Anaesthesia and peri-operative care incorrects Flashcards
patient with new onset atrial fiibrillation following right hemicolectomy
feculent material present in abdominal drain
most likely diagnosis?
investigation?
anastomotic leak
CT with luminal contrast
most likely cause for patients stats falling following intubation?
esophageal intubation
patients with diabetes should be first on the list for surgery
complications of perioperative hypothermia? (temp <36!!)
prolonged/ excessive bleeding!!!
prolonged recovery from anaesthesia
impaired wound healing
increased risk of infection
when a surgery is undertaken which has a low chance of transfusion all you need is group and save, you dont need cross match
name aneasthetics that can cause malignant hyperthermia
management?
isoflurane, desflurane, sevoflurane
(volatile liquid anaesthetics)
suxamethonium
halothane
manage = dantrolene
name an anesthetic that is useful in trauma as it doesnt cause a drop in BP
ketamine
nitrous oxide should be avoided in patients with what emergency presentation?
pneumothorax
when can metformin be continued as normal in a patient with diabetes undergoing surgery?
one meal will be missed during the surgery, and the patient’s eGFR is above 60 mL/min/1.73m
after indduction with anesthesia and intubation, a low oxygen saturation, absent air entry in both lung bases, and distended abdomen suggests what?
esophageal intubation
patient presenting after tonic clonic siezure. groans and localises to pain but does not open eyes. sats 95%
next step in management?
oropharyngeal airway - as patient has reduced consciousness
airway protection comes before 02 and possibly CT head
causes of post-operative fever?
Day 1-2: ‘Wind’ - Pneumonia, aspiration, pulmonary embolism
Day 3-5: ‘Water’ - Urinary tract infection (especially if the patient was catheterised)
Day 5-7: ‘Wound’ - Infection at the surgical site or abscess formation
Day 5+: ‘Walking’ - Deep vein thrombosis or pulmonary embolism
Any time: Drugs, transfusion reactions, sepsis, line contamination.
patient. 12 hours after the operation her epidural fell out, leaving her in significant pain. following morning, shortness of breath and fever 38
most likely cause of fever?
penumonia
pain -> shallow breathing -> atelectasis and respiratory tract infections
which neuromuscular blocker is contraindicated in surgery for a patient with hyperkalemia?
suxamethonium/ succinylcholine
which anaesthetic is best used in a patient with a history of post-op nausea and vomiting
propofol
what is the potential complication of excessive administration of NaCl post op
hyperchloraemic ACIDOSIS
and therefore Hartmans solution may be preferred where large volumes of fluid are to be administered.
first line emergency access if cannulation fails?
intraosseus access
food can be consumed up till x hours before surgery
fluids can be consumed up till x hours before surgery
6
2
rapid sequence induction and what else helps reduce risk of aspiration during induction?
administration of antacid
acute onset of breathlessness, LAPCHOLY 10 days ago.
normal temp and other obs.
minimal tenderness over right hypochondrium.
most likely diagnosis?
pulmonary embolism!!!!
findings dont support a subphrenic abscess or pneumonia!
patient intubated but it was difficult
most useful test to check placement?
capnography - helps rule out esophageal intubation
management of sulfonylurueas specifically eg gliclazide, when a patient has a surgery on the day?
omit the drug
except the patient has BD dose and surgery is in the morning -> can give afternoon dose
A 23-year-old man is undergoing an inguinal hernia repair as a daycase procedure and is being given sevoflurane.
What is the most appropriate method for airway access?
This procedure will be associated with requirement for swift onset of anaesthesia and recovery. Muscle paralysis is not required and this would an ideal case for laryngeal mask airway.!!
- note laryngeal mask has poor control against reflex of gastric contents
A 48-year-old man is due to undergo a laparotomy for small bowel obstruction.
What is the most appropriate method for airway access?
endotracheal intubation
how would obstructive fibrinous tracheal psuedomembrane present as a complication of intubation?
it involves the formation of a physical barrier in the airway due to inflammation tissue. This ‘pseudomembrane’ would cause upper airway obstruction signs
upper airway noises (e.g. stridor), difficulty breathing around 3 days post-extubation and respiratory distress signs (increased work of breathing, low sats and high respiratory rate).
Endoscopy is the investigation of choice
how would tracheomalacia present as a complication of intubation?
block the airway, depending on the degree of deformity, resulting in respiratory symptoms like decreased vital capacity and upper airway sounds like stridor.
A 58-year-old man is seen in the neurosurgery ward coughing and choking after meals, bringing up yellow and brown sputum.
He has been recovering from a traumatic brain injury, for which he needed to be intubated for 2 months.
Upon examination, there are mild crackles in the right middle zone.
trancheosophageal fistula!! -> has now caused aspiration penumonia