Anaesthestics

Question 1

where is epidural placed before C sections

Answer 1

L3/4 or L4/5

Question 2

low pressure headache is a common complication of…

Answer 2

obstetric epidural

Question 3

general anaesthesia has two main drugs:

Answer 3

anaesthetic + neuromuscular blocker

Question 4

2 common inhaled general anaesthetics and side effects

Answer 4

sevoflourane = malignant hyperthermia
desflourane = respiratory irritation

Question 5

inhaled anaesthetic, rigid muscles especially masseter, core body temp increasing, co2 trace increasing
what is happening and why and management??

Answer 5

malignant hyperthermia
caused by autosomal dominant inheritance of mutated ryanodine receptor 1
mx = dantrolene

Question 6

3 common IV GA and side effects

Answer 6

ketamine = increased ICP
propofol = propofol related infusion syndrome, hypotension
sodium thiopentane

Question 7

what is propofol related infusion syndrome

Answer 7

causes type b lactic acidosis
renal failure, arrhythmia, rhabdomyolysis
Mx: dialysis

Question 8

2 main neuromuscular blocks

Answer 8

rocoronium
suxamethonium

Question 9

rigid muscles esp diaphragm, therefore still needs ventilatory support
what is this complication?

Answer 9

suxamethonium apnea

Question 10

signs of local anaesthetic toxicity and Mx

Answer 10

confusion, drowsiness, bradycardia
Mx: lipid emulsion, atropine for bradycardia

Question 11

indications for Rapid Sequence Induction

Answer 11

full stomach, intact gag reflex, risk of aspiration

Question 12

steps for Rapid Sequence Induction

Answer 12

1. prep
2. pre oxygenation for 5 mins
3. pretreatment
4. paralysis (rocoronium) and anaesthetic (ketamine)
5. pressure and positioning of airway
6. placement and proof of tube
7. post-intubation taping etc

Question 13

smaller trace on capnography and asymmetrical chest rise

Answer 13

endobronchial intubation

Question 14

no trace on capnography

Answer 14

incorrectly placed intubation

Question 15

3 ways to check if intubation has been placed correctly

Answer 15

1. direct vision (of epiglottis)
2. bilateral auscultation
3. trace on capnography

Question 16

what is the correct peri-operative insulin regime

Answer 16

continue long acting insulin
stop short acting insulin
switch to a variable rate insulin infusion

Question 17

effect of Alpha 1 receptor

Answer 17

calcium release from the sarcoplasmic reticulum
vasoconstriction

Question 18

effect of beta 1 receptor

Answer 18

increased cardiac output
positive inotropy
increased renin release

Question 19

effect of beta 2 receptor

Answer 19

smooth muscle relaxation
blood vessels (vasodilation), bronchi

Question 20

effect of adrenaline

Answer 20

dose-dependant effect
low dose: mainly beta effect (increased CO, smooth muscle relaxation)
high dose: mainly alpha effect (vasoconstriction)

Question 21

effect of noradrenaline

Answer 21

mainly alpha effect

Question 22

effect of dopamine

Answer 22

low dose: beta 1 effect (increased CO)
high dose: alpha effect ( vasoconstriction)

Question 23

what score is used to determine chance of post op nausea and vomiting
what is included

Answer 23

apfel score

1. female
2. non smoker
3. previous PONV
4. post op opioid use