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Y5 - T+O > anaesethics > Flashcards

anaesethics Flashcards

1
Q

into what space is a spinal anaesethic put

A

subarachnoid (normally below the level where the spinal cord ends at L2)

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1
Q

what is different about the local anaesethics used for spinal compared to normal local anaesthetics

A

they are made hyperbaric by adding glucose so that they are heavier than CSF and move more with gravity

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2
Q

how long does a single spinal injection last

A

2-3 hours (so can’t be used for longer operations)

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3
Q

does spinal injection affect the sympathetic nervous system

A

yes - reduces systemic vasoconstriction so can drop BP

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4
Q

what is different about the needle used for epidural rather than spinal

A

is it longer and larger

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5
Q

why is an epidural better for longer surgery

A

catheter remains in place so anaesethic can be put in continuously

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6
Q

how is hypotension from epidural managed

A

can use phenylephrine

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7
Q

how does local anaesethic work

A

block Na channels

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8
Q

why is adrenaline added to local anaesethic (not in fingers)

A

reduce blood flow so reduce systemic uptake and potentiate action

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9
Q

IV commonly used induction anaesethic for GA

A

propofol (potentiates GABAa)

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10
Q

inhaled / volatile commonly used anaesethic for GA

A

sevoflurane (can cause malignant hyperthermia)

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11
Q

Mx of malignant hyperthermia (caused by suxamethonium and sevoflurane) and will show raised CK on Ix

A

dantrolene (muscle relaxant)

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12
Q

stages of a GA

A

1) oxygen (to replace the nitrogen in the lungs)
2) induction - IV propofol
3) muscle relaxant
4) secure airway
5) phenylephrine to maintain BP as SNS impaired
6) consider if anything else is need eg IV hydrocortisone if on LT steroid or insulin

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13
Q

what score assesses the airway

A

malampati

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14
Q

what is an ASA VI pt

A

brain dead

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15
Q

what is an ASA V pt

A

unlikely to survive eg ruptured AAA

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16
Q

what is an ASA II patient

A

mild, well controlled illness eg well controlled diabetes/smoker or obese

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17
Q

what is an ASA III patient

A

not well controlled disease HTN/DM/ BMI >40

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18
Q

what is an ASA IV pt

A

severe disease which is a constant threat to life –> LTOT, MI in last 3 months

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19
Q

RF of post op nausea

A

female, young, personal hx of motion sickness

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20
Q

when is the WHO checklist for surgical safety done

A

before induction of anaesthesia, before incision of skin and before the patient leaves the operating theatre

21
Q

what are checked in the surgical safety

A
  • Patient identity and allergies checked
    • Site is marked
    • Pulse oximetry on patient and working
    • Risk of blood loss
      Anaesthesia safety check
22
Q

when is a pre op done

A

2-4 weeks before elective and 4-7 days before urgent

23
Q

when is an ECG done at preop

A

if >80
or if > 60 and a surgical severity score of 3+

24
Q

SE of epidural

A

hypotension, post dural puncture headache, epidural haematoma

25
Q

MX of post dural puncture headache (can get from LP, spinal or epidural)

A

lie flat, stay hydrated, drink caffeine
May need a blood patch

26
Q

how does a post dural puncture headache present

A

like a bad migraine which is worse when stood up

27
Q

does a spinal or epidural work faster

A

spinal as this is in the CSF

28
Q

into what space is an epidural put

A

between the ligamentum flavum and the dura matter

29
Q

how long do patients need to fast before surgery

A

at least 6 hours

30
Q

how long before surgery can patients drink clear fluid

A

2 hours

31
Q

when do type 2 DM who normally control DM with oral meds, need a VRIII in surgery

A

poor glycamic control, more than one meal missed

32
Q

is metformin taken on surgery day

A

yes, just omit lunchtime dose (if there is one)

33
Q

is gliclazide taken on surgery day

A

no

34
Q

are SGLT2 inhibitors taken on surgery day

A

no

35
Q

are the glitazones, gliptins and GLP1 mimetics taken on surgery day

A

yes

36
Q

are long acting insulin taken on surgery day

A

yes just reduce dose by 20%

37
Q

what needs to happen to steroid dose on surgery

A

-double usual steroid for 24-48 hours
-hydrocortisone 100mg IV on induction followed by IV infusion 200mg/24 hours

38
Q

when does a DOAC need to be stopped

A

24 -72 hours before surgery

39
Q

when does clopidogrel need to be stopped before surgery

A

7 days

40
Q

when does warfarin need to be stopped before surgery

A

5 days and then bridging therapy with LMWH used

41
Q

what do all patients need before surgery

A

G+S (and cross match if high risk of bleeding) and MRSA screen

42
Q

when does COCP / HRT need to be stopped before surgery

A

4 weeks

43
Q

considerations for diabetic patients

A

first on list, switch back to normal insulin regime at first meal but need to have SC insulin before taking down as half life of insulin is 5 minutes, optimisation of diabetes before surgery

44
Q

what is an acceptable CBG in surgery and how often is it monitored

A

6-10 and monitored hourly

45
Q

what is insulin infused through in VRIII

A

dextrose 5% (+added K+)

46
Q

how is hyperglycaemia managed on surgery day

A

if CBG >12, check ketones.

47
Q

risks of diabetics having surgery

A

higher risk son wound infections, risks of mistakes with insulin prescribing, underlying diabetes problems like higher risk of kidney insult

48
Q

what are the diabetes sick day rules

A

increase CBG monitoring to hourly, increase fluid to 3L, continue insulin even if not eating and measure ketones

49
Q

what happens in HIT

A

heparin induced antibodies attack platelet factor 4 and cause hypercoaguable state of blood. May present with a DVT. Need to stop UFH and start another anticoagulant.

50
Q

complications of anaesthetic

A

1) sore throat post intubation
2) aspiration of gastric contents in non fasted individuals
3) urinary retention
4) PONV (RF - female, young, opioids used in surgery, hx of motion sickness)
5) PO cognitive dysfunction - increasing age / lower IQ
6) hypothermia

51
Q

whats a sign of local anaesthetic toxicity

A

arrhythmias

Y5 - T+O (11 decks)

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