anaesthetic most important parts Flashcards
what are useful fluids for resuscitation of the shocked patient?
plasmalyte 148
packed red blood cells
0.9% NaCl
Suitable locations for the insertion of a central venous catheter (“central line”)?
Internal Jugular Vein
Subclavian vein
Femoral vein
treatment for severe pain?
titrate morphine
Ibuprofen is on the bottom of the pain ladder and therefore not suitable on its own for severe acute pain. TCADs are for neuropathic pain. We never use placebo to diagnose pain. Placebos can be used in controlled drug trials, but unethical to use routinely.
drug regimen of choice in severe acute pain secondary to trauma?
Morphine alone
as adding NSAIDs increases bleeding risk
When evaluating pain in a 50 year old lady who has had her gall bladder removed, the most important characteristic to consider when assessing her immediate post operative pain is….
Pain severity
everity is the most important as that tells you whether your analgesic regimen is sufficient. However, increasing severity of pain post operatively can also be due to a change in the clinical condition and it might be that there is a complication of the surgery, so this must be excluded before altering the pain treatment. Time after surgery can be relevant but it is not the most important. If someone had a lot of pain several days post operatively, again you should think about complications. The amount of time in surgery can definitely result in increased post -operative pain, as it might be that the surgery was technically difficult and there was more tissue damage. However, it is your assessment that is key here.
Neuropathic pain is….
Due in part to anatomical and biochemical changes in the nervous system
preoperative anaesthetic visits includes:
NOT consent- role of surgeon
Assessing for a potential difficult airway
Providing fasting and medication administration instructions
Identifying individual patients risk factors for optimisation
Fasting times may vary depending on specialty (e.g. paediatrics and obstetrics) or if emergency surgery, but we should avoid lengthy fasting times and generally it would be 6 hours for food and 2 hours for fluid.
what medications do you stop before surgery?
Diabetic meds
anti coagulants like Warfarin for AF
Every patient undergoing anaesthesia should have the following monitors in place…
ECG Oxygen saturation probe Airway pressure monitor Expired carbon dioxide level monitor Blood pressure
effects of anaesthesia on cvs…
There will be significant effects on vascular smooth muscle tone and cardiac contractility with subsequent changes in BP (mostly hypotension) and heart rate (brady and tachycardias).
The triple airway manoeuvre consists of
head tilt,
chin LIFT
jaw thrust
during anaesthesia do you always need muscle paralysis for ventilation?
No
Accidental awareness during the surgery is common
T or F?
F
muscle relaxant factors
All the muscles of respiration are affected, and the patient will be apnoeic.
Should never be administered without general anaesthesia – this results in awareness under anaesthesia, a very serious complication of anaesthesia.
Act at the neuromuscular junction
Interact with the nicotinic acetylcholine receptor
some demoralise and some hyper polarise: Suxamethonium is a depolarising neuromuscular blocker. Another group are the non-depolarising drugs which are competitive antagonists of Ach.
risk of suxamethonium
Malignant hyperpyrexia is a life-threatening reaction which can be caused by suxamethonium
