Surgery and anaesthesia

Question 1

How long do you have to be fasted before surgery

Answer 1

6hrs solids
2 hrs liquids including black coffee and tea without milk

Question 2

How long do you have to stop COCP before surgery

Answer 2

4 weeks

Question 3

Which Diabetic drugs need to be modified for surgery

Answer 3

Metformin- normal- but omit lunch dose if TDS
Sulphonylureas- if morning omit morning, afternoon, both
SGLT2- omit on day

Question 4

DVT prophylaxis

Answer 4

 Low risk: early mobilisation

 Med: early mobilisation + TEDS + 20mg enoxaparin 2 hrs pre

 High: early mobilisation + TEDS + 40mg enoxaparin 12 hours pre surgery

Avoid in eGFR <15

Question 5

ASA grades

Answer 5

1- normal
2- mild systemic disease
3- severe- limits
4- systemic this a constant threat
5- not expected to survive in 24 hrs

Question 6

Insulin changes for surgery

Answer 6

Reduce long acting by 20% night before and day of
Omit other insulin
Start sliding scale
Continue until tolerating food

Question 7

Risks of steroids during surgery

Answer 7

Poor wound healing
Infection
Adrenal crisis

Question 8

Stopping warfarin and DOACs before surgery

Answer 8

Warfarin 5days bridge with LMWH
DOACs- 2 days

Question 9

Drugs used in anaesthesia

Answer 9

Induction- propofol
Muscle relaxant- suxamethonium- depolarising
Vecuronium- non
Maintain- halothane

Question 10

Sx of malignant hyperpyrexia

Answer 10

Complication of suxamethonium or sevoflurane

Rise in temp and masseter spasm

Question 11

Tx of malignant hyperpyrexia

Answer 11

Dantrolene and cooling

Question 12

VTE prophylaxis after surgery

Answer 12

LMWH 6-12/ Fondaparinux 6 hours after surgery

Question 13

Cause of post op fever and their time line

Answer 13

Day 1-2 - wind- pneumonia, PE
3-5 water- UTI
5-7 wound - surgical site
5+ walking- DVT

Question 14

Types of IV access

Answer 14

Peripheral- large 14G if emergency, small 20G if not

Hickman- long term - 3 lumens- better for chemo

PICC-2 cannulas

Swanz gauz- in heart measure pressure

Question 15

ASA levels

Answer 15

1- normal
2- smoker, mild disease
3- substantial disease
4- severe
5- moribund

Question 16

Alcoholics requirement for anaesthesia and post surgery seizure

Answer 16

Often require larger doses of induction agent

IV lorazepam for seizure IV 4mg

Question 17

If raised ICP in ICU what factors can you do

Answer 17

Mannitol
Raise head to 30
Increase RR to hyperventilate

Question 18

If low BP after propofol induction what should you start

Answer 18

Metaraminol

Question 19

Why do you apply cricoid pressure

Answer 19

Occludes upper oesophagus
Prevents passive reflux

Question 20

Induction given with no chest movements what are the next steps

Answer 20

Insert OPA
Then once neuromuscular blockade given
Intubate

Question 21

Suxamethonium affects on electrolytes

Answer 21

Hyperkalaemia

Question 22

Rapid sequence induction steps

Answer 22

Preoxygenate- 5 min
Paralysis- induction and paralysing agent
Protection- cricoid pressure
Placement- intubation

Question 23

If patient with stent from MI what do you do regarding stopping medications

Answer 23

Speak to cardiology
AS stopping may cause stenosis

Question 24

Analgesia for rib fratures

Answer 24

Transversus abdominal plane block

Question 25

How to change steroids before surgery

Answer 25

Long term Increase HC Stop FC Start again 48-72 hours post op if eating and drinking

Question 26

Mx of spasmodic pain

Answer 26

Diazepamm

Question 27

Mx of lactate acidosis after surgery

Answer 27

Fluid bolus Can be caused by metformin

Question 28

Local anaesthesia toxicity sx

Answer 28

Numbing Tinnitus Dizziness

Question 29

Diabetic drugs and surgery

Answer 29

Metformin- if 3 omit lucch sulph-omit morning Gliptins, GLP- take normal SGLT2- omit on surgery

Question 30

Prescribing fluid

Answer 30

30ml/kg/day Calculate fluid deficit and add it on

Question 31

BMI ASA grading

Answer 31

30-40 ASA 2 >40- ASA 3

Question 32

If on prednisolone and about to have surgery what do you prescribe

Answer 32

Hydrocortisone

Question 33

End stage renal disease with dialysis ASA

Answer 33

3

Question 34

What goes in ASA 4

Answer 34

Recent MI, stroke, severe valve disease, end renal disease with no dialysis

Question 35

SE of etomidate

Answer 35

Adrenal suppression

Question 36

Inducing agent in haemodynamically unstable patients

Answer 36

Ketamine

Question 37

T2DM on gliclazide with HbA1c of 70 for morning surgery, what do you do

Answer 37

Omit morning gliclazide VRII- since above 69

Question 38

Inheritance of malignant hyperthermia

Answer 38

AD

Question 39

When is suxamethonium CI

Answer 39

Eye injuries Glaucoma Since increases IOP If hyperkalaemic

Question 40

When to do tracheostomy instead of ETT

Answer 40

Severe upper airway obstruction