Anaesthesiology- Conduct, Principles and Phamacology

Question 1

What are the phases of getting an anaesthetic?

Answer 1

Induction
Maintenance
Emergence
Recovery

Question 2

List the different things an anaesthetist needs to monitor during surgery with a patient under anaesthetic.

Answer 2

ECG
Oxygen Sat
BP
End tidal CO2
Airway pressure

Question 3

Patients who are undergoing anaesthetic get given pre-operative supplemental oxygen. Why?

Answer 3

To give the anaesthetist more time to take over and control their breathing for them
Increases time to desaturation

Question 4

What happens to functional residual capacity under anaesthetic?

Answer 4

Decreases

Question 5

What are the three categories of drug required for induction of anaesthesia?

Answer 5

Analgesic
Hyponotic
Muscle relaxant

Question 6

Which analgesics are most commonly given in induction?

Answer 6

Fentanyl
Alfenanil

Question 7

Which hypnotics are most commonly given in induction?

Answer 7

Propofol
Thiopentone
Ketamine

Question 8

Why is airway management often required when the patient in under anaethesia>

Answer 8

Loss of airway reflexes
Relaxation of tissues

Question 9

Stages of airway management?

Answer 9

Head tilt, jaw thrust
Oxygen mask
Oropharyngeal airway
Laryngeal mask airway
Endotracheal tube

Question 10

How often does the anaesthetist needs to check observations during surgery?

Answer 10

At least every 5 mins

Question 11

What are some complications which can occur when a patient is under anaesthetic?

Answer 11

Anaphylaxis
Regurgitation and aspiration
Airway obstruction and hypoxia
Laryngospasm
Cardiovascular instability
Rarely- cardiac arrest

Question 12

What is meant by awareness during anaesthesia?

Answer 12

Patient aware of something- often just noises etc.

Very very rarely, patient may become conscious and feel pain

Question 13

What are some other potential complications that can happen to a patient under anaesthetic?

Answer 13

Eye injury- corneal abrasion as patient cannot blink to protect eyes- often taped shut

Hypothermia

Pressure injury

VTE

Nerve injury

->VTE prophylaxis given prior to surgery to reduce risks

Question 14

What are the two ways of maintaining anaesthesia?

Answer 14

Vapour (‘gas’)

Intravenous anaesthesia (TIVA)

->vapour only really used in children if cannot gain IV access

Question 15

What are the advantages of using fentanyl/afentanyl for analgesia over morphine?

Answer 15

Quick-acting

However, morphine has a longer duration of action

Question 16

What is the ‘THE ONE BIG ANAESTHETIC EMERGENCY THAT EVERYONE LEARNS ABOUT BUT NO ONE SEES’?

Answer 16

Malignant hyperthermia

->a severe reaction to certain drugs used for anaesthesia

Question 17

What is an important question to ask in the pre-op assessment to determine the patient’s ability to withstand stress?

Answer 17

Ask about their exercise tolerance

Question 18

If you need to get a quick idea of a patient’s exercise tolerance, what can you ask?

Answer 18

Are they able to walk up a flight of stairs?

->if yes, should be okay for surgery, if no, probably unsuitable. Very vague but sometimes helpful

Question 19

Why is it important to ask about exercise tolerance?

Answer 19

Gives an idea of cardio-respiratory function and if any underlying disease

->cardio-resp function needs to be okay for major surgery

Question 20

Which genetic conditions can cause difficulties in surgery?

Answer 20

Malignant hyperpyrexia
Cholinesterase deficiency

->don’t affect life other than under anaesthetic. Important to know if family members ever died in surgery as may be indicative of a FH of these conditions

Question 21

Which grading can be used to determine the physiological risk to patient’s before undergoing surgery?

Answer 21

ASA grade

->ASA1- otherwise healthy patient
ASA2= mild to moderate systemic disturbance
ASA6- organ retrieval

Question 22

Which factors of lifestyle can be adjusted to optimise chances of a successful surgery and reduce risks of complications?

Answer 22

Smoking
Alcohol
Obesity
Exercise

Question 23

Most medications should be continued pre-operatively. Which ones especially are very important?

Answer 23

Inhalers
Anti-anginals
Anti-epileptics

->anaesthetist will send back to ward if have not had these if they regularly do

Question 24

Most medications should be continued pre-operatively. Which drugs are the exceptions?

Answer 24

Anti-diabetic medication
Anticoagulants

->anti-diabetic meds include type 2 diabetic drugs e.g. biguanides (metformin) sulfonylureas (glipizide, gliclazide) etc.