Anaesthesia

Question 1

Aims of anaesthesia

Answer 1

Hypnosis
Analgesia
Muscle relaxation

Question 2

Airway control

Answer 2

Endotracheal tube

or laryngeal mask airway

Question 3

Maintenance

Answer 3

Usually volatile agent added to N2O/O2 mix

Question 4

Muscle Relaxation

Answer 4

Depolarising: suxamethonium

Non-depolarising: vecuronium, atracurium

Question 5

Induction

Answer 5

IV propofol

Question 6

End of Anaesthesia

Answer 6

Change inspired gas to 100% O2
Reverse paralysis: neostigmine + atropine
(prevent muscarinic side effects)

Question 7

Neostigmine

Answer 7

Acetylcholinesterase uptake inhibitor

Question 8

Pre-medication: 7As

Answer 8

• Anxiolytics and Amnesia: e.g. temazepam
• Analgesics: e.g. opioids, paracetamol, NSAIDs
• Anti-emetics: e.g. ondansetron or metoclopromide 10mg
• Antacids: e.g. lansoprazole
• Anti-sialogue e.g. glycopyrolate (↓ secretions)
• Antibiotics

Question 9

Regional Anaesthesia

Answer 9

Used for minor procedures or if unsuitable for general anaesthesia
• Nerve or spinal blocks
• Use long-acting agents: e.g. bupivacaine

Question 10

Contraindications of nerve or spinal blocks

Answer 10

Local infection

Clotting abnormality

Question 11

Complications of propofol induction

Answer 11

Cardiorespiratory depression

Question 12

Complications of intubation

Answer 12

Oro-pharyngeal injury with laryngoscope or oesophageal intubation

Question 13

Complications of loss of pain sensation

Answer 13

• Urinary retention
• Pressure necrosis
• Nerve palsies

Question 14

Complications of loss of muscle power

Answer 14

• Corneal abrasion

* No cough → atelectasis + pneumonia

Question 15

Malignant Hyperpyrexia

Answer 15

Rare complication of halothane or
suxamethonium
• Autosomal Dominant inheritance
• Rapid rise in temperature + masseter spasm
• Tx - dantrolene + cooling

Question 16

Epidural anaesthesia

Answer 16

Bupivacaine

Question 17

Malignant hyperthermia reaction to general anaesthetic

Answer 17

Presentation:

• limb rigidity
• tachycardia
• hypertension
• increased temperature
• FHx

Immediate Mx:
- Dantrolene

Question 18

surgical checklist

Answer 18

1. Sign in - initial checks, check name and pt knows what surgery they are having
2. Time out - before skin incision - confirm correct identity, imaging, prophylactic abx, operation and location
3. Sign out - before they leave the theatre

Question 19

Which anaesthetic muscle relaxant is contraindicated in eye injuries and increased ICP

Answer 19

Suxamethonium - as can cause increased ICP

Question 20

ASA

Answer 20

ASAN1 - healthy

ASA 2 - mild systemic disease + smoke

ASA 3 - alcohol dependence + moderate disease

ASA 4 - severe constant threat to life

ASA 5 - won’t survive without surgery