Passmed Anaesthetics Mushkies Flashcards
(87 cards)
1
Q
4 IV induction agents?
A
- Propofol
- Sodium thiopentone
- Ketamine
- Etomidate
2
Q
Food and water before general anaesthetics?
A
No food for 6 hours and no fluids for 2 hours before
3
Q
3 s/e of halothane?
A
- Hepatotoxicity
- Myocardial depression
- Malignant hyperthermia
4
Q
S/e of thiopental?
A
Laryngospasm
5
Q
Favoured post-op fluid management?
A
Ringers lactate/Hartmanns
6
Q
MOA of malignant hyperthermia?
A
Excessive release of Ca2+ from the sarcoplasmic reticulum of skeletal muscle
7
Q
Mx of malignant hyperthermia?
A
Dantrolene (prevents Ca2+ release from the sarcoplasmic reticulum)
8
Q
What anaesthetic agent has proven anti-emetic properties?
A
Propofol
9
Q
Pre thyroid surgery prep?
A
Vocal cord checl
10
Q
Pre parathyroid surgery prep?
A
Methylene blue to identify gland
11
Q
Pre sentinel node biopsy prep?
A
Radioactive marker/patent blue dye
12
Q
Pre colorectal surgery prep?
A
Bowel prep, esp. if left sided surgery
13
Q
Types of VTE prophylaxis?
A
- Mechanical = stockings, intermittent compression boots
2. Pharm = Fondaparinux, LMWH, UFH
14
Q
When to stop COCP before surgery?
A
4 weeks
15
Q
Pseudocholinesterase deficiency aka?
A
Suxamethonium apnoea
16
Q
Pseudocholinesterase deficiency defn?
A
- A rare abnormality in the production of plasma cholinesterases, leading to increased duration of action of muscle relaxants e.g. suxamethonium
- Respiratory arrest is inevitable unless the patient can be mechanically ventilated safely while waiting for the circulating muscle relaxants to degrade
- FHx
17
Q
Some causes of paralytic ileus?
A
- Bowel surgery
- Pneumonia
- MI
- Stroke
- AKI
18
Q
Dx of anastomotic leak?
A
Abdo CT
19
Q
`Laporoscopic port insertion artery risk?
A
Inferior epigastric artery
20
Q
Nerve injury following posterior triangle lymph node biopsy?
A
Accessory nerve
21
Q
Nerve injury following posterior approach to hip?
A
Sciatic nerve
22
Q
Nerve injury following axillary node clearance?
A
Long thoracic nerve
23
Q
Nerve injury following pelvic cancer surgery?
A
Pelvic autonomic nerves
24
Q
Nerve injury following thyroid surgery?
A
Recurrent laryngeal nerves
25
Nerve injury following carotid endarterectomy?
Hypoglossal nerve
26
Nerve injury following upper limb fracture repairs?
Ulnar and median nerves
27
IO access most commonly obtained where?
Anteromedial aspect of proximal tibia
28
3 sites of IO access/
1. Proximal tibia
2. Distal femur
3. Humeral head
29
Maximal flow rates of cannulas?
1. 14G = 270ml/min
2. 16G = 180ml/min
3. 18G = 80ml/min
4. 20G = 54ml/min
5. 22G = 33ml/min
30
Smoker ASA grade?
Grade 2
31
ASA 1?
Health, non-smoking, no or minimal alcohol use
32
Lidocaine toxicity mx?
IV 20% lipid emulsion
33
Suxamethonium e- s/e?
Hyperkalaemia
34
Classification of neuromuscular blocking drugs?
1. Depolarising
| 2. Non-depolarising
35
Depolarising neuromuscular blocker MOA?
Binds to nACHR resulting in persistent depolarisation of motor end plate?
36
Non-depolarising neuromuscular blocker MOA?
Competitive antagonist of nACHR
37
Depolarising neuromuscular blocker example?
Suxamethonium (a.k.a succinylcholine)
38
Non-depolarising neuromuscular blocker example?
1. Atracurium
| 2. Vecuronium
39
S/e of depolarising neuromuscular blocker?
1. Malignant hyperthermia
| 2. Hyperkalaemia
40
S/e of non-depolarising neuromuscular blocker?
Hypotension
41
Reversal of non-depolarising neuromuscular blocker?
Acetylcholineterase inhibitors e.g. neostigmine
42
Muscle relaxant of choice for rapid sequence induction and intubation?
Suxamethonium
43
Neuromuscular blocker that causes fasciculations?
Suxamethonium
44
Suxamethonium C/I?
1. Penetrating eye injuries
2. Acute narrow angle glaucoma
As suxamethonium increases intra-ocular pressure
45
Maximum 1% lignocaine dose?
3mg/kg - 200ml (20ml)
46
Maximum 1% lignocaine with 1 in 200,000 adrenaline dose?
7mg/kg - 500mg (50ml)
47
Long-term mechanical ventilation in trauma pts s/e?
Tracheo-oesophageal fistula formation
48
4 airway managements?
1. Oropharyngeal airway
2. Laryngeal mask
3. Tracheostomy
4. ET tube
49
Oculogyric crises and diffuse muscle spasm after thyroidectomy?
Hypocalcaemic tetany --> IV calcium
50
Bowel prep for colonoscopy?
Bowel prep the day before the colonoscopy
51
Hypovolaemia and e- disturbance in the few days following surgery?
Ileus
52
What blood product doesnt have to be cross matched?
Platelets
53
WHO checklist 3 phases?
1. Before the induction of anaesthesia (sign in)
2. Before incision of the skin (time out)
3. Before the pt leaves the operating room (time out)
54
When does VTE usually present post-op?
Within 5-10 days
55
4 stages of wound healing?
1. Haemostasis = mins-hrs
2. Inflammation = 1-5 days
3. Regeneration = d7-56
4. Remodelling = 6w-1yr
56
4 drugs which impair wound healing?
1. NSAIDs
2. Steroids
3. Immunosuppressives
4. Anti-neoplsatic
57
Complication of poor post-operative pain management?
Pneumonia (abdo pain --> shallow breathing --> RF for atelectasis and respiratory tract infections)
58
Potential cause of new-onset AF following GI surgery?
Anastomotic leak
59
Ischaemic colitis Hx?
Severe abdominal pain and passing of bloody stools
60
Nasopharygneal airway C/I?
Base of skull fractures
61
Nasopharyngeal airway is ideal for what pt?
Seizures
62
Mx of post-op ileus?
NBM and NGT
63
When can pt shower post-op w/ surgical wound?
48 hours
64
Mycosis fungoides aka?
Cutaneous T cell lymphoma
65
Keloid scar description?
A shiny dark protuberant scar tissue that projects beyond the limits of the skin incision
66
Benzo OD mx?
Flumazenil
67
Isolated fever in well pt in first 24 hours following surgery?
Physiological reaction to operation
68
Lidocaine MOA?
Blockage of sodium channels, disrupting the AP
69
2 causative agents of malignant hyperthermia?
1. Halothane
| 2. Suxamethonium
70
How should TPN be administered?
Central vein
71
6 feeding options in surgical pts?
1. Oral
2. NG
3. NJ
4. Feeding jejunostomy
5. PEG
6. TPN
72
Hyperchloraemic acidosis post op cause?
Excessive infusion of IV fluid
73
Anastomotic leak mx?
Surgical emergency and pts must be taken back to theatre ASAP
74
Why does hypothermia cause increased bleeding intra-operatively?
Coagulation factors are less effective
75
Ways thermoregulation is affected during surgery?
1. Administration of unwarmed IV fluids, inhalation gases, or or irrigation of body cavities
2. Cold theatre environment
3. Muscle relaxants prevent shivering
4. Spinal/epidural anaesthesia prevents peipheral vasoconstriction via reduced sympathetic tone
76
What neuromuscular blocking drug cannot be reversed?
Suxamethonium
77
Elective hip replacement VTE prophylaxis duration?
28 days
78
Elective knee replacement VTE prophylaxis duration?
14 days
79
Hip fracture VTE prophylaxis duration?
Until the pt no longer has significantly reduced mobility
80
Morbidly obese (BMI>40) ASA grade?
ASA III
81
Local anaesthetic toxicity IV 20% lipid emulsion MOA?
It is proposed that lipid infusion creates a lipid phase that extracts the hydrophobic molecules of LA from the aqueous plasma phase and hence reduces serum LA concentration.
82
Muscle relaxant of choice for rapid sequence induction for intubation?
Suxamethonium
83
What is required prior to surgery for pts taking prednisolone?
Hydrocortisone supplementation
84
Flumazenil MOA?
Competes with BZDs for GABA binding sites
85
What anaesthetic agent is hepatotoxic?
Halothane
86
Post-oesophagectomy feeding?
Feeding jejunostomy
87
When should LMWH be started post surgery?
6 hours
