Anaesthesia Flashcards
1
Q
Aims of anaesthesia (4)
A
1. No conscious awareness of pain 2. Still surgical field 3. Anxiolysis, sedation or complete hypnosis 4. Cardiorespiratory stability
2
Q
The 7 A’s of anaesthesia
A
- Allergy
- Aspirations
- Apnea
- Access
- Activity levels/function
- Aortic stenosis
- Airway assessment
3
Q
What level activity generally sufficient for aneasthesia
A
Carrying two arms of groceries up two flights of stairs
4
Q
Items to discuss with the anethetist
A
- Previous anaesthesia
- Family history->malignant hyperthermia, bleeding, reactions to anaesthesia
- Medications->considerations to cease/withhold
- CVD risk: comorbidities, risk factors
- CNS: stroke, TIA, seizures
- Respiratory: smoke, asthma, triggers, bronchitis
- LFTs, OSA, ABG
- Airway examination
- Endocrine, thyroid, obesity
- Fluid status
- Strategy for blood replacement
- GIT aspiration risk
- Arthritis
5
Q
Indication of end point LOC
A
Loss of eyelash response
6
Q
Examination pre-aneasthetic
A
- Open mouth
- Presence of teeth
- Size of tongue
- Subluxation of TMJ
- Relative position of larynx
- CV and respiratory
- Assess recent blood
- Signs and symptoms of reason for operation
7
Q
Patient monitoring during anaesthesia
A
- Blood pressure
- ?ECG
- Respiratory
- Depth of anaesthesia monitoring
8
Q
Management of acute post-operative pain
A
- NSAIDS
- Paracetamol
- Opioids
a. PCA 1mg morphine bolus with 5-8 minute lockout
b. Consider tramadol if no PCA - Epidural
9
Q
Preoperative check list
A
1. Bloods and investigations FBC, UEC, LFTs, crossmatch GH, INR, glucose (some will depend on patient) 2. IV cannula 3. ECR + CXR 4. Drug chart Regular medications Analgesia Antiemetic Antibiotics Heparin, compression stockings 5. Consent 6. Mark side/site 7. Inform anaesthetics 8. Inform theatre 9 Infections risk 10. NBM >2 hr preop clear fluids, >6-8 h for solids 11. Catheter if required 12. Post-op physioT
10
Q
Specific complications of surgery: laparoscopic, biliary, thyroid, breast
A
- Laparoscopic: conversion to open procedure
- Biliary: damage to common bile duct, anastomic leak, retained stone with another surgery, post hepatic jaundice, stricture, pancreatitis
- Thyroid: bleeding->airway compromised, hypocalcemia, hypothyroid, recurrent and superficial laryngeal nerve palsy, voice different for few days (intubation and swelling)
- Breast: lymphedema, seroma, hematoma, brachial plexus injury
11
Q
Specific complications of surgery: arterial, colonic, SB surgery, splenectomy
A
- Arterial: graft infection, AV fistula, graft failure
- Colonic: damage to other structures, leakage, ileus, adhesions
- SB: damage to surrounds, leak, ileus, short gut, adhesions
- Splenectomy: damage to surrounds, acute gastric dilitation, sepsis/future infections->will need vaccinations
12
Q
Specific complications of surgery: GU, hemorrhoidectomy, prostate, gastrectomy
A
- GU: Damage, ureters, subfertility
- Hemorrhoidectomy: stenosis
- Prostate: blood in urine/ejaculate initially, urethral stricture, retrograde ejaculation, incontinence and impotence
- Gastrectomy: dumping syndrome, weight loss, malabsorption, ulceration of stomach, tumor, blind loop syndrome, abdominal fullness/early satiety
13
Q
General surgical risks
A
1. Anaesthetic Toxic->brady, asystole, dizzy, NV, CNS depression Failure MI, stroke Allergy Death 2. Surgical Hemorrhage Infection of wound, other Impaired healing Surgical injury Atelectasis, pneumonia, ARDS VTE Sepsis Urinary retention UTI Electrolyte disturbances Antibiotic colitis Pressure sores
14
Q
ASA system
A
- Healthy person.
- Mild systemic disease-
X interfere normal activity - Severe systemic disease-
limits normal - Severe systemic disease-
that is a constant threat to life. - A moribund person who is not
expected to survive without the operation-
wont live >24 hours - A declared brain-dead person whose
organs are being removed for donor purposes.
E- signifies emergency
