wk 11- perioperative medicines, procedures and cams

Question 1

what general anaesthetic do pods have access to

Answer 1

methoxyflurane

Question 2

what is methoyflurane used for now

Answer 2

a short term, low dose analgesic inhaler

a mild sedative effect in some patients

not as an anaesthetic

Question 3

where is methoxyflurane metabolised/excreted

Answer 3

metabolised - liver
excreted- lungs and kidneys

Question 4

what is the onset and duration

Answer 4

onset-1-3mins
duration 5-10mins

Question 5

what is methoxyflurane contraindicated in

Answer 5

allergy
<1 yr old
severe cardiac disease
renal disease
orhepatic disease
respiratory depression
malignant hyperthermia
pregnancy (CAT C)
breastfeeding

Question 6

methoxyflurane drug interactions

Answer 6

beta blockers- hypertension

rifampicin, tetracycline, gentamicin, and other antibiotics - antibiotics

barbiturates- eplisepsy

drugs that reduce CNS- narcotics

IV adrenaline

Question 7

what can you use methoxyflurane for in operation

Answer 7

prior to local injection to reduce pain

Question 8

lorazepam is used for

Answer 8

pre procedural anxiety

Question 9

any drug interactions for lorazepam

Answer 9

no

Question 10

when do they take it for the procedure

Answer 10

night before and or 1/2 hours before the procedure

Question 11

what does LA with adrenaline do

Answer 11

prolongs LA block and provides haemostasis (vasoconstrictive)

Question 12

who cant you use adrenaline with

Answer 12

1. hyperthyroidism
2. severe heart disease
3. extremities with lack of blood supply (fingers and toes, PVD, raynaud’s)

Question 13

EMLA cream is

Answer 13

local anaesthetic topical

Question 14

whats a conservative way to make the needle stick less painful

Answer 14

icing

Question 15

local corticosteroid injections used for

Answer 15

soft tissue inflammation

Question 16

should you use corticosteroid injection for joint inflmmation

Answer 16

no, too many risks v benefit

Question 17

when would you use US guided injection

Answer 17

smaller tissues such as tendon sheath or neural

Question 18

risks of corticosteorid injections

Answer 18

infection
tissue necrosis
systemic factors

Question 19

how many local corticosteroid injections can someone have per year

Answer 19

4

Question 20

whats the risk with multiple corticosteroid injections into weightbearing tendons

Answer 20

spontaneous rupture

so keep it minimal if any

Question 21

what are long acting corticosteroids

Answer 21

dexamethasone
betamethasone

Question 22

short acting corticosteroids are

Answer 22

hydrocortisone
cortisone
predinisone
triamcinolone

Question 23

different preparations of corticosteroid

Answer 23

cortico and LA- to provide rapid relief of symptoms and confirm diagnosis

short acting and long acting cortico- to offer benefits of both, fast acting and long duration

Question 24

if a cortico is less soluble what does that mean for duration

Answer 24

longer duration

Question 25

if a corticosteroid is soluble what does that mean for duration

Answer 25

small duration

Question 26

where shouldnt you use low soluble agents what agent should you use thats got a higher solubility

Answer 26

soft tissue due to risk of tissue atrophy methylprednisiolone agent of choice or hydrocortisone

Question 27

corticosteroid injection indicated in what soft tissue conditions

Answer 27

bursitis tendonitis ganglion cysts neuromas entrapment syndromes fascitiis trigger points

Question 28

joint condiitons you can use cortico for

Answer 28

RA OA gout must rule out sepsis/septic arthritiis

Question 29

what is contraindicated in corticosteroids

Answer 29

infection fracture joint prosthesis achilles/patella tendinopathies allergy minimal relief after 2 injections anticoagulation therapy surrounding joint osteoporosis too many surrounding structures unmanaged diabetes

Question 30

how long do steroid flares last

Answer 30

1-3 days and ice can help relieve

Question 31

corticosteroids can cause what in unmanaged diabetes

Answer 31

hyperglycaemia