Surgery - Anaesthetics

Question 1

what are the 2 types of anaesthesia?

Answer 1

• general| - regional

Question 2

what is true NBM pre-operatively?

Answer 2

• 6h no food| - 2h no clear fluids

Question 3

which medications can be offered pre-op? give the indication for each one

Answer 3

NAME?

Question 4

why and when is rapid sequence induction used?

Answer 4

NAME?

Question 5

key complication in RSI? how can this be avoided?

Answer 5

• aspiration of stomach contents into lungs| - apply cricoid pressure

Question 6

what is the triad of GA?

Answer 6

NAME?

Question 7

what is the role of hypnotic agents in GA?

Answer 7

to make the pt unconscious

Question 8

hypnotic agents which can be administered IV?

Answer 8

used to induce LOC:- propofol- ketamine- thiopental sodium- etomidate (rare)

Question 9

hypnotic agents which are inhaled?

Answer 9

mostly used to maintain LOCvolatile:- sevoflurane- desflurane- isofluranenon-volatile:- nitrous oxide

Question 10

where do muscle relaxants act?

Answer 10

NMJ

Question 11

name a depolarising muscle relaxant

Answer 11

suxamethonium

Question 12

name a non-depolarising muscle relaxant

Answer 12

• rocuronium| - atracurium

Question 13

how can a muscle relaxant’s actions be reversed?

Answer 13

• neostigmine| - sugammadex (only for non-depolarising ones)

Question 14

give examples of analgesic agents used in GA?

Answer 14

all opiates:- fentanyl - alfentanil- remifentanil- morphine

Question 15

which antiemetics are used prophylactically post-op?

Answer 15

NAME?

Question 16

drug class of ondansetron?

Answer 16

5HT3 (serotonin) receptor antagonist

Question 17

drug class of dexamethasone?

Answer 17

corticosteroid

Question 18

drug class of cyclizine?

Answer 18

H1 (histamine) receptor antagonist

Question 19

who should cyclizine be used with caution in?

Answer 19

• pts with HF| - elderly

Question 20

who should dexamethasone be used with caution in?

Answer 20

• pts with DM| - immunocompromised pts

Question 21

how can you test if the muscle stimulant has worn off?

Answer 21

NAME?

Question 22

describe train-of-four stimulation

Answer 22

• try to stimulate a nerve 4 times| - if the muscle responses get weaker with each stimulation, it means the relaxant has not yet worn off

Question 23

what is malignant hyperthermia?

Answer 23

rare but dangerous hypermetabolic response to anaesthesia

Question 24

which agents carry a risk of malignant hyperthermia?

Answer 24

NAME?

Question 25

presentation of malignant hyperthermia?

Answer 25

- increased body temp LMAO- increased CO2 exhalation- high HR- muscle rigidity- acidosis- high K+

Question 26

management of malignant hyperthermia?

Answer 26

dantrolene

Question 27

how is a peripheral nerve block carried out?

Answer 27

#NAME?

Question 28

indications for a spinal block?

Answer 28

- C-sections- TURP- hip fracture repairs

Question 29

how is a spinal block carried out?

Answer 29

#NAME?

Question 30

typical indication for an epidural?

Answer 30

woman in labour with vaginal delivery

Question 31

how is an epidural carried out?

Answer 31

- catheter inserted into epidural space (OUTSIDE of CSF and spinal cord)- levobupivacaine inserted +/- fentanyl

Question 32

key risks of using epidural in labour?

Answer 32

- prolonged second stage of labour| - increased chances of needing instrumental delivery

Question 33

why is it important that a pt is able to do a straight leg raise under epidural anaesthesia?

Answer 33

- if not, catheter may be in subarachnoid space| - needs urgent anaesthetic review

Question 34

example of LA?

Answer 34

lidocaine

Question 35

examples of indications for LA use?

Answer 35

#NAME?

Question 36

indications for a tracheostomy?

Answer 36

#NAME?

Question 37

what can an arterial line be used for?

Answer 37

#NAME?

Question 38

where might a central venous catheter (central line) be inserted?

Answer 38

#NAME?

Question 39

define chronic pain

Answer 39

pain that has been present for 3+ months

Question 40

what is allodynia?

Answer 40

when pain is experienced with sensory inputs which should not cause pain, e.g. light touch

Question 41

features of neuropathic pain?

Answer 41

#NAME?

Question 42

what are the 3 steps of the WHO analgesic ladder?

Answer 42

1. non-opioids (paracetamol, NSAIDs)2. weak opioids (codeine, tramadol)3. strong opioids (morphine, oxycodone, fentanyl, buprenorphine)

Question 43

which adjuvants can be used to treat neuropathic pain?

Answer 43

#NAME?

Question 44

common side effects of NSAIDs?

Answer 44

#NAME?

Question 45

in which pts are NSAIDs inappropriate / contraindicated?

Answer 45

#NAME?

Question 46

which drugs are co-prescribed with NSAIDs?

Answer 46

PPIs (e.g. omeprazole)

Question 47

key side effects of opioids?

Answer 47

#NAME?

Question 48

how is opioid overdose reversed?

Answer 48

naloxone

Question 49

how are opioids prescribed in palliative care?

Answer 49

- background opioids| - plus rescue doses for breakthrough pain

Question 50

how is the rescue dose of an opioid calculated for palliative care?

Answer 50

rescue dose = 1/6 of total background dose over 24 hrs

Question 51

how is bradycardia secondary to patient-controlled analgesia overuse managed?

Answer 51

atropine

Question 52

common areas affected by chronic pain?

Answer 52

#NAME?

Question 53

describe the analgesic ladder for treating pain secondary to OA

Answer 53

1. PO paracetamol + topical NSAIDs2. add PO NSAIDs (+PPI)3. consider opioids

Question 54

which 4 medications are used first-line in the treatment of neuropathic pain?

Answer 54

#NAME?

Question 55

1st line treatment for trigeminal neuralgia?

Answer 55

carbamazepine (different to other neuropathic pain conditions!)

Question 56

describe the different "levels" of patient care needs in a hospital

Answer 56

- level 1 = ward-based care- level 2 = HDU - level 3 = ICU (highest level of support needed)

Question 57

common reasons for ICU admission?

Answer 57

#NAME?

Question 58

how can enteral nutrition be given in the ICU setting?

Answer 58

#NAME?

Question 59

why is TPN given via central line rather than a cannula?

Answer 59

- it irritates peripheral veins| - causes thrombophlebitis

Question 60

complications of mechanical ventilation?

Answer 60

#NAME?

Question 61

which drug can be administered to treat agitated pts with delirium in ICU setting?

Answer 61

dexmedetomidine