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Medicine Finals > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

How long prior to surgery does the COCP need to be stopped? How long to wait after surgery before restarting?

A

4 weeks prior to surgery

Wait 2 weeks before restarting

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2
Q

How long prior to surgery does Warfarin need to be stopped?

A

5 days prior to surgery

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3
Q

How long prior to surgery does Clopidogrel need to be stopped?

A

7 days prior to surgery

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4
Q

How do you treat anaemia detected in a peri-operative patient?

A

> 6 weeks to surgery – oral iron

<6 weeks to surgery – IV iron

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5
Q

What should you do with a patient whose on oral prednisolone prior to surgery?

A

Switch to IV Hydrocortisone

If major surgery - continue IV hydrocortisone for 72 hours

If minor surgery - can go straight back to oral pred after surgery

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6
Q

What to do with diabetic meds prior to surgery?

A

Metformin - if OD/BD - take as normal. IF TDS - omit lunchtime dose.

Gliclazide - omit morning dose.

Sliding scale insulin (if insulin dependent)

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7
Q

Which muscle relaxant is used for rapid sequence intubation?

A

Suxamethonium (depolarising muscle relaxant)

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8
Q

Which drugs are used to induce unconsciousness?

A

Propafol - anti-emetic, pain on injection

Ketamine - analgesic properties, does not cause hypotension (good in trauma)

Thiopentone

Etomidate - favourable cardiac safety profile

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9
Q

Which drugs are used to maintain unconsciousness?

A

Isoflurane

Sevoflurane

Desflurane

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10
Q

What is the risk associated with sevoflurane, desflurane and suxamethonium?

A

Malignant hyperthermia

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11
Q

Which drugs are at risk of causing malignant hyperthermia?

A

Sevoflurane

Desflurane

Suxamethonium

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12
Q

Which type of muscle relaxant is de-polarising?

A

Suxamethonium

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13
Q

What is an example of a non-depolarising muscle relaxant and what drug can be used to reverse them?

A

Atracurium, vecuronium

Reversal agent = Neostigmine

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14
Q

What are side effects of suxamethonium?

A

Hyperkalaemia

Malignant hyperthermia

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15
Q

What are side effects of atracurium? (Non-depolarising muscle relaxant)

A

Facial flushing

Tachycardia

Hypotension

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16
Q

What are contraindications to suxamethonium?

A

Penetrating eye injuries

Acute angle closure glaucoma

Pseudocholinesterase deficiency

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17
Q

What are risks of general anaesthetic?

A

Sore throat

Nausea/vomiting

Aspiration

Anaphylaxis

Malignant hyperthermia

Death

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18
Q

What is malignant hyperthermia? How does it present?

A

A rare but potentially fatal reaction to anaesthetic

Hyperthermia

Tachycardia

Muscle rigidity

Acidosis

Hyperkalaemia

Raised CK

19
Q

How is malignant hyperthermia treated?

A

IV Dantrolene

20
Q

Where does anaesthetic go in a spinal block?

A

Subarachnoid space

21
Q

Where is anaesthetic placed in an epidural?

A

Epidural space

22
Q

What are adverse effects of an epidural?

A

Headache

Hypotension

Motor weakness

Nerve damage

Infection

Haematoma

23
Q

How long must a patient fast prior to surgery?

A

Usually
Clear fluids only from 6 hours prior
Completely NBM from 2 hours prior

24
Q

Which diabetic drugs must be omitted on the day of surgery?

A

Sulfonylurea
SGLT-2 inhibitors
Metformin

25
Q

Which airway management is best used for a patient having seizures?

A

Nasopharyngeal airway

26
Q

Where can a central line be placed?

A

Internal jugular vein
Subclavian vein
Axillary vein
Femoral vein

27
Q

Which general anaesthetic has anti-emetic properties?

A

Propofol

28
Q

Which general anaesthetic for inducing anaesthesia is better for trauma and why?

A

Ketamine - it doesn’t cause a drop in BP but Propofol does

29
Q

What positional manoeuvres can open the airway?

A

1) Head tilt
2) Chin lift
3) Jaw thrust

30
Q

When do you use a nasopharyngeal airway over an oropharyngeal airway? When are nasopharyngeal airways contraindicated?

A

Nasopharyngeal airway = usually when patient is more conscious. tolerated better
Contraindicated in base of skull fracture

31
Q

Which diabetes drugs should be stopped before surgery?

A

Metformin + Sulfonylurea + SGLT-2 Inhibitors

Omit dose prior to surgery

Can take as normal after surgery

32
Q

Which anaesthetic agent can cause hyperkalaemia?

A

Suxamethonium

33
Q

What is the ASA classification?

A

ASA I - completely healthy, non-smoker, normal BMI

ASA II - mild systemic disease/smoker/drinker/pregnant/obese

ASA III - severe systemic disease/COPD/alcohol abuse/pacemaker/end stage renal disease/CVA

ASA IV - systemic illness which is a constant threat to life, MI <3 months ago, sepsis, DIC, ARD

ASA V - patient not expected to live without surgery

ASA IV - braindead

34
Q

Where can a central line be placed?

A

Internal jugular vein
Subclavian vein
Axillary vein
Femoral vein

35
Q

Which types of anaesthetic can cause malignant hyperthermia?

A

Suxamethonium

Isoflurane/Sumoflurane/Desflorane

36
Q

What kind of inherited condition can cause increased risk of malignant hyperthermia?

A

Autosomal dominant

37
Q

What can be used to treat lidocaine toxicity? E.g. if accidentally injected into vein

A

20% lipid emulsion

38
Q

How does a post-op ileus present?

A

Abdominal distension/bloating
Abdominal pain
Nausea/vomiting
Inability to pass gas

39
Q

What is an anastomotic leak? How does it present and how is it diagnosed?

A

Contents of organ leaks through sutures into the peritoneum
Leads to peritonitis and sepsis

Presents with fever usually 5-7 days post surgery

Diagnosis = CT abdo

40
Q

What is atelectasis and how is it managed?

A

Basal alveolar collapse leading to respiratory difficulty
Presents with dyspnoea + hyperaemia approx 72 hours post op

Management - position pt upright, chest physo

41
Q

What are causes of post-op pyrexia?

A
  • Day 1-2: ‘Wind’ - Pneumonia, aspiration, pulmonary embolism
  • Day 3-5: ‘Water’ - Urinary tract infection (especially if the patient was catheterised)
  • Day 5-7: ‘Wound’ - Infection at the surgical site or abscess formation
  • Day 5+: ‘Walking’ - Deep vein thrombosis or pulmonary embolism
  • Any time: Drugs, transfusion reactions, sepsis, line contamination.
42
Q

How much should once dose daily insulin be reduced by on the morning of surgery?

A

20%

43
Q

Which anaesthetic causes adrenal suppression?

A

Etomidate

Medicine Finals (32 decks)

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