Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3b > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

Before the induction of anaesthesia, the following must have been checked:

A

Patient has confirmed: Site, identity, procedure, consent
Site is marked
Anaesthesia safety check completed
Pulse oximeter is on patient and functioning
Does the patient have a known allergy?
Is there a difficult airway/aspiration risk?
Is there a risk of > 500ml blood loss (7ml/kg in children)?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How would you an define ASA 1 patient?

A

Definition: A normal healthy patient

example: Healthy, non-smoking, no or minimal alcohol use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How would you an define ASA II patient?

A

A patient with mild systemic disease

Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (BMI 30 - 40), well-controlled Diabetes Mellitus/Hypertension, mild lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How would you an define ASA III patient?

A

A patient with severe systemic disease

Substantive functional limitations; One or more moderate to severe diseases. Examples include (but not limited to): poorly controlled Diabetes Mellitus/Hypertension, COPD, morbid obesity (BMI > 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, End-Stage Renal Disease (ESRD) undergoing regularly scheduled dialysis, history (>3 months) of Myocardial infarction, Cerebrovascular accidents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How would you an define ASA IV patient?

A

A patient with severe systemic disease that is a constant threat to life

Examples include (but not limited to): recent (< 3 months) of Myocardial infarction, Cerebrovascular accidents, ongoing cardiac ischaemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How would you an define ASA V patient?

A

A moribund patient who is not expected to survive without the operation

Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intra-cranial bleed with mass effect, ischaemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How would you an define ASA VI patient?

A

A declared brain-dead patient whose organs are being removed for donor purposes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 2 main categories of muscle relaxants used in anaesthetics?

A

depolarising
e.g. suxamethonium

and non-depolarising

e. g.
- Rocuronium
- Atracurium
- Mivacurium
- Pancuronium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is sugammedex?

A

used for the reversal of neuromuscular blockade caused by rocuronium and vecuronium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does suxamethonium work?

A

inhibits the action of acetylcholine at the neuromuscular junction

Fastest onset and shortest duration of all muscle relaxants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does atracurium work?

A

Non-depolarising neuromuscular blocking drug

Duration of action usually 30-45 mins

May produce facial flushing, tachycardia and hypotension due to generalised histamine release

Broken down in tissues by hydrolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In what patients could vecuronium effects be prolonged?

A

Vecuronium is degraded by the liver and kidney so in organ dysfunction effects can be prolonged.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how long is the onset of action for pancuronium?

A

2-3- mins and can last up to 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the role of neostigmine?

A

reverses the action of atracurium, vecuronium and pancuronium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Up to how long before surgery can patients drink clear fluids (water, fruit juice with pulp, coffee/tea without milk and ice lollies)?

A

2 hours

Drinking fluids can help reduce headaches, N+V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

should diabetics take medication prior to surgery?

A

controlled by medication: medication should be omitted and BM checked regularly

poorly controlled/insulin: variable rate insulin infusion and potassium supplementation should be given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what generic tests should patients have before elective surgery?

A
  • pre-op clinic appointment
  • blood tests (FBC, U+E, LFTs, clotting, group and save)
  • urinalysis
  • pregnancy test
  • sickle cell
  • ECG/chest Xray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

For what purpose should hydrocortisone be prescribed preoperatively?

A

to patients taking regular prednisolone for moderate-major surgery.
Chronic glucocorticoid therapy such as Tx of GCA with pred can suppress the HPA axis meaning that in times of stress (surgery), the adrenal glands cannot respond appropriately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is pseudocholinesterase deficiency?

A

Rare abnormality in the production of plasma cholinesterase’s - leads to an increased duration of action of muscle relaxants (ie suxamethonium)
Also called suxamethonium apnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What effects could hypothermia have perioperatively?

A
  • slower metabolisation of anaesthetic drugs

- less effective platelet, coagulation and immune systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How could thermoregulation be impaired perioperatively?

A
  • administering unwarmed IV fluids, inhalation gases or irrigation of body cavities
  • exposure to cold theatre environment
  • use of cool skin preparation fluids
  • use of muscle relaxants (prevents shivering
  • spinal/epidural prevents peripheral vasoconstriction via reduced sympathetic tone –> increased heat loss from peripheries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what time period does thermoregulation in the perioperative period refer to?

A

1 hour before surgery and 24 hours after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the risk factors for perioperative hypothermia?

A 
ASA grade 2 or above 
major surgery
LBW 
large volumes of unwarmed IV fluids 
unwarmed blood transfusions
24
Q

what are the complications of perioperative hypothermia?

A
  • intraoperative blood loss: hypothermia reduces the bloods ability to clot
  • prolonged recovery time from anaesthesia: NMBAs, propofol and inhalational agents
  • reduced wound healing: hypothermia = vasoconstriction = reduces perfusion to the skin = reduced necessary immune moderators available at the site to promote healing.
  • infection: as a result from poorer healing and less immune cells accessing the skin
  • shivering: in certain patients can cause sig. increase in metabolic rate and lead to myocardial ischemia
25
Q

How can local anaesthetic (lidocaine) toxicity be treated?

A

IV 20% lipid emulsion

26
Q

Four days after undergoing a right hemicolectomy for colon cancer, a 67-year-old woman develops vomiting. On examination she has a distended abdomen and no bowel sounds. Her temperature is 36.8 ºC, her blood results show the following:

CRP 124 mg/l
WBC 5.2 * 109/l

The nursing notes indicate she has not opened her bowels since undergoing surgery. What is the most likely cause of all her symptoms and signs?

A

paralytic ileus - common complication after surgery involving handling of the bowel - no peristalis = pseudo-obstruction.

27
Q

other than surgery, when can paralytic ileus occur?

A

in association with chest infections, MI, stroke, AKI

28
Q

what are the most common clinical features of an anastomotic leak?

A

fever and abdo pain

29
Q

How is a anastomotic leak best diagnosed?

A

abdo CT

30
Q

If a patient had an arrhythmia following cardiac surgery, what complication would you be worried about?

A

more susceptible to hypokalaemia

31
Q

What are the 2 key differentials you want to rule out as serious causes of post-operative fever?

A

infection and thrombosis

32
Q

what are the causes of early post-op pyrexia (<5 days) ?

A
  • blood transfusion
  • cellulitis
  • UTI
  • physiological systemic inflammatory reaction
  • pulmonary atelectasis (not much evidence)
33
Q

what are the causes of late post-op pyrexia (>5 days)?

A
  • venous thromboembolism
  • pneumonia
  • would infection
  • anastomotic leak
34
Q

what are the 4 stages of wound healing?

A
  1. haemostasis - mins following injury
    (vasospasm in adjacent vessels, platelet plug formation and generation of fibrin rick clot)
  2. inflammation - 1-5 days
    (neutrophils migrate into wound; growth factors released; fibroblasts replicate within the adjacent matrix and migrate into wound; macrophages and fibroblasts couple matrix regeneration and clot substitution)
  3. regeneration - 7-56 days
    (platelet driven growth factor and transformation growth factors stimulate fibroblasts and epithelial cells; fibroblasts produce a collagen network; angiogenesis occurs and wound resembles granulation tissue)
  4. remodeling - 6 weeks-1 year
    (fibroblasts become differentiated (myofibroblasts and these facilitate wound contraction; collagen fibres remodelled; microvessels regress leaving a pale scar)
35
Q

How do vascular disease, shock and sepsis impair healing?

A

compromise microvascular flow

36
Q

what drugs impair wound healing?

A
  • NSAIDs
  • Steroids
    _ immunosuppressive agents
  • Anti-neoplastic drugs
37
Q

what is the mechanism of action of lidocaine?

A

blockage of sodium channels disrupting the action potential

38
Q

what is the mechanism of digoxin?

A

inhibition of sodium/potassium pump

39
Q

When should the ‘time out’ stage of the WHO checklist occur?

A

before the first incision is made

40
Q

When should the ‘sign in’ occur?

A

Before the induction of anaesthesia

41
Q

when does the ‘sign out’ occur?

A

prior to the patient leaving the operating theatre

42
Q

A 22-year-old female is extubated following an uncomplicated laparoscopic appendicectomy. However, no respiratory effort is made and she is re-intubated and ventilated. She is monitored in the intensive care unit and all observations are normal. She is weaned from the ventilator 24 hours later successfully. What complication has occurred?

A

suxamethonium apnoea

43
Q

what causes suxamethonium apnoea?

A

A small subset of the population has an autosomal dominant mutation, leading to a lack of the specific acetylcholinesterase in the plasma which acts to break down suxamethonium, terminating its muscle relaxant effect. Therefore, the effects of suxamethonium are prolonged and the patient needs to be mechanically ventilated and observed in ITU until the effects of suxamethonium wear off.

44
Q

how does malignant hyperpyrexia manifest?

A

rise is body temp, rise in BP, muscle spasm, type 2 resp failure, metabolic acidosis and arrhythmias

45
Q

when is ketamine a preferable analgesia?

A
  • pre-hospital setting
  • pain relief and facilitate intubation
  • preserves BP and doesn’t cause cardiosuppression
46
Q

what are side effects of propofol use?

A

hypotension through vasodilation and myocardial depression

47
Q

If struggling to gain access in a paediatric cardiac arrest , what would be your next step in gaining access?

A

intraosseous access
typically at the anteromedial aspect of the proximal tibia and provides access to the marrow cavity and circulatory system

48
Q

When should the OCP be stop before an operation?

A

4 weeks prior

49
Q

what could cause new onset AF following gastro surgery?

A

anastomotic leak

50
Q

why should patients be encouraged to stop smoking following a fracture repair?

A

smoking largely slows bone healing

51
Q

what is the muscle relaxant of choice in rapid sequence induction?

A

Suxamethonium

52
Q

what is the definitive treatment for malignant hyperpyrexia?

A

IV dantrolene

53
Q

which agent reverses the action of midozolam ?

A

Flumazenil

54
Q

What anaesthetic agent has anti-emetic properties?

A

propofol

55
Q

via what vessel should total parenteral nutrition be given?

A

A central vein, ie. internal jugular, subclavian, femoral

3b (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions