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3. Mondays > 304 Perioperative anaesthesia > Flashcards

304 Perioperative anaesthesia Flashcards

1
Q

What are the factors the patient needs to be fit enough for before surgery?

A

Potential complications and the stress response to surgery

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2
Q

What is the surgical stress response?

A

Complex neuro-endocrine activation that leads to metabolic, immunological, and haematological activations

It’s relative to the size of the insult so can be minimised by reducing invasiveness

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3
Q

What is the Duke activity status questionnaire (DASI)?

A

It estimates metabolic equivalents

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4
Q

How many metabolic equivalents is walking up 2 flights of stairs considered to be?

A

4

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5
Q

What is the ASA score?

A

American society of Anaesthesiologists

A method of assessing fitness for surgery

1: normal healthy patient
2: Patient with mild systemic disease
3: Patient with severe systemic disease
4: Systemic disease that is a constant risk to life
5: Patient won’t survive without surgery
6: Brain dead patient ready for organ donation

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6
Q

What are some surgical risk prediction models?

A

P-POSSUM
- Predicts 30-day mortality. It considers patient and surgical factors

NELA
-Predicts 30-day mortality of emergency laparotomy patients

SORT
-Predicts 30-day mortality

ACS NSQIP
-Predicts 30-day mortality, return to theatre, readmission, and discharge for acute care facility. But is time0consuming and expensive

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7
Q

What is the minimum size of an AAA to require surgery?

A

5.5cm

But also depends on the speed of development

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8
Q

How does cardiopulmonary exercise testing test fitness?

A

It provides an objective measure of physical fitness to predict perioperative risk

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9
Q

What is CPET?

A

Cardiopulmonary exercise testing

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10
Q

How does CPET work?

A

A patient is asked to cycle against resistance while their breath is measured for different gasses

Fitter people can go longer before they start producing lactic acid

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11
Q

What gas is measured in CPET?

A

VO2 or VCO2

Oxygen consumption or CO2 excretion to calculate the anaerobic threshold

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12
Q

What si meant by failure to rescue?

A

Dealing with complications early to improve mortality

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13
Q

At what anaerobic threshold is a patient considered high risk?

A

<11

Shows increased risk of complications

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14
Q

What are the benefits of CPET?

A

-Identifies pathology
-May encourage patients to exercise because it proves that it is safe
-Helps patients to understand the risk of surgery
-Identifies needs for prehabilitation

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15
Q

What is ‘prehabilitation’?

A

-Improving physical activity
-Optimising nutrition
-Improving psychological well-being

All to improve the improve the anaerobic threshold and improve outcomes of surgery

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16
Q

What are the disadvantages of ‘prehabilitation’?

A

-Requires delay to surgery which isn’t always appropriate
-Not all patients will benefit because they are already fit
-It’s resource intensive and not available everywhere

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17
Q

Which pathologies provide a window for prehabilitation?

A

Fully elective surgery

Patients with cancers and having neo-adjuvant chemotherapy

18
Q

What is neo-adjuvant chemotherapy?

A

Chemo before and after resection

It has better outcomes

19
Q

How does the dose of morphine differ between oral and subcutaneous administration?

A

Morphine has a lower bioavailability orally than subcut, so give half dose subcut

Morphine bioavailability orally: 30-50%

20
Q

How much is given for a breakthrough dose for opioids?

A

1/6th of the normal dose

21
Q

What is a breakthrough dose?

A

The dose given to a patient with chronic pain when when their pain had a sudden exacerbation but they’re already on analgesia

22
Q

How does a decreased ability to take deep breaths increase risk of complications?

A

It prevents the constant flow of air throughout the lung and makes pneumonia and lung collapse a greater risk

Can be minimised with analgesia to allow the patient to breath because they wont feel the postoperative pain

23
Q

What is the massive haemorrhage?

A

Loss of more than one blood volume within 24 hours (around 70 mL/kg, >5 litres in a 70 kg adult) 50% of total blood volume lost in less than 3 hours. Bleeding in excess of 150 mL/minute

24
Q

What is the purpose of cricoid pressure during anaesthetic induction?

A

To prevent the passage of gastric contents in the airway

25
Q

How does a spinal anaesthetic cause a headache?

A

The spinal anaesthetic needle will create a hole that will cause a leak of CSF from the sura that pulls the meninges to cause a headache

Treated with analgesia and sealing the hole with the patients blood

26
Q

How long should surgery be postponed for after a resp tract infection?

A

4 weeks

Because the infection will cause hyperactivity in the resp tract and increase the risk of infection post-op

27
Q

What is the aim for [Hb] in patients with IHD compared to no IHD?

A

IHD <90 Hb
No IDH <70 Hb

28
Q

What is the difference between group and screen and crossmatch?

A

A type and screen is ordered if blood transfusion is likely but not certain

While a crossmatch order indicates to the transfusion service that blood transfusion is required

29
Q

Why are 2 samples for group and save taken?

A

To minimise errors

30
Q

What is a group and screen test?

A

The type and screen are the primary pre-transfusion tests performed. Testing includes the determination of patient’s ABO group, RhD type, and a screen for the detection of atypical antibodies

Additional testing for red cell antibody identification is performed when atypical antibodies are detected

31
Q

What is a cross match test?

A

a way to test your blood against a donor’s blood to make sure they are fully compatible

It’s essentially a trial transfusion done in test tubes to see exactly how your blood will react with potential donor blood

32
Q

How long before surgery so antiplatelets need to be stoped?

A

7 days

Eg. clopidogrel, prasugrel and ticagrelor

33
Q

What is the surgical aim for HbA1c?

A

<69mmol/mol

34
Q

What is the starvation period for food/milk?

A

> 6hrs

35
Q

What is the starvation period for clear fluid?

A

> 2hrs

Includes black coffee sometimes

36
Q

When should steroids be prescribes for anaesthesia?

A

If the patient has been on 10mg prednisolone or more for 2 weeks+ in the past 3 months

37
Q

How is obstruction sleep apnoea screened?

A

Using STOP-BANG

38
Q

Why is obstructive sleep apnoea screened for before surgery?

A

Because patients will have intermittent obstruction when asleep after recovery as their tissues relax after surgery

39
Q

Why does aortic stenosis contraindicates spinal anaesthesia?

A

Because it causes decreased BP and myocardial perfusion which isn’t tolerated well in these patients

40
Q

By how much does frailty increase the risk of complications?

A

x2

41
Q

What is epiglotitis?

A

An emergency

May respond to steroids and antibiotics but may also ned intubation to secure the airway

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