Anaesthesiology- Conduct, Principles and Phamacology Flashcards
What are the phases of getting an anaesthetic?
Induction
Maintenance
Emergence
Recovery
List the different things an anaesthetist needs to monitor during surgery with a patient under anaesthetic.
ECG
Oxygen Sat
BP
End tidal CO2
Airway pressure
Patients who are undergoing anaesthetic get given pre-operative supplemental oxygen. Why?
To give the anaesthetist more time to take over and control their breathing for them
Increases time to desaturation
What happens to functional residual capacity under anaesthetic?
Decreases
What are the three categories of drug required for induction of anaesthesia?
Analgesic
Hyponotic
Muscle relaxant
Which analgesics are most commonly given in induction?
Fentanyl
Alfenanil
Which hypnotics are most commonly given in induction?
Propofol
Thiopentone
Ketamine
Why is airway management often required when the patient in under anaethesia>
Loss of airway reflexes
Relaxation of tissues
Stages of airway management?
Head tilt, jaw thrust
Oxygen mask
Oropharyngeal airway
Laryngeal mask airway
Endotracheal tube
How often does the anaesthetist needs to check observations during surgery?
At least every 5 mins
What are some complications which can occur when a patient is under anaesthetic?
Anaphylaxis
Regurgitation and aspiration
Airway obstruction and hypoxia
Laryngospasm
Cardiovascular instability
Rarely- cardiac arrest
What is meant by awareness during anaesthesia?
Patient aware of something- often just noises etc.
Very very rarely, patient may become conscious and feel pain
What are some other potential complications that can happen to a patient under anaesthetic?
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
What are the two ways of maintaining anaesthesia?
Vapour (‘gas’)
Intravenous anaesthesia (TIVA)
->vapour only really used in children if cannot gain IV access
What are the advantages of using fentanyl/afentanyl for analgesia over morphine?
Quick-acting
However, morphine has a longer duration of action
What is the ‘THE ONE BIG ANAESTHETIC EMERGENCY THAT EVERYONE LEARNS ABOUT BUT NO ONE SEES’?
Malignant hyperthermia
->a severe reaction to certain drugs used for anaesthesia
What is an important question to ask in the pre-op assessment to determine the patient’s ability to withstand stress?
Ask about their exercise tolerance
If you need to get a quick idea of a patient’s exercise tolerance, what can you ask?
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
Why is it important to ask about exercise tolerance?
Gives an idea of cardio-respiratory function and if any underlying disease
->cardio-resp function needs to be okay for major surgery
Which genetic conditions can cause difficulties in surgery?
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
Which grading can be used to determine the physiological risk to patient’s before undergoing surgery?
ASA grade
->ASA1- otherwise healthy patient
ASA2= mild to moderate systemic disturbance
ASA6- organ retrieval
Which factors of lifestyle can be adjusted to optimise chances of a successful surgery and reduce risks of complications?
Smoking
Alcohol
Obesity
Exercise
Most medications should be continued pre-operatively. Which ones especially are very important?
Inhalers
Anti-anginals
Anti-epileptics
->anaesthetist will send back to ward if have not had these if they regularly do
Most medications should be continued pre-operatively. Which drugs are the exceptions?
Anti-diabetic medication
Anticoagulants
->anti-diabetic meds include type 2 diabetic drugs e.g. biguanides (metformin) sulfonylureas (glipizide, gliclazide) etc.
