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Flashcards in Pre-AMS Deck (27)
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1
Q

Outline the American Society of Anethesiologicals (ASA) classification

A
  1. Normally healthy patient
  2. Mild systemic disease
  3. Severe systemic disease that limits activity but is not incapacitating
  4. Incapacitating systemic disease which poses a constant threat to life
  5. Moribound: not expected to survive 24h even with operation

Suffixe E is used to denote Emergency (eg 2E)

2
Q

What blood tests should ALWAYS be performed preoperatively and for what reason?

A
  • U&E - renal failure?
  • FBC - anaemia inc risks [Hb <100 tell anaesthetist], baseline
  • Blood glucose (finger-prick)
3
Q

When should a cross-match be performed?

A

Cross-match - predicted & held for 24hr

4
Q

When should LFTs be performed

A
  • Jaundice
  • Malignancy
  • Alcohol Abuse
5
Q

When should Amylase be performed

A

Acute abdo pain

6
Q

When should Blood Glucose be performed?

A

Diabetics

7
Q

When should Clotting studies be performed?

A
  • Live/ renal disease
  • DIC
  • Massive blood loss
  • On;
    • Valproate
    • Warfarin
    • Heparin
8
Q

When should Sickle test be performed?

A
  • Malarial area origins
  • Africa, West Indies or Mediterranean
9
Q

When should Thryoid FTs be performed

A

Thyroid disease

10
Q

When should Spirometry be performed

A

Obstructive/ restrictive lung pathology

11
Q

When should a CXR be performed

A
  • Abso, Cardio, Thoracic, Thyroid, Neck, Head
  • Neurosurgery [due to prolonged anaethesia/ postop ITU]
  • Lymph node surgery
  • >65 yrs
12
Q

When should ECG be performed

A
  • >65yrs
  • Poor exercise tolerance
  • Hx of cardiovascular/ rheumatological conditions
13
Q

When sould an Echocardiogram be performed

A

Suspicion of LV dysfunction

14
Q

What is suxamethonium

A

Agent of choice for rapid paralysis (rapid metabolism)

Depolarising muscle relactant

Fasiculations then paralysis

15
Q

Outline the cause of Suxamethonium Apnoea

A
  • Incapable of metabolising drug sufficiently rapidly enough
  • Remain paralysed & unable to breath post-surgery as they cannot regain muscle function

Causes;

  • Metabolised by Cholinesterase, 10% excreted by kidney
  1. Congenital/ inherited - varies with phenotype
  2. Aquired
    • Pregnancy, liver/kidney disease/ Hypothyroidism
    • Drugs: methotrexate, monoamine oxidase inhibitors
16
Q

What is malignant hyperthermia/ pyrexia
Outline aetiology & pathophysiology

A
  • Rapid rise in temperature usually triggered by anaesthetic

Aetiology

  • Inherited myopathy due to genetic mutation

Pathophys

  • Inc intramyoplasmic calcium ions via sarcoplasmic reticulum release
  • Hypermetabolism
  • Muscle rigidity & rhabdomyolysis
17
Q

Outline the treatment of Malignant hyperpyrexia/ thermia

A

Dantrolene Sodium

muscle relaxant - ryanodine receptor, blocks coupling

18
Q

What is Porphyria

What is the risk in surgery

A

Inherited metabolic disorders

  • 8 types - each a partial deficiency in 1 of the enzymes involved in Haem synthesis
  • Overproduction & inc. excretion of toxic haem precursors

Risks

  • Acute porphyria
  • Drug interactions
19
Q

Outline the clinical features of Acute Porphyria

A

Acute neuropsychiatric features

20
Q

What implications does an MI have on surgery?

A

Delay elective surgery 6months post-MI

Urgent surgery: benefits/ risks/ consider 3 months

21
Q

What implications does Hypertension have on surgery

A
  • >180 systolid or >110 diastolic on 3 measurment over 1-2hrs = DELAY ELECTIVE
22
Q

What implications does Stroke/ TIA have on surgery

A

postpone 4 weeks

23
Q

What implications does being >60yrs old have on surgery

A

Do a 12 lead ECG

24
Q

What is Bowel Preparation?

A

Medication to empty the bowel to assist surgery

25
Q

What operations require require/ do not require bowel preparation and what time of preparation?

A
  • RIGHT colon - non
  • LEFT colon
    • 2 sachets PICOLAX day before
  • Closure of colostomy
    • Picolax & enema prep rectally
  • Stapled transanal rectal resection (STARR) or Laparoscopic ventral rectopexy
    • Phosphate enema on arrival
26
Q

What are contraindications to Picolax regimen?

A
  • Bowel obstruction/ strictures
  • Epileptic (due to anti-epileptic medication absorption)
  • Severe renal impairment (seek alternative)
    • WARNING: Bowel prep affects absorption of drugs, admit if therapeutic control is critical
27
Q

Outline the preperation, administration & monitoring required for Pixolax regimen

A

Prep:

  • Check electrolytes to exclude hypokalaemia
  • Day prior: light diet

Administration day prior:

  • 1 sachet at 8am & 2pm
    • +150mL cold water & stir & drink when cool
  • Drink plenty of fluids/ 1L IV infusion/8hr

Monitoring:

  • Dehydration
  • Electrolyte imbalance