathophysiology of anaphylactic shock

Answer 28

Histamine release

Question 29

Symptoms of anaphylactic shock

Answer 29

Unexplained tachycardia followed by hypotension | Increased airway resistance

Question 30

Treatment

Answer 30

Adrenaline - 1ml (1:1000) | Dose : 1 ml of 1:10000 IV or 0.5 ml of 1:1000 s/c

Question 31

ASA Grading

Answer 31

Grade1 :normal Grade2 : mild systemic disease under control Grade 3 : moderate affecting lifestyle E.g CRF , Chronic liver failure Grade 4 : severe systemic disease threat to life e.g unstable angina cerebral aneurysm and aneurysm>6.5 cm Grade 5 : moribund pt Grade 6: brain dead pt

Question 32

Risk stratification ACC/AHA Guidelines

Answer 32

6 steps 1) proceed with surgery and monitor in post op ward in emergency surgeries urgent 2) postpone the surgery for these active conditions including acute coronary syndrome decompensated heart failure severe valvular disease and significant arrhythmia 3) post operative risk based on scoring ..Intra thoracic surgery 1point ..History of ischemic heart disease 1 point ..History of congestive heart failure 1 Point ..history of CVA 1 Point ..History of diabetes mellitus requiring insulin 1 Point ..History of serum creatinine >2 mg/dl **score more than 2-3 means high chance post operative mortality or morbidity 4) assessment of functional activity measured as METS (metabolic equivalent) 5) CORONARY RE VASCULARISATION IN CASE OF Major SURGERIES 6) do alternative treatment #*#*!Canadian guidelines BNP >92 ng ml or high Pro BNP--hy chance of peri operative cardiac events

Question 33

Coronary stents

Answer 33

Bare metal stent ....wait for 1 month drug eluting stunt.... wait for 6 months

Question 34

Pulmonary risk stratification

Answer 34

Active URTI wait 4-6 weeks ABG analysis :::only for Major vascular surgeries chest X-ray :::pneumonia PFT ::: pneumonectomy, lobectomy

Question 35

CNS risk stratification

Answer 35

H/ o stroke wait 9 month

Question 36

Pre medication anxiety

Answer 36

Short acting benzodiazapines

Question 37

Reduce secretions pre medication

Answer 37

Atropine glycopyrolate anticolineergic

Question 38

Post op nausea and vomiting

Answer 38

Ondansetron act on 5HT3 receptors

Question 39

Pre medication for infections reduction

Answer 39

Antibiotics 30 minute to 1 hour prior to surgery

Question 40

Premptive analgesia

Answer 40

Just before surgical incision opioids

Question 41

Fasting guidelines

Answer 41

``` ADULTS ::6-8 hours CHILDREN:: 2 hours for clear fluid 4 hours for breast milk 6 hours for solid meal,non human milk 8 hours for heavy fatty meal ```

Question 42

Emergency surgeries

Answer 42

Ryle tube aspiration Pro kinetics metochlopramide (s/ e extra pyramidal symptoms) PPI or H2 BLOCKERS #antacids 0.3 mol of sodium citrate 30 ml 30 minutes prior to surgery to decrease the chance of aspiration pneumonia

Question 43

Pre-op room

Answer 43

IV cannula Check investigations mark surgical site patient identification