safety and quality in anaesthetic practice Flashcards

Question

23.1 Therapeutic privilege is defined as A. Withholding information to obtain consent B. Getting presents and money for treating someone. C. Not telling pt info because of their religious or cultural beliefs. D. Withholding information to the patient if you think it will cause harm

Answer 1

D. Withholding information to the patient if you think it will cause harm https://www.sciencedirect.com/topics/medicine-and-dentistry/therapeutic-privilege “Therapeutic privilege,” also known as “therapeutic nondisclosure,” is defined as the withholding of relevant health information from the patient if nondisclosure is believed to be in the best interests of the patient (President’s Commission, 1982; Berger, 2005). The two most common justifications for such nondisclosure are that the disclosure would create incapacitating emotional distress and that disclosure would violate a patient’s personal, cultural, or other social requirements (Crawley et al., 2001; Berger, 2005).

Answer 2

a) Autonomy - Obligation to respect the decision-making capacities of persons. Non-maleficence: Obligation to avoid causing harm - If refused to proceed. Paternalism: A set of attitudes and practices in which the health provider determines that a patient's wishes or choices should not be honored. - If transfused patient against their wishes Beneficence: Obligation to provide benefits and to balance benefits against risks; obligation of physician to act for the benefit of the patient - Controversial interpretation in this case. Both proceeding and refusing to do case may be acting for the benefit of the patient, depending on how you look at the scenario. BJA: ‘MORAL balance’ decision-making in critical care https://www.bjaed.org/article/S2058-5349(18)30145-8/fulltext

Answer 3

a) anaesthetic consent implied in surgical consent or e) nil consent required if would be in patients interest/ not against wishes https://journals.sagepub.com/doi/pdf/10.1177/0310057X1003800504 The anaesthetist should give the parent or relative the same kind of information as a patient and recommend the appropriate procedure. The consent of a parent or relative is lawful authority to proceed. If the parent or relative does not wish to take this role, it may be necessary for a court or a guardianship body to appoint someone else to make the decision. This may take some time, and if the procedure is medically necessary and cannot be deferred, then reasonable treatment may be administered without consent (this is a principle of the common law and, in some jurisdictions, is also in legislation: for example, in New South Wales, the Guardianship Act 1987 (NSW) s 37; and in Victoria

Answer 4

e. Oxygen consumption/min divided by HR VO2/HR: oxygen consumption divided by HR, known as the ‘oxygen pulse’ (ml beat–1) https://www.bjaed.org/article/S2058-5349(19)30021-6/fulltext The objective of CPET is to determine functional capacity in an individual. Deficiencies in CPET-derived variables—specifically: 1. ventilatory anaerobic threshold (AT) 2. peak O2 consumption (VO2peak) 3. ventilatory efficiency for carbon dioxide (VE/VCO2) —are associated with poor postoperative outcomes (mortality, morbidity, admission to intensive care, and length of hospital stay) after intra-abdominal surgery. 7. Does the oxygen pulse increase with exercise? The oxygen pulse is the VO2 divided by HR, and represents the product of the stroke volume and the arterial-venous oxygen difference. It can be seen in panel 2 and can be viewed as a surrogate for stroke volume, and as such should increase at the start of exercise before slowly reaching a plateau at its highest predicted value.

Answer 5

C. Oesophageal stricture ## Footnote https://www.asecho.org/wp-content/uploads/2014/05/2013_Performing-Comprehensive-TEE.pdf

Answer 6

a) 1:670 (or 1:700)

Answer 7

d. asepsis Asepsis: the prevention of microbial contamination of living tissues or sterile materials. Disinfection: the inactivation of non-sporing organisms using either thermal or chemical means. Sterilisation: complete destruction of all micro-organisms, including spores. https://www.anzca.edu.au/getattachment/e4e601e6-d344-42ce-9849-7ae9bfa19f15/PG28(A)-Guideline-on-infection-control-in-anaesthesia

Answer 8

4 | GCS 7-12

Answer 9

c) DOO The pacing mode will be DOO when the programmed pacing mode is a dual chamber mode or an MVP mode (AAIR<=>DDDR, AAI<=>DDD), VOO when the programmed pacing mode is a single chamber ventricular mode, and AOO when the programmed pacing mode is a single chamber atrial mode.

Answer 10

1 hour ASRA: 1 hour Although the occurrence of a bloody or difficult neuraxial needle placement may increase risk, there are no data to support mandatory cancellation of a case. Direct communication with the surgeon and a specific risk-benefit decision about proceeding in each case are warranted. Currently, insufficient data and experience are available to determine if the risk of neuraxial haematoma is increased when combining neuraxial techniques with the full anticoagulation of cardiac surgery. We suggest postoperative monitoring of neurologic function and selection of neuraxial solutions that minimise sensory and motor block to facilitate detection of new/progressive neurodeficits. NYSORA: Administration of intravenous heparin intraoperatively should be delayed for at least 1 hour after epidural placement; a delay before administration of subcutaneous heparin is not required. In cases of full heparinization for CPB, additional precautions include delaying surgery for 24 hours in the event of a traumatic tap, tightly controlling the heparin effect and reversal, and removing catheters when normal coagulation is restored.

Answer 11

a. 35 Major updates (2022) to 1991 National Institutes of Health guidelines for bariatric surgery Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) 35 kg/m2 , regardless of presence, absence, or severity of co-morbidities. MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2 BMI thresholds should be adjusted in the Asian population such that a BMI 25 kg/m2 suggests clinical obesity, and individuals with BMI 27.5 kg/m2 should be offered MBS. Long-term results of MBS consistently demonstrate safety and efficacy. Appropriately selected children and adolescents should be considered for MBS. https://www.soard.org/article/S1550-7289(22)00641-4/fulltext#:~:text=The%201991%20NIH%20Consensus%20Statement,surgery%20that%20is%20applied%20universally Contraindications: - Inflammatory disease of GI tract (ulcers, oesophagitis, Crohn's) - Upper GI bleeding - Portal Htn - Liver Cirrhosis - Chronic Pancreatitis - Laparascopic surgery may be technically difficult in patients weighing >180kg and may be considered a relative contraindication

Answer 12

e. Hypotension https://www.safetyandquality.gov.au/sites/default/files/2022-06/sepsis_clinical_care_standard_2022.pdf

Answer 13

pain score

Answer 14

a. 3 (snoring, BMI, Htn) Snoring loudly Tiredness during day time Observed Apnoea Pressure: Htn BMI > 35 Age > 50 Neck circumference >40cm (43cms male) Gender: Male

Answer 15

b. 24 hours ASA guidelines -If creatinine clearance >/=30 ml.min-1 (Cockcroft-Gault), proceed with surgery after two half lives (24 h) since the last dose, under general anaesthesia (or spinal anaesthesia if indicated) - If creatinine clearance < 30 ml.min-1, proceed with surgery after four half lives (48 h) since the last dose, under general anaesthesia (or spinal anaesthesia if indicated)

Answer 16

Nitrous oxide Nitrous oxide boiling point -88.6C, critical temperature +36C -> so is below critical temp at room temp, therefore exists as a vapour in equilibrium with its liquid phase and is dependent upon pressure applied to it. Pressure gauge not informative – will always read ~52 bar (the pressure at which N2O liquefies at 20C). As vapour is drawn off, N2O moves from liquid to vapour phase, maintaining the equilibrium and same vapour pressure within the cylinder. To determine contents: cylinder must be weighed and weight of empty cylinder subtracted, then number of moles of N2O in cylinder calculated using Avogadro’s number.

Answer 17

a) Critical appraisal PICO is a mnemonic used to describe the four elements of a good clinical foreground question: P = Population/Patient/Problem - How would I describe the problem or a group of patients similar to mine? I = Intervention - What main intervention, prognostic factor or exposure am I considering? C = Comparison - Is there an alternative to compare with the intervention? O = Outcome - What do I hope to accomplish, measure, improve or affect?

Answer 18

30ml/kg https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Executive_Summary__Surviving_Sepsis_Campaign_.14.aspx

Answer 19

c) 1:8000 Awareness rates GA with no muscle relaxant = 1:136,000 GA with muscle relaxation = 1/8,000 CTS 1/8,600 E-LSCS = 1/670 Overall 1:19,000

Answer 20

c. 5 min Circulatory determination of death in the context of organ donation 12 Circulatory determination of death in the context of organ donation requires the absence of spontaneous movement, breathing and circulation. Absence of circulation is evidenced by absent arterial pulsatility for 5 minutes, using intra-arterial pressure monitoring and confirmed by clinical examination (absent heart sounds and/or absent central pulse). In cases without an arterial line, electrical asystole should be observed for 5 minutes on the electrocardiogram and confirmed by clinical examination. 13 For the purposes of organ donation, circulatory determination of death should be documented using a specific form (see Appendix E) to demonstrate explicitly that all criteria set out in this Statement are met. The same criteria should be listed in local hospital forms

Answer 21

a. Bullying Bullying is unreasonable behaviour that creates a risk to health and safety. It is behaviour that is repeated over time or occurs as part of a pattern of behaviour. “Unreasonable behaviour” is behaviour that a reasonable person, having regard to all the circumstances, would expect to victimise, humiliate, undermine or threaten the person to whom the behaviour is directed. 1. Direct bullying – behaviour that is overt and usually involves conduct directed at a person to belittle or demean them. Examples include: > Aggressive and intimidating behaviour. > Belittling, degrading or humiliating comments. > Spreading misinformation or malicious rumours. > Interfering with a person’s property or work equipment. > Displaying offensive material (for example pornography). 2. Indirect bullying – behaviour that excludes or removes benefits from a person. Examples include: > Assigning meaningless tasks unrelated to the job. > Setting tasks that are unreasonably below or beyond a person’s skill level. > Deliberately changing work rosters to inconvenience particular employees. > Deliberately withholding information that is vital for effective work performance. Harassment is any type of unwanted behaviour that offends, humiliates or intimidates a person, and targets them on the basis of a characteristic covered by anti-discrimination law, for example gender, race, ethnicity or disability, etc. In general, harassment is any behaviour that is: Unwelcome, not asked for and not returned. Likely to humiliate (put someone down), seriously embarrass, offend or intimidate (threaten or scare) someone. Based on a personal characteristic (or family or friend’s characteristic) protected by law. Discrimination means treating a person with an identified attribute or personal characteristic as set out in legislation less favourably than a person who does not have the attribute or personal characteristic. > Gender. > Transgender, gender history and trans-sexual status. > Pregnancy and potential pregnancy. > Childbirth or breastfeeding. > Marital status. > Sexual orientation. > Lawful sexual activity. > Disability or impairment. > Race (including colour, nationality, descent and origin). > Physical features. > Age. > Carer status and family responsibilities. > Religious belief or activity. > Political belief or activity. > Trade union membership and industrial activity. > Associated with a person who is identified by reference to any of these attributes Sexual Harassment Sexual harassment is against the law. Sexual harassment is unwelcome sexual behaviour, which could be expected to make a person feel offended, humiliated or intimidated. It can be physical, verbal or written. Victimisation Victimisation is unlawful. Victimisation occurs when a person is treated unfairly due to that person having made a complaint of sexual harassment. Victimisation is behaviour that makes a person suffer a detriment including feeling uncomfortable, isolated, insecure or intimidated. https://www.anzca.edu.au/resources/corporate-documents/anzca-policy-on-bullying-discrimination-and-harass.pdf

Answer 22

c) 4 weeks ANZCA PS

Answer 23

e. Increased risk of non fatal cardiac arrest POISE II * clonidine 200mcg per day - did not reduce the rate of composite outcome of death or nonfatal MI - but it increased the risk of clinically important hypotension and nonfatal cardiac arrest * aspirin initiation or continuation – no significant effect on rate of composite of death or non fatal MI but increased risk of major bleeding

Answer 24

c) comparisons of means between three groups in normally distributed data ANOVA (analysis of variance): comparisons of means between more than two groups or between several measurements in the same group is called analysis of variance and is frequently cited by the acronym ANOVA

Answer 25

d) Trigger for initiating CICO Rescue is SpO2 <90% - According to the Vortex Approach the trigger for initiating CICO Rescue is the inability to confirm adequate alveolar oxygen delivery following best efforts at all three upper airway lifelines. Trigger for Initiating CICO Rescue VORTEX APPROACH The trigger for initiating CICO Rescue is the inability to confirm adequate alveolar oxygen delivery following best efforts at all three upper airway lifelines. Note that this trigger is independent of the oxygen saturations since, even in the unusual situation where the oxygen saturations remain high following best efforts at all three lifelines, the inability to confirm alveolar oxygen delivery means that eventual desaturation is inevitable. Rather than being a deterrent to its performance, recognition of the need for CICO Rescue while the oxygen saturations remain high should be viewed as advantageous – providing increased time to perform this confronting procedure in a more controlled manner, thereby increasing the chance of success. Conversely, a critically low oxygen saturation is not in itself a trigger to initiate CICO Rescue if best efforts at all three lifelines have not yet been completed. While legitimate opportunities to enter the Green Zone in a timely fashion via the familiar upper airway lifelines remain, these should be given priority, as they are more likely to be successful than resorting to an unfamiliar and more traumatic technique. Oxygen saturations are therefore not a relevant consideration in deciding the trigger for CICO Rescue – this is always “the inability to confirm adequate alveolar oxygen delivery following best efforts at all three upper airway lifelines”. They are, however, a relevant consideration in making the context dependent decision of what constitutes a best effort at each lifeline in a particular situation. This is because the oxygen saturations impact on how much time it is reasonable to invest in optimising each of the upper airway lifelines before declaring a best effort. When the oxygen saturations are critically low it might be reasonable to have only one attempt at each lifeline before declaring a best effort, even though this means leaving some potential optimisation interventions untried. This is because the incremental benefit of repeated attempts to optimise a lifeline that has already failed is typically low relative to untried alternative lifelines. Thus the time expended on such low yield interventions cannot be justified when the patient is already critically hypoxaemic and alternatives (including CICO Rescue) with a substantially higher likelihood of success remain.

Answer 26

a. 1% i.e. what is the positive predictive value (PPV) for this test PPV= TP/ TP +FP Negative Predictive Value = TN / TN + FN Prevalence of 1/1000 Sensitivity of 100% Specificity of 90% Of patients that are disease positive in population of 1000 TP = 1 FN = 0 -> 100% sensitivity Of patients that are disease negative in population of 1000 FP = 99 TN = 900 -> 90% Specificity PPV= 1/ 1 + 99 = 1/100 =1% NPV= 900/ 900 + 0 = 1/1 = 100%

Answer 27

e) Standards of quality improvement Quality Improvement (Standards for QUality Imporvement and Reporting Excellence) CONSORT: randomised trials PRISMA: systematic reviews and meta-analysis (Preferred Reporting Items for Systematic reviews and meta-analysis). STROBE: observational studies

Answer 28

A Apnea is defined as the cessation of airflow for ten or more seconds. Hypopnea is defined as a recognizable, transient reduction, but not a complete cessation of, breathing for ten or more seconds. Hypopnea requires a 4% fall in SpO2 https://www.ncbi.nlm.nih.gov/books/NBK441909/#:~:text=Obstructive%20Sleep%20Apnea%20(OSA)%2C,for%20ten%20or%20more%20seconds.

Answer 29

c) 0, 1, 4, 24 Serum tryptase levels are recommended to be collected as soon as possible after the onset of symptoms and then at 1 hour, 4 hours and after 24 hours. https://www.anzca.edu.au/resources/professional-documents/endorsed-guidelines/anaphylaxis-guideline-2022.pdf

Answer 30

e) Interquartile Range https://statisticsbyjim.com/basics/skewed-distribution/ https://statisticsbyjim.com/basics/variability-range-interquartile-variance-standard-deviation/ A measure of variability is a summary statistic that represents the amount of dispersion in a dataset. How spread out are the values? While a measure of central tendency describes the typical value, measures of variability define how far away the data points tend to fall from the center. In statistics, variability, dispersion, and spread are synonyms that denote the width of the distribution. Just as there are multiple measures of central tendency, there are several measures of variability. When a distribution has lower variability, the values in a dataset are more consistent. However, when the variability is higher, the data points are more dissimilar and extreme values become more likely. Consequently, understanding variability helps you grasp the likelihood of unusual events. > Range is easy to understand, it is based on only the two most extreme values in the dataset, which makes it very susceptible to outliers. If one of those numbers is unusually high or low, it affects the entire range even if it is atypical. >The interquartile range is the middle half of the data. To visualize it, think about the median value that splits the dataset in half. The interquartile range is the middle half of the data that is in between the upper and lower quartiles. In other words, the interquartile range includes the 50% of data points that fall between Q1 and Q3 > The interquartile range is a robust measure of variability in a similar manner that the median is a robust measure of central tendency. Neither measure is influenced dramatically by outliers because they don’t depend on every value. Additionally, the interquartile range is excellent for skewed distributions, just like the median. > when you have a normal distribution, the standard deviation tells you the percentage of observations that fall specific distances from the mean. However, this doesn’t work for skewed distributions, and the IQR is a great alternative. > Variance is the average squared difference of the values from the mean. Unlike the previous measures of variability, the variance includes all values in the calculation by comparing each value to the mean. To calculate this statistic, you calculate a set of squared differences between the data points and the mean, sum them, and then divide by the number of observations. Hence, it’s the average squared difference. >While higher values of the variance indicate greater variability, there is no intuitive interpretation for specific values. Despite this limitation, various statistical tests use the variance in their calculations. For an example, read my post about the F-test and ANOVA. While it is difficult to interpret the variance itself, the standard deviation resolves this problem! > The standard deviation is the standard or typical difference between each data point and the mean. When the values in a dataset are grouped closer together, you have a smaller standard deviation. On the other hand, when the values are spread out more, the standard deviation is larger because the standard distance is greater > The standard deviation is just the square root of the variance. Recall that the variance is in squared units. Hence, the square root returns the value to the natural units. The symbol for the standard deviation as a population parameter is σ while s represents it as a sample estimate. To calculate the standard deviation, calculate the variance as shown above, and then take the square root of it. Voila! You have the standard deviation! > People often confuse the standard deviation with the standard error of the mean. Both measures assess variability, but they have extremely different purposes. > When you have normally distributed data, or approximately so, the standard deviation becomes particularly valuable. You can use it to determine the proportion of the values that fall within a specified number of standard deviations from the mean. For example, in a normal distribution, 68% of the values will fall within +/- 1 standard deviation from the mean. This property is part of the Empirical Rule. This rule describes the percentage of the data that fall within specific numbers of standard deviations from the mean for bell-shaped curves.

Answer 31

doing an epidural on a patient who is labouring with normal pregnancy and no comorbidities 1. Avoid routinely performing preoperative blood investigations, chest X-ray or spirometry prior to surgery, but instead order in response to patient factors, symptoms and signs, disease, or planned surgery. 2. Avoid ordering cardiac stress testing for asymptomatic patients prior to undergoing low to intermediate risk non-cardiac surgery. 3. Avoid administering packed red blood cells (blood transfusion) to a young healthy patient with a haemoglobin of ≥70g/L who does not have on-going blood loss, unless the patient is symptomatic or haemodynamically unstable. 4. Avoid initiating anaesthesia for patients with limited life expectancy, at high risk of death or severely impaired functional recovery, without discussing expected outcomes and goals of care. 5. Avoid initiating anaesthesia for patients with significant co-morbidities without adequate, timely preoperative assessment and postoperative facilities to meet their needs. 6. Avoid routine prescription of slow-release opioids in the management of acute pain unless there is a demonstrated need, close monitoring is available and a cessation plan is in place

Answer 32

c) Discharge from recovery Aldrete score, which includes five elements (activity, respiration, circulation, consciousness, oxygen saturation) [16]. The original scoring system was developed before the invention of pulse oximetry and used the patient's colouration as a surrogate marker of their oxygenation status. A modified Aldrete scoring system was described in 1995 which replaces the assessment of skin colouration with the use of pulse oximetry to measure SpO2. The Modified Aldrete system includes five additional elements that are particularly useful during the Phase II recovery period prior to discharge to home (dressing, pain, ambulation, feeding, urine output)

Answer 33

a) 30 min If the anaesthesia machine requires electrical power for normal operation, a backup power supply must be a part of the machine and permit normal operation for at least 30 minutes after a mains power supply failure. An alarm must be activated at the time of the mains failure and the state of the reserve power supply must be indicated while it is in use. https://www.anzca.edu.au/getattachment/f05e02ec-2023-4c50-b57f-9549ea0c4183/PS54(A)-Position-statement-on-the-minimum-safety-requirements-for-anaesthesia-machines-and-workstations-for-clinical-practice-2021#page=

Answer 34

d) Reduce length of stay less time in aged care and reduced mortality Blue book 2019: "A referral to a geriatrician for further assessment and management may also be warranted in the preoperative period. Indeed, a meta-analysis of perioperative interventions to reduce delirium found that a geriatrics consultation before surgery was one of only two perioperative interventions that were associated with a reduction in delirium." Association of anaesthetists: The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review - reduced medical complications > reduced postop delirium, > reduced pneumonia > reduced pressure sores - fewer cancellations - reduced length of stay

Answer 35

a) Accurate delivery of volatile concentration from vaporiser PS31 Level two check should be performed at the start of each anaesthetic list. 4.2.3.2 Inhalational anaesthesia delivery devices (vapouriser) 4.2.3.2.1 Ensure electricity is connected to vapourisers that require it. 4.2.3.2.2 Check the anaesthetic liquid level is within marked limits. 4.2.3.2.3 Ensure all filling ports are sealed. 4.2.3.2.4 Check correct seating, locking and interlocking of detachable vapourisers or casettes. 4.2.3.2.5 Test for circuit leaks with a cassette installed or for each vapouriser in the “on” and “off” state. 4.2.3.3 Check for machine leaks upstream from the common gas outlet or breathing system, using a protocol appropriate for the anaesthesia delivery system.

Answer 36

c) Breast milk 3 hours before, clear fluids 1 hour before 3mls/kg PS07 - patient preparation and preanaesthetic consultation appendix 1 2023 Children up to 16 years: Clear fluids of 3ml/kg up to 1 hour before. <6 months Formula 4 hours Breast 3 hours Clear 1 hour >6 months: solids and formula wait 6 hours. Breast milk 4 hours. Clear 1 hour

Answer 37

a) Non-inferiority is not demonstrated Possible outcomes in a non-inferiority trial. In A (blue), non-inferiority is demonstrated. In B (green), non-inferiority is not demonstrated, and the trial is inconclusive. In C (red), the new treatment is inferior.

Answer 38

a. 1% i.e. what is the positive predictive value (PPV) for this test PPV= TP/ TP +FP Negative Predictive Value = TN / TN + FN Prevalence of 1/1000 Sensitivity of 100% Specificity of 90% Of patients that are disease positive in population of 1000 TP = 1 FN = 0 -> 100% sensitivity Of patients that are disease negative in population of 1000 FP = 99 TN = 900 -> 90% Specificity PPV= TP/ TP + FP = 1/ 1 + 99 = 1/100 =1% NPV= TN/ TN + FN =900/ 900 + 0 = 1/1 = 100%

Answer 39

Answer: 3/100 In statistical analysis, the rule of three states that if a certain event did not occur in a sample with n subjects, the interval from 0 to 3/n is a 95% confidence interval for the rate of occurrences in the population. When n is greater than 30, this is a good approximation of results from more sensitive tests. For example, a pain-relief drug is tested on 1500 human subjects, and no adverse event is recorded. From the rule of three, it can be concluded with 95% confidence that fewer than 1 person in 500 (or 3/1500) will experience an adverse event. By symmetry, for only successes, the 95% confidence interval is [1−3/n,1]. The rule is useful in the interpretation of clinical trials generally, particularly in phase II and phase III where often there are limitations in duration or statistical power. The rule of three applies well beyond medical research, to any trial done n times. If 300 parachutes are randomly tested and all open successfully, then it is concluded with 95% confidence that fewer than 1 in 100 parachutes with the same characteristics (3/300) will fail.

Answer 40

D. 4 * alternatively her Fisher score is: grade 2 (diffuse thin (<1 mm) SAH, no clots; which estimates an incidence of symptomatic vasospasm of 25%) Note the new modified Fischer scale. G0 No SAH or IVH (0%) G1 Focal or diffuse thin SAH but no IVH (6-24%) G2 Focal or diffuse thin SAH with IVH (15-33%) G3 Thick SAH no IVH (33-35%) G4 Thicc SAH with IVH (34-40%) The main differences between the Fisher scale and modified Fisher scale are: 1) Fisher scale, no SAH is grade 1, but 0 in modified Fisher scale 2) Fisher scale, thin SAH & no IVH is grade 2, but 1 in modified Fisher scale 3) Fisher scale, thick SAH with no IVH is grade 3 and the same 3 in modified Fisher scale 4) Fisher scale, any IVH is grade 4, irrespective of the presence of SAH but in modified Fisher scale it is either 2 if thin or no SAH, or grade 4 if thick SAH Modified Fisher Scale: grade 0 - no subarachnoid hemorrhage (SAH) - no intraventricular hemorrhage (IVH) - incidence of symptomatic vasospasm: 0% 3 grade 1 - focal or diffuse, thin SAH - no IVH - the incidence of symptomatic vasospasm: 24% grade 2 - focal or diffuse, thin SAH - IVH present - the incidence of symptomatic vasospasm: 33% grade 3 - thick SAH - no IVH - the incidence of symptomatic vasospasm: 33% grade 4 - thick SAH - IVH present - the incidence of symptomatic vasospasm: 40% Note: the original study did not include a specified measurement or criteria to define thick vs thin hemorrhage. REPEAT

Answer 41

a. Drugs that absolutely must not be used for pregnancy. (absolute contraindication) https://www.tga.gov.au/australian-categorisation-system-prescribing-medicines-pregnancy

Answer 42

C 3 hours for breast milk, 1 hour for clear fluids also B. 4 hours for formula, 1 hour clear fluids 0-6mo 4/3/1 Children > 6mo 6/4/1 Clear fluids 3mL/kg max

Answer 43

Line isolation monitor alarms when single fault in system. If the alarm is going off, the last piece of equipment plugged in is usually suspect and should be unplugged.

Answer 44

100 years Desflurane: 10yrs Sevoflurane 1yr

Answer 45

e) Maintain SBP 140-180 1. Tight control of BP, preferentially with IABP > goal of >140/90 mmHg and <180/105 mmHg. 2. Oxygen supplementation to maintain SpO2 >92%. 3. Maintenance of eucapnia to avoid cerebral vasoconstriction > (ETCO2 35- 45 mmHg) 4. Temperature maintained 35-37c 5. Euglycaemia (BGL 70-140 mg/dL (4-8 mmol/L)) and hourly monitoring

Answer 46

c) p-value e) robustness of the statistics The power of a study is determined by: 1. Frequency of outcome being studied 2. magnitude of effect 3. study design 4. sample size. The greater the error variance (or standard deviation) the less the power BARASH: Experimental Medicine: Statistical Analysis POWER: The error of failing to reject a false null hypothesis (false-negative) is called a type II or β-error. (The power of a test is 1−β.) The probability of a type II error depends on four factors. 1. Unfortunately, the smaller the α, the greater the chance of a false-negative conclusion; this fact keeps the experimenter from automatically choosing a very small α. 2. The more variability there is in the populations being compared, the greater the chance of a type II error. This is analogous to listening to a noisy radio broadcast; the more static there is, the harder it will be to discriminate between words. 3. Increasing the number of subjects will lower the probability of a type II error. 4. The most important factor is the magnitude of the difference between the two experimental conditions. The probability of a type II error goes from very high, when there is only a small difference, to extremely low, when the two conditions produce large differences in population parameters. There are four options for decreasing type II error (increasing statistical power): (1) raise α, (2) reduce population variability, (3) make the sample bigger, and (4) make the difference between the conditions greater. What is Alpha: Alpha is also known as the level of significance. This represents the probability of obtaining your results due to chance. The smaller this value is, the more “unusual” the results, indicating that the sample is from a different population than it’s being compared to, for example. Commonly, this value is set to .05 (or 5%), but can take on any value chosen by the research not exceeding .05. Alpha also represents your chance of making a Type I Error. What’s that? The chance that you reject the null hypothesis when in reality, you should fail to reject the null hypothesis. In other words, your sample data indicates that there is a difference when in reality, there is not. Like a false positive.

Answer 47

a) case control https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section5.html

Answer 48

Sx and exacerbations FEV1 GOLD ABE assessment tool

Answer 49

b. GA Independent predictors for severe BCIS were: ASA grade III—IV chronic obstructive pulmonary disease medication with diuretics or warfarin Source: BJA 2014 Article https://academic.oup.com/bja/article/113/5/800/2920080

Answer 50

d) Creatinine - Originally devised to predict outcomes in Cirrhotic patients undergoing portosystemic Surgery - Assess perioperative risk for patients with liver disease who undergo hepatic or non-hepatic surgery - Factors include: o Encepahlopathy § None +1 § Mild to moerate + 2 § Severe +3 o Ascites § None +1 § Mild to moderate (diuretic responsive) +2 § Severe (diuretic refractory) +3 o Bilirubin § <2 mg/dl +1 § 2-3mg/dl +2 § >3 mg/dl +3 o Albumin § >3.5g/dl +1 § 2.8-3.5g/dl +2 § <2.8g/dl +3 o INR § <1.7 +1 § 1.7-2.3 +2 § >2.3 +3 - Class A 5-6 points o 1-5yr survival rate 95% - Class B 7-9 points o 1-5 year survival rate 75% - Class C 10-15 points 1-5 yr survival rate 50% Original study Mortality rates in patients who undergo abdominal surgeries: - Class A 10% - Class B 82% - Class C 82% Newer Study mortality rates after surgery: - Class A 2% - Class B 12% - Class C 12% Drawbacks: - Subjective measurement of: o ascites o encephalopathy - Does not consider o Pre-op infection o Aetiology of cirrhosis o Surgery type

Answer 51

c) 93% ANZCOR suggests against the routine administration of oxygen in persons with chest pain.13 [2015 COSTR, weak recommendation, very-low certainty evidence] For persons with heart attack, routine use of oxygen is not recommended if the oxygen saturation is >93% [National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: practice advice].9

Answer 52

Nitrous oxide Halothane & isoflurane cause catalytic destruction of ozone, but halothane hardly used and isoflurane has short atmospheric lifetime. Desflurane + sevoflurane don’t cause ozone depletion.

Answer 53

c. 9 AHA guidelines 12 Months But 12 weeks minimum Although the evidence between surgical timing and stroke risk is limited to only these 2 studies, we suggest that elective noncardiac surgery be deferred at least 6 months after a prior stroke, and possibly as long as 9 months to reduce the risk of perioperative stroke in patients undergoing noncardiac surgery. Alternatively, patients who stand to gain significant improvements in quality of life with elective surgery may consider waiting only 6 months after a prior stroke REPEAT

Answer 54

A or D International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion Findings: In patients with ruptured intracranial aneurysms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival benefit continues for at least 7 years. The risk of late rebleeding is low, but is more common after endovascular coiling than after neurosurgical clipping.

Answer 55

400mls of clear fluids pre op Safe upper limit - definitely has not not been identified and will vary from patient to patient. Clear fluids Water / CHO rich fluids / pulp free fruit juice / clear cordial / black tea and coffee

Answer 56

Repeat c) Breast milk 3 hours, clear fluids 1 hour to max 3ml/kg Infants <6 months having elective procedure * 4 hours for formula * 3 hours for breast milk * 1 hour for clear fluids (≤3 ml/kg/hr) Children > 6 months having elective procedure * 6 hours for limited solid food or formula * 4 hours for breast milk * 1 hour for clear fluids (≤ 3ml/kg/hr)

Answer 57

a) 100-200 2012 BERLIN DEFINITION OF ARDS ARDS is an acute diffuse, inflammatory lung injury, leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue…[with] hypoxemia and bilateral radiographic opacities, associated with increased venous admixture, increased physiological dead space and decreased lung compliance. Key components - acute, meaning onset over 1 week or less - bilateral opacities consistent with pulmonary edema must be present and may be detected on CT or chest radiograph - PF ratio <300mmHg with a minimum of 5 cmH20 PEEP (or CPAP) - “must not be fully explained by cardiac failure or fluid overload,” in the physician’s best estimation using available information — an “objective assessment“ (e.g. echocardiogram) should be performed in most cases if there is no clear cause such as trauma or sepsis. Severity - ARDS is categorized as being mild, moderate, or severe:

Answer 58

b) 3 months | ANZCA PS09 2014 ## Footnote NB: PG09 was updated in 2022 and no longer states a minimum timeframe, so this is unlikley to return as an MCQ

Answer 59

d. 65 to 85 per hundred 85% of australians are CMV positive by the age of 40 https://www.blood.gov.au/system/files/documents/cmv-blood-components.pdf

Answer 60

Cardiac Arrest Source: LITFL

Answer 61

age Domains: 1. Cognition 2. General health status 3. Functional independance 4. social support 5. Medication use 6. Nutrition 7. Mood ?interpreted as mental illness in stem? 8. Continence 9. Functional performance Scoring 0-5= Not frail 6-7= Vulnerable 8-9= Mild Frailty 10-11= Moderate Frailty 12-17= Severe Frailty Easy way to remember is CONFUSION Cognition Overall Health Nutrition Function performance Urine incontinence Social support Independence Oral Meds Nightmares

Answer 62

B) analyse the difference between the means of more than two groups

Answer 63

(base rate is 10%, experimental group is 8% (20% below 10%) therefore 100/ 2 = 50 or 1 divided by risk reduction population risk = 10/100 patients get PONV population risk + new antiemetic = 8/100 patients get PONV (8/100 as reduction by 20% with new drug) RR= 0.10-0.08=0.02 NNT= 1/RR =1/0.02 =50

Answer 64

e) 54 ANZCA PS 29: 1. Ex-preterm infants at risk of post-op apnoea should not be considered for same day discharge unless they are medically fit and have reached a PMA of 54 weeks. 2. Term infants should not be considered for same day discharge unless they are medically fit and have reached a PMA of 46 weeks. SPANZA PS29 BP: Apnoea significant if: - lasts more than 15 seconds - HR <100 (or <30 from baseline) - SpO2 <90% Apnoea risks are: PMA, anaemia, chronic lung disease, pre-operative apnoea of prematurity Most post-op apnoea occur within first 2 hours In healthy infants, after 12 apnoea free hours, apnoea risk approaches preop levels in health infants infants should be monitored for 12 apnoea free hours high risk infants need to be admitted for a longer period of monitoring

Answer 65

c) Wipe with detergent Laryngoscope handles: -non-critical devices -should be cleaned with detergent and water between each patient use. -If contaminated with blood, they should be washed and disinfected. Laryngoscope blades: -considered critical equipment because they may penetrate skin or mucous membranes, require sterilisation. Bougies: -Re-use of these items has been associated with cross-infection. -It is preferable that alternative single-use intubation aids are employed when possible Face Masks: -In contact with intact skin, these items are frequently contaminated by secretions -considered semi-critical, requiring cleaning and thermal disinfection

Answer 66

B. Aspiration Aspiration was the single commonest cause of death in anaesthesia events. Poor judgement was the likely root cause in many cases which included elements of poor assessment of risk (patient and operation) and failure to use airway devices or techniques that would offer increased protection against aspiration. Several major events occurred when there were clear indications for a rapid sequence induction but this was not performed.

Answer 67

B RR = 0.25-0.2 = 0.05 NNT = 1/RR = 20

Answer 68

CO2 Laser danger is proportional to penetration. Penetration inversely proportional to the laser wavelength. CO2 laser has very little penetration (~ 10micrometres), as it has a wavelength of 10 600nm. Helium-Neon laser also has very little penetration. Nd:YAG is the most powerful, with a penetration of 2-6mm, as it has a wavelength of 1064nm.

Answer 69

3 months full time Source: ANZCA PG 09

Answer 70

E. Decreased acute kidney injury Restrictive had more AKI Otherwise no outcome significant statistically https://www.thebottomline.org.uk/summaries/relief/

Answer 71

a) <1% low risk for 30 day adverse cardiovascular event. >5% high. 1-5% therefore moderate. https://www.ahajournals.org/doi/10.1161/circ.105.10.1257 Based on surgery type c) 10-15% (unlikely this) Based on patient factors alone, adults can be categorized into low (<5%), borderline (5 to <7.5%), intermediate (≥7.5 to <20%), or high (≥20%) 10-year CVD risk. Source: ACC/AHA Guideline 2019 https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2019/03/07/16/00/2019-acc-aha-guideline-on-primary-prevention-gl-prevention https://www.jacc.org/doi/epdf/10.1016/j.jacc.2019.03.010

Answer 72

D) Age Can Grandma Functionally Support Medication Nutrition Mood Continence Self i.e. C (cognition) G (general health) F (functional independence) S (social support) M (medication use) N (nutritional status) M (mood, presence of mental illness) C (continence) S (self reported performance)

Answer 73

100 < PaO2/FiO2 ≤ 200 with PEEP ≥5 cmH2O https://link.springer.com/article/10.1007/s00134-012-2682-1/tables/3

Answer 74

e) hypoglycaemia

Answer 75

C. 3 - if male CHA2DS2-VASc score ≥2 to be recommended chronic OAC (Grade 1A). - if female CHA2DS2-VASc score ≥3 to be recommended chronic OAC (Grade 1A). * non-sex risk factor also holds bearing: - For patients with CHA2DS2-VASc score of 1 in males and 2 in females based on age 65 to 74 years, we recommend chronic OAC (Grade 1A). Up to date: Our approach to deciding whether to prescribe anticoagulant therapy for patients with AF (excluding those with rheumatic mitral stenosis that is severe or clinically significant [mitral valve area ≤1.5 cm2], a bioprosthetic valve [surgical or bioprosthetic] within the first three to six months after implantation, or a mechanical heart valve) is as follows: *For a CHA2DS2-VASc score ≥2 in males or ≥3 in females, we recommend chronic OAC (Grade 1A). *For a CHA2DS2-VASc score of 1 in males and 2 in females: -For patients with CHA2DS2-VASc score of 1 in males and 2 in females based on age 65 to 74 years, we recommend chronic OAC (Grade 1A). Age 65 to 74 years is a stronger risk factor than the other factors conferring one CHA2DS2-VASc score point. -For patients with other risk factors, the decision to anticoagulate is based upon the specific nonsex risk factor and the burden of AF. For patients with very low burden of AF (eg, AF that is well documented as limited to an isolated episode that may have been due to a reversible cause such as recent surgery, heavy alcohol ingestion, or sleep deprivation), it may be reasonable to forgo chronic OAC and institute close surveillance for recurrent AF, although it may not be possible to reliably estimate AF burden from surveying symptoms or infrequent monitoring. The frequency and duration of AF episodes vary widely over time, and episodes are often asymptomatic. *For patients with a CHA2DS2-VASc of 0 in males or 1 in females, we suggest against OAC (Grade 2C). Patient values and preferences may impact the decision. For example, a patient who is particularly stroke averse and is not at increased risk for bleeding may reasonably choose anticoagulation, particularly if the patient is a candidate for treatment with a direct oral anticoagulant (DOAC). 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline

Answer 76

d) The pooled data from all of the studies Forest plots or blobbograms are used in order to show graphically the studies which have been included in the meta-analysis. They demonstrate the differences between studies and provide an estimate of the overall result.

Answer 77

None of those? Mathematical model for plotting responses to 2 varying drugs when used in conjunction (Ie opioid and propofol) (create a surface that encompass the complete set of isobolograms, concentration-effect curves and the shift of concentration-effect curve in the presence of another drug https://www.sciencedirect.com/science/article/pii/S1875459715000569)

Answer 78

e) discarding not required

Answer 79

c) Increased mortality Use of perioperative metoprolol was associated with: * Decreased rate of myocardial infarction * Decreased rate of revascularisation * Decreased rate of developing new atrial fibrillation * INCREASED rate of death * INCREASED rate of stroke * INCREASED rate of significant hypotension INCREASED rate of significant bradycardia

Answer 80

d. Able to turn head 45 deg NEXUS criteria: One easy mnemonic for these criteria is NSAID: Neuro Deficit Spinal Tenderness (Midline) Altered Mental Status/Level of Consciousness Intoxication Distracting Injury

Answer 81

Gown and gloves, hand hygiene, eye protection, mask. CDC

Answer 82

strained broth ANZCA PS07: "Clear fluids are regarded as water, carbohydrate rich fluids, specifically developed for perioperative use, pulp free fruit juice, clear cordial, black tea and coffee. It excludes fluids containing particulate matter, soluble fibre, milk-based drinks and jelly"

Answer 83

a. Teicoplanin

Answer 84

c= Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Category A Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed. Category B1 Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have not shown evidence of an increased occurrence of fetal damage. Category B2 Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals are inadequate or may be lacking, but available data show no evidence of an increased occurrence of fetal damage. Category B3 Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans. Category C Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details. Category D Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details. Category X Drugs which have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy.

Answer 85

e. 1:136,000 https://www.bjanaesthesia.org/article/S0007-0912%2817%2930746-8/fulltext 1/670 E-LSCS 1/8000 with muscle relaxation 1/8600 CTS 1/8200 Volatile + neuromuscular blocking Overall 1:19000

Answer 86

B. 2 ( CVA, Insulin use) ## Footnote UTD CHF Renal impairment Insulin use Stroke Ischaemic heart Surgically high risk

Answer 87

A. Offering an epidural on a patient who is labouring spontaneously with a normal pregnancy and no comorbidities, upon request

Answer 88

c. 9 AHA guidelines 12 Months But 12 weeks minimum Although the evidence between surgical timing and stroke risk is limited to only these 2 studies, we suggest that elective noncardiac surgery be deferred at least 6 months after a prior stroke, and possibly as long as 9 months to reduce the risk of perioperative stroke in patients undergoing noncardiac surgery. Alternatively, patients who stand to gain significant improvements in quality of life with elective surgery may consider waiting only 6 months after a prior stroke

Answer 89

b) Decreased mortality due to bleeding TXA decreased death due to bleeding. No difference in all cause mortality. No difference in use of blood products. No difference in surgical interventions. No difference in thromboembolic events.

Answer 90

Codeine Source Appendix ANZCA PG 07

Answer 91

d. 65 to 85 per hundred Risk of acquiring CMV through a leucodepleted blood product is estimated at around 1 in 13,575,000. This compares to a community acquired risk where 85% of Australian adults are infected by the age of 40. 85% of australians are CMV positive by the age of 40 https://www.blood.gov.au/system/files/documents/cmv-blood-components.pdf

Answer 92

C) Adverse event—a clinical incident in which unintended or unneccessary harm resulted. Sentinel event: Sentinel events are a subset of adverse patient safety events that are wholly preventable and result in serious harm to, or the death of, a patient Adverse event—a clinical incident in which unintended or unneccessary harm resulted. Harm—impairment of structure or function of the body and/or any deleterious effects arising there from. Harm includes disease, injury, suffering, psychological harm, disability and death.* Near miss: an incident or potential incident that was averted and did not cause harm, but had the potential to do so. Near miss = an act that could have caused harm but was avoided Sentinel event = serious permanent harm (there are 12 listed) Adverse event = preventable event that did result in harm Malfeasance = less clear, more lawyer talk, but caused harm Misconduct = deliberate wrongful act

Answer 93

No change in Mortality, no change in POD No evidence was found that mortality or serious complication were modified by targeting either a BIS of 50 or 35 A broad range of anaesthetic depth can be delivered safely when using volatile anaesthetic agents and processed electroencephalographic monitoring https://www.thebottomline.org.uk/summaries/pom/balance/

Answer 94

b) cohort study What is a Cohort Study design? - Cohort studies are longitudinal, observational studies, which investigate predictive risk factors and health outcomes. - They differ from clinical trials, in that no intervention, treatment, or exposure is administered to the participants. - The factors of interest to researchers already exist in the study group under investigation. - Study participants are observed over a period of time. The incidence of disease in the exposed group is compared with the incidence of disease in the unexposed group. - Because of the observational nature of cohort studies they can only find correlation between a risk factor and disease rather than the cause. Cohort studies are useful if: - There is a persuasive hypothesis linking an exposure to an outcome. - The time between exposure and outcome is not too long (adding to the study costs and increasing the risk of participant attrition). - The outcome is not too rare.

Answer 95

Inconclusive/Noninf not demonstrated

Answer 96

d) 1:19000 The estimated incidence of patient reports of AAGA was ~1:19,000 anaesthetics. However, this incidence varied considerably in different settings. The incidence was ~1:8,000 when neuromuscular blockade was used and ~1:136,000 without it. Two high risk surgical specialties were Cardiothoracic anaesthesia (1:8,600) and Caesarean section (~1:670).

Answer 97

Answer: a) Codeine TGA Pregnancy categories https://www.tga.gov.au/prescribing-medicines-pregnancy-database Category A ■ Codeine Category C ■ Methadone ■ Tramadol ■ Oxycodone ■ Morphine

Answer 98

b. 1 or more RF In this iteration of the PONV guideline, one of the major changes is that we now recommend the use of multimodal prophylaxis in patients with one or more risk factors. This decision was made due to the concern over inadequate prophylaxis as well as the availability of antiemetic safety data.

Answer 99

b. 0.5% Chlorhexidine/ETOH For skin preparation, 0.5 per cent chlorhexidine in alcohol, where available, is recommended for neuraxial techniques although it should be noted that very small quantities of neuraxial chlorhexidine have been implicated in cases of severe neurotoxicity

Answer 100

Answer: a) 1:700 NAP5 Summary The incidence of reports of AAGA after general anaesthetic Caesarean section was much higher, ~1:670.

Answer 101

D. Albumin ## Footnote https://www.tamingthesru.com/blog/r1-diagnostics/labs-in-hepatic-failure

Answer 102

d. 7 weeks UPDATE: 2-3 weeks PG68(A) https://www.anzca.edu.au/getattachment/af1fb728-5e87-413a-b006-c54cecf282b1/PG68(A)-Guideline-surgical-patient-safety-SARS-CoV-2 For most patients, it is safe to proceed with surgery TWO TO THREE WEEKS post SARS-CoV-2 infection provided no ongoing symptoms are present. For high-risk patients, it is recommended to perform an individualised risk assessment and utilise Shared Decision Making to determine optimal timing of surgery post SARS-CoV-2 infection. Patients who are asymptomatic, have returned back to baseline, are vaccinated, aged <70 years and without comorbidity can proceed with non-urgent elective minor surgery (day case) and endoscopy procedures without delay beyond the infectious period (timeframe as per local guideline and expertise ALL patient with ongoing symptoms, especially those who have not returned to baseline function and those patients with a history of moderate or more severe25 SARS-CoV-2 infection: recommended delay for non-urgent elective surgery is still 7 weeks

Answer 103

ANSWER: d. Ferritin <100mcg/L Serum ferritin level < 30 μg.l−1 is the most sensitive and specific test used for the identification of absolute iron deficiency. However, in the presence of inflammation (C-reactive protein > 5 mg.l−1) and/or transferrin saturation < 20%, a serum ferritin level < 100 μg.l−1 is indicative of iron deficiency. International consensus statement on peri-operative management of anaemia and iron deficiency https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.13773#:~:text=Recommendations%20for%20best%20clinical%20practice,-Physicians%20should%20consider&text=Serum%20ferritin%20level%20%3C%2030%20%CE%BCg,serum%20ferritin%20level%20%3C%20100%20%CE%BCg.

Answer 104

d. 54 Ex-preterm infants at risk of post-operative apnoea should not be considered for same day discharge unless they are medically fit and have reached a postmenstrual age of 54 weeks. Term infants should not be considered for same day discharge unless they are medically fit and have reached a postmenstrual age of 46 weeks.d) 54 weeks ## Footnote https://www.anzca.edu.au/getattachment/568bad2d-7517-4eea-9c5d-cb7aa1c60

Answer 105

a) case control https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section5.html

Answer 106

d) Hypotension The commonest presenting feature of perioperative anaphylaxis by far was hypotension (accounting for 46%), followed by bronchospasm/high airway pressure (18%), tachycardia (9.8%), flushing/non-urticarial rash 6.6% and cyanosis/oxygen desaturation (4.7%).

Answer 107

b) Stop/stop antibiotics For adults with suspected sepsis or septic shock, we suggest AGAINST using procalcitonin plus clinical evaluation to decide when to start antimicrobials, as compared to clinical evaluation alone. Weak, very low quality of evidence For adults with an initial diagnosis of sepsis or septic shock and adequate source control where optimal duration of therapy is unclear, we suggest using procalcitonin AND clinical evaluation to decide when to discontinue antimicrobials over clinical evaluation alone. Weak, low quality of evidence

Answer 108

10mins PG18

Answer 109

NOT for this question (base rate is 10%, experimental group is 8% (20% below 10%) therefore 100/ 2 = 50 or 1 divided by risk reduction population risk = 10/100 patients get PONV population risk + new antiemetic = 8/100 patients get PONV (8/100 as reduction by 20% with new drug) RR= 0.10-0.08=0.02 NNT= 1/RR =1/0.02 =50

Answer 110

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15291 The 2011 guidelines list seven ‘acceptable’ reasons for delaying surgery: 1 Haemoglobin < 80 g.l−1 2 Plasma sodium concentration < 120 or > 150 mmol.l−1 and potassium concentration < 2.8 or > 6.0 mmol−1 3 Uncontrolled diabetes 4 Uncontrolled or acute onset left ventricular failure. 5 Correctable cardiac arrhythmia with a ventricular rate > 120.min−1 6 Chest infection with sepsis 7 Reversible coagulopathy

Answer 111

No change in Mortality, no change in POD No evidence was found that mortality or serious complication were modified by targeting either a BIS of 50 or 35 A broad range of anaesthetic depth can be delivered safely when using volatile anaesthetic agents and processed electroencephalographic monitoring https://www.thebottomline.org.uk/summaries/pom/balance/

Answer 112

Primum non nocere: First, do no harm - Non maleficence

safety and quality in anaesthetic practice Flashcards

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