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Surgery > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

Why should a patient be NBM prior to an operation?

A

Empty gastric contents to reduce risk of reflux into the oropharynx and aspirated into the trachea

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2
Q

How long should a patient be NBM prior to surgery?

A

6 hours for solids

2 hours for clear fluids

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3
Q

What is preoxygenation?

A

Before being put under a general anaesthetic, the patient will have a period of several minutes where they breathe 100% oxygen. This gives them a reserve of oxygen for the period between when they lose consciousness and are successfully intubated and ventilated (in case the anaesthetist has difficulty establishing the airway). This step may need to be skipped when an emergency general anaesthetic is required.

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4
Q

What is premedication?

A

Medications given prior to GA to ensure ease of intubation

Clonidine - sedation and reduced pain

Opiates - reduce pain and hypertensive response

BZDs - relax muscle and reduce anxiety

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5
Q

Why is cricoid pressure applied in Rapid Sequence Induction?

A

prevent the stomach contents from refluxing into the pharynx

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6
Q

What is the triad of general anaesthesia?

A

Hypnosis

Muscle relaxation

Analgesia

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7
Q

Which of the following is not an IV GA?

A. Propofol

B. Ketamine

C. Thiopental

D. Sevoflurane

A

D

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8
Q

Which of the following is not an Inhaled GA?

A. NO

B. Desflurane

C. Thiopental

D. Sevoflurane

A

C

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9
Q

What are the two types of muscle relaxants?

A

Depolarising - Suxamethonium

Non-depolarising - Rocuronium

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10
Q

Sugammadex is used to reverse what?

A

Non-depolarising muscle relaxants e.g. Rocuronium; Atracurium

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11
Q

Which patients should you avoid using Ondansetron in?

A

Prolonged QT interval

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12
Q

Which patients should you be cautious with Cyclizine use in?

A

HF

Elderly patients

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13
Q

What is the term for emergence when still paralysed from muscle relaxants?

A

Awareness under anaesthesia

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14
Q

What are the risks of general anaesthesia?

A 
Aspiration
Dental injury 
Anaphylaxis 
CV side effects
Accidental awareness
Malignant hyperthermia 
Death
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15
Q

Which medications increase the risk of malignant hyperthermia?

A

Sevoflurane
Desflurane
Suxamethonium

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16
Q

How do you treat Malignant hyperthermia?

A

Dantrolene

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17
Q

What is the difference between central neuraxial anaesthesia and epidural anaesthesia?

A

Central neuraxial anaesthesia delivers local anaesthetic into subarachnoid space. Lasts 1-3 hours, test with cold spray

Epidural delivers LA into epidural space, above the dura mater. Commonly use levobupicaine

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18
Q

How long does levobupivicaine last?

A

9 hours if epidural; 6.5 hours if intrathecal

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19
Q

what are the adverse effects of an epidural anaesthetic?

A

Headache if the dura is punctured, creating a hole for CSF to leak from (“dural tap”)
Hypotension
Motor weakness in the legs
Nerve damage (rare)
Infection
Haematoma (may cause spinal cord compression)

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20
Q

Outline the process of ETT.

A

Flexible, plastic tube within an inflatable cuff.

Insert ETT through mouth, pharynx, larynx and vocal cords into trachea.

Inflate cuff and interpret pilot balloon which correlates to inflated cuff. Pressure in cuff checked with manometer.

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21
Q

Describe a Central line.

A

A central line is also called a central venous catheter. This is essentially a long thin tube with several lumens (usually 3-5) that is inserted into a large vein, with the tip located in the vena cava.

They may be inserted into the:

Internal jugular vein
Subclavian vein
Femoral vein

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22
Q

Describe a PICC Line.

A

A peripherally inserted central catheter (PICC line) is a type of central venous catheter. A long, thin tube is inserted into a peripheral vein (e.g., in the arm) and fed through the venous system until the tip is in a central vein (the vena cava or right atrium).

They contain one or two lumens that are a narrower diameter than a standard central line.

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23
Q

Describe a Tunelled Central Venous Catheter.

A

A Hickman line is a type of tunnelled central venous catheter. It is a long, thin catheter that enters the skin on the chest, travels through the subcutaneous tissue (“tunnelled”), then enters into the subclavian or jugular vein, with a tip that sits in the superior vena cava or right atrium.

There is a cuff (sleeve) that surrounds the catheter. It promotes healing and adhesion of tissue to the cuff, making the catheter more permanent and providing a barrier to bacterial infection. They can stay in longer-term and be used for regular IV treatment (e.g., chemotherapy or haemodialysis).

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24
Q

Describe a Pulmonary Artery Catheter.

A

Pulmonary artery catheters are also known as Swan-Ganz catheters. A pulmonary artery catheter is inserted through the central venous system, right atrium, right ventricle and into a pulmonary artery. It has a balloon on the end that can be inflated to “wedge” the catheter in a branch of the pulmonary artery. The pressure distal to the wedged balloon can be measured. This gives the pulmonary artery wedge pressure, which gives an indication of the pressures in the left atrium. This is mostly used in specialist cardiac centres for close monitoring of cardiac function and response to treatment.

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25
Q

Define pain.

A

“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”

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26
Q

Outline the differences between the fibres which transmit pain.

A

C fibres (unmyelinated and small diameter) – transmit signals slowly and produce dull and diffuse pain sensations

A-delta fibres (myelinated and larger diameter) – transmit signals fast and produce sharp and localised pain sensations

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27
Q

How may you measure pain?

A

VAS

28
Q

Outline the analgesic ladder.

A

Step 1: NSAIDs

Step 2: Weak opioids

Step 3: Strong opioids

29
Q

What is the rescue dose for morphine if the background dose is 30mg per day?

A

1/6 thus 5mg PRN

30
Q

How do you convert between morphine and codeine PO?

A

1 to 10

31
Q

How much stronger is diamorphine cf morphine?

A

2x

32
Q

Which drugs should patients not be started on for chronic primary pain?

A 
Paracetamol
NSAIDs
Opiates
Pregabalin
Gabapentin
33
Q

What questionnaire may be used to assess for neuropathic pain?

A

DN4 questionnaire

34
Q

Which form of neuropathic pain is not treated with a standard neuropathic pain?

A

Trigeminal neuralgia, carbamazepine

35
Q

In what way does HDU differ from ICU?

A

HDU = Level 2

ICU = Level 3

36
Q

Which scoring systems may be used to predict mortality at time of admission to ICU?

A

Acute Physiology and Chronic Health Evaluation (APACHE)

37
Q

Describe TPN.

A

Total parenteral nutrition (TPN) involves meeting the complete nutritional requirements of the patient using an intravenous infusion of a solution of carbohydrates, fats, proteins, vitamins and minerals. This is used where it is not possible to use the gastrointestinal tract for nutrition. It is prescribed under the guidance of a dietician. TPN is very irritant to veins and can cause thrombophlebitis, so it is normally given through a central line rather than a peripheral cannula.

38
Q

What are the potential complications associated with admission to ICU?

A

Delirium

Ventilator-associated lung injury (volutrauma, barotrauma)
Ventilator-associated pneumonia
Sepsis 
Stress-related mucosal disease 
Delirium 
VTE
Critical illness polyneuropathy
39
Q

What is the usual pH range of blood?

A

7.35-7.45

40
Q

What is the usual PaO2 in arterial blood.

A

10.7-13.3kPa

41
Q

What is the usual PaCO2 in arterial blood?

A

4.7-6.0kPa

42
Q

What is the normal bicarbonate range in arterial blood?

A

22-28

43
Q

What is the usual lactate in blood?

A

0.5-1.0

44
Q

PaO2 = 7kPa

PCO2 = 3.5kPa

What type of respiratory failure is this?

A

Type 2

45
Q

PaO2 = 6.8kPa

PCO2 = 6kPa

What type of respiratory failure is this?

A

Type 1 Respiratory Failure

46
Q

What is the most commonly encountered cause of a respiratory alkalosis?

A

Anxiety

PE

Pain

47
Q

What are the causes of high anion gap metabolic acidosis?

A

Mnemonic: LTKR

Lactate

Toxins

Ketones

Renal

48
Q

What are the causes of normal anion gap metabolic acidosis?

A

Mnemonic: CAGE

Chloride excess
Acetazolamide/Addisons
GI causes
Extra - RTA

49
Q

How may a nephrotic syndrome influence the interpretation of a metabolic acidosis?

A

Hypoalbuminaemia can result in a reduction on anion gap thus corrected AG equation should be used AG + (1/4 x (40-albumin)) g/L

50
Q

What is the ladder of respiratory support available?

A 
Oxygen 
High-flow nasal cannula 
Non-invasive ventilation
Intubation and mechanical ventilation 
ECMO
51
Q

What are the benefits of prone positioning in acute respiratory distress syndrome?

A 
Reduced compression
Improved blood flow to lungs
Improved clearance of secretions
Improved overall oxygenation
Reduced assistance from mechanical ventilation
52
Q

8L per minute via a non-rebreather mask delivers what FiO2?

A

80-85%

53
Q

A simple face mask at 8L/min delivers what FiO2?

A

60%

54
Q

what type of face mask may be used in COPD?

A

Venturi masks - deliver exact concentrations of oxygen which reduce risk of over-oxygenating and contributing towards respiratory depression in a CO2 retainer

55
Q

How does a high-flow nasal cannula increase the efficiency of breathing?

A

Positive end-expiratory pressure added which reduces the risk of collapse at the end of exhalation

It also provides dead space washout, reducing physiological deadspace by providing increased air reaching the alveoli

56
Q

What forms of non-invasive ventilation exist?

A

CPAP = constant pressure, adding to lungs to keep expanded

BiPAP = cycle of high and low pressure to assist patient’s inspiration and expiration.

  • IPAP is the pressure during inspiration
  • EPAP is the pressure during expiration
57
Q

Describe Mechanical Ventilation.

A

Invasive ventilation via ETT or tracheostomy which connects ventilator to the lungs.

Can adjust: 
FiO2
RR
TV
I:E ratio
Peak flow rate
Peak inspiratory pressure
Positive end-expiratory pressure
58
Q

Describe the process of extracorporeal membrane oxygenation.

A

Blood is removed from the body, passed through a machine where oxygen is added and carbon dioxide is removed, then pumped back into the body. The process is similar to haemodialysis but for respiratory support rather than renal support.

Always a short-term measure

59
Q

What is the MOA of Levosimendan?

A. PDE3i

B. Increase sensitivity to Na+

C. Increase sensitivity to Ca2+

D. Stimulate alpha receptors

A

C

60
Q

What is the MOA of Milrinone?

A. PDE3i

B. Increase sensitivity to Na+

C. Increase sensitivity to Ca2+

D. Stimulate alpha receptors

A

A

61
Q

What is the MOA of Vasopressin?

A

ADH which acts as a vasopressor, vasocontricting smooth muscle in blood vessels and stimulating water reabsorption in CD to increase intravascular volume and subsequent blood pressure

62
Q

Outline the physiology of an intra-aortic balloon pump.

A

A catheter is inserted into the arterial system via femoral artery, fed up via external iliac artery, then common iliac arteries then abdominal aorta and descending aorta to inflate.

During systole the balloon is deflated which creates a vacuum effect, reducing afterload and increasing CO.

During diastole the balloon inflates which allows perfusion of the coronary arteries

63
Q

What are the indications for Acute Dialysis in a patient with severe acute kidney injury?

A

Mnemonic: AEIOU

Acidosis 
Electrolyte imbalance
Intoxication
Oedema
Uraemia
64
Q

Outline the difference between a spinal block and an epidural.

A

Both are types of regional anaesthesia.

Spinal block uses anaesthetic which is injected into the subarachnoid space (L3/L4 or L4/L5)

An epidural involves local anaesthetic e.g. Levobupivicaine which is injected outside the dura matter and infused through catheter to diffuse to surrounding tissue and spinal nerve roots.

65
Q

Give 3 potential adverse effects of an epidural.

A 
Headache (dura punctured) 
Hypotension
Motor weakness in legs
Nerve damage 
Infection
Haematoma

Surgery (10 decks)

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