Anaesthetics

Question 1

What are the 5 Main Available Cannulas? [Smallest to largest]

Gauge?
Flow Rate?
Uses?

Answer 1

Blue - 22G + 33ml/min
Pink - 20G + 54ml/min
Green - 14G + 80ml/min
Grey - 14G + 180ml/min
Orange - 14G + 270ml/min 

**
Yellow - Neonates (24G) ~ 20ml/min
Purple - Neonates (26G) ~ 13ml/min

Uses
Orange - Emergencies/Rapid blood transfusion(RBT)
Grey - Emergencies/Rapid blood transfusion(RBT)
Green - Blood products/transfusions, medicines, fluids
Pink - IV infusions / General crystalloid use
Blue - Paediatrics, Oncology, Maintenance infusions

Question 2

What are the common muscle relaxants used in surgery?

Answer 2

Suxamethonium - Depolarising neuromuscular block
Atracurium - Non-depolarising neuromuscular block
Vecuronium - Non-depolarising neuromuscular block
Pancuronium - Non-depolarising neuromuscular block

Question 3

When is a good idea to use NPA?

The main contraindication?

Answer 3

Decreased GCS - Patients having seizures, not able to insert OPA.

C/I - Base of the skull fractures as they can cause further damage.

Question 4

Mechanism of action for Depolarising and Non-depolarising blocking drugs?

Adverse Effects

Answer 4

Depolarising - Binds to nicotinic Ach receptors resulting in persistent depolarisation of the motor end plate

Non-depolarising: Competitive antagonist of nicotinic Ach receptors

Depolarising NMB Advs - Malignant hyperthermia, Transient hyperkalemia, fasiculations. Suxamethonium C/I - in Acute narrow angel glaucoma/penetrating eye injuries as causes +IOP

Non-depolarising NMB Advs: Hypotension

Question 5

Identify the 6 Main ASA classifications?

Answer 5

ASA I - A normal healthy patient
ASA II - A patient with mild systemic disease
ASA III - A patient with severe systemic disease
ASA IV - A patient with severe systemic disease that is a constant threat to life
ASA V - A moribund patient who is not expected to survive without the operation
ASA VI - A declared brain-dead patient whose organs are being removed for donor purposes

Question 6

What are the primary airway management manoeuvres?

Answer 6

Head tilt, Chin lift, Jaw thrust

Question 7

Main airway adjuncts are available to use and important features?

Answer 7

1. Oropharyngeal airway (OPA/Guedel)
   Easy to insert and use, No paralysis required, Ideal for very short procedures.
2. Tracheostomy - Reduces WOB/ Dead space, Used in ITU, Dries secretion, Useful for slow weaning, humidified air usually required.
3. Endotracheal tube (ET): Provides optimal control of the airway once cuff inflated, Usually 18cm is sufficient, Short term/Long term ventilation, Paralysis often required, Higher ventilation pressures can be used.
4. Laryngeal mask: Easy to insert, Device sits in pharynx and aligns to cover the airway, Poor control against gastric contents reflux, Not suitable for high pressure ventilation, Commonly used for wide range of anaesthetic uses - esp. day surgery.

Question 8

Main IV induction Anaesthetic agents?

Answer 8

Propofol
Sodium thiopentone
Ketamine
Etomidate

Question 9

What’s the difference between a crossmatch and a group and save?

Answer 9

Group and Save - Sample processing (Blood group and antibody screen, Atypical red cell antibodies in blood?

Crossmatch - Lab actually provides red cells products for the patient. G+S always required b4 crossmatch can take place.

Question 10

What drugs impair wound healing?

Answer 10

NSAIDS, Steroids, Immunosuppressants, Anti-neoplastic drugs.

Question 11

What are the four main stages of wound healing?

Answer 11

Haemostasis, inflammation, regeneration, remodelling

Question 12

If someone develops malignant hyperthermia as a result of anaesthesia (Suxamethonium).

What is the TREATMENT?

Answer 12

IV Dantrolene therapy

Question 13

What are the clinical signs of Malignant Hyperthermia?

Answer 13

Hypercapnia (++End tidal CO2), Tachycardia, Muscle rigidity, Rhabdomyolysis (+CK), Hyperthermia and Arrhythmias .

> 40.6 C

Question 14

What agents can cause Malignant Hyperthermia?

Answer 14

Halothane
Suxamethonium
Antipsychotics (NMS)

Question 15

What are the signs of a basal skull fracture?

Answer 15

Racoon Eyes (Tarsal plate sparing)
CSF Otorrhoea (Halo Sign - Otoscope)
CSF Rhinohoea
Haematoma
Contusions (Brusing)
Haemotypaneum (presence of blood in your middle ear cavity/ behind eardrum)
Battle Signs (Post Auricular Haematoma/Ecchymosis/ Ear/neck bruising)
Skull Fracture (Petrous part of temporal bone - Linear fracture seen on CT)