Anaesthetics Flashcards
A patient has mild pyrexia following a surgcial proceedure. What should be done?
Nothing, this is normal
How much fluid should be given to a burns patient (calculation)
4 x weigth (kg) x %burn = ml fluid required in first 24 hours
What kind of burns warrant referral to burns unit in the hospital
Partial thickness (>10%), full thickness (>5%) and if young or elderly
Management of a cluster headache
100% nasal oxygen and sumatriptan
How long before surgery should clopidogrel be stopped
7 days before
When should ACEi be stopped before surgery
1 day
When should warfarin be stopped before surgery
5 days
When after surgery can COCP be restarted
2 weeks
Where is epidural anaesthesia inserted at
L3-L4
Side effect of epidural anaesthesia
Hypotension of the mother
What systolic BP indicates a need for fluid resus
<100mmHg
What HR indicates fluid resus
> 90
WHat capillary refill indicates needing fluid resus
> 2s
What resp rate indicates a need for fluid resus
> 20
What NEWS score indicates a need for fluid resus
> 5
What fluid resus is used in dehydration
500ml crystaloid over 15 minutes
What is a crystalloid fluid
Solution containing sodium, chloride
What is a colloid IV fluid
SOlutions containing albumin and other large molecules
What is the maintenance fluid given to people
25-30mg/kg/d water
1mmol/kg/day for na, k and chloride
When should a bolus fluid of 250ml be used over 500ml
If there is cardiac disease or elderly (increased risk of pulmonary oedema)
What is the max amount of fluid that should be given in fluid resus
2000ml
What can cause lactic acidosis
Tissue hypoxia (e..g, shock, ischaemia, anaemia and excercise)
Metabolism of lactate issues (e.g., Diabetic Ketoacidosis and liverdisease)
What drugs can cause lactic acidosis
Metformin
Aspirin
First step management of local anaesthetic toxicity
STOP anaesthetic
ABCDE
ECG
Lipid emulsion (20% intralipid) every 3 minutes up to 3ml/kg
0.25ml/kg/min
What types of anaesthetic drugs cause malignant hyperthermia
Inhaled (Sevo) or Suxamethonium
What genetic predisposition results in malignant hyperthermia
mutation in ryanodine receptor 1 (increases calcium levels in the sarcoplasmic reticulum)
Management of melignant hyperthermia
Stop agent
IV Dantrolene (ryanodine receptor antagonist)
How do we confirm NG tube placement
pH of NG tube aspirate:
pH <5 is okay
or
Erect Chest X-Ray (tip must be below the diaphragm)
What is CPAP used for
Type 1 resp failure (hypoxia and no hypercapnia)
Keeps alveoli open to facilitate gas exchange
What is BiPAP used for
Type II resp failure
WHen should Non invasive ventilation be used
Patient is awake and co-operative
COntraindications for NIV
Vomiting
Pneumothorax
Haeodynamically unstable
Refusal
When is oral iron indicated in perioperative anaemia
> 6 weeks until planned surgery
When should IV iron be given in periopertaive anaemia
<6 weeks until surgery
What else should be given alongside iron in perioperative anaemia
B12 and folate
Erythropoiesis stimulating egent
Perioperative management of people on steroids
Switch oral to IV hydrocortisone
Add in fludrocortisone if hypotensive
When can people be switched form IV hydrocortisone to oral after surgery
Sratight away, major - wait 72 horus
HOW DOES LIDOCAINE WORK
BLACKS SODIUM CHANNELS
What advice should be given regarding food before surgery
No fofod for 6 hours and no clear fluids for 2 hours
What screening tool is used to check for potential obstructive apnoea before surgery
STOPP-BANG s
What is the problem with GA in someone with COPD
ANyone who might have obstructive bretahing issues, and thus making extubation worse - remember opiates are used in GA and can supress respiration
What is the benefit of spinal anaesthesia over GA
Faster recovery, more likely to be discharged.
What should be done to someone who is on long term oral steroids on the day of the surgery
Double their oral dose and then switch to IV hydrocortisone during surgery
If someone is being weaned off steroids, pserioperatively what should be done
Nothing, continue as normal as long as the dose is below 10mg
How long should we wait after giving LMWH to give spinal anaesthesia
12 hours
How long after giving LMWH heparin should we remove the indwelling catheter that puts spinal anaesthesia in
12 horus
What is the conversion from oral steroids to hydrocortisone
10mg -> 40mg
1:4
Why are all diabetic drugs stopped the morning of surgery
Stress during operation further pushes insulin levels up
Do not take someone off parkinson’s or PPIs
Only ACEi need to be stopped, all other BP drugs are okay
What is the perio-operative management of diabetes
Stop insulin drugs and begin sliding scale insulin infusion as soon as the patient is nil by mouth.
Continue infusion until patient is able to eat operatively
When should someone with Diabetes be switched from sliding scale to normal insulin regimen post-operatively
Around their first meal
When is sliding scale insulin indicated
When you miss at least one meal
Why should patients with diabetes be placed first on the list
So that they only miss one meal
Should long acting insulin be continued in T1DM people
Yes
What is VRIII replacing in patients
Just the fast atcinng insulin that people inject after meals
Management of hypoglycaemia in T1DM post operatively
STOP variable rate insulin
Start dextrose
If a patient has no IV access and is hypoglycaemic, what should be done
IM glucagon
How does emergency surgery differ from elective surgery when managing patients with
diabetes?
You don’t have time to optimise the blood glucose in emergency.
Effects of hyperglycaemia in surgical patients
Can worsen wound healing and cause infections (bacteria like sugar)
Causes of post-operatiev nausea and vomiting
Infection
Hypovolaemia
Pain
Paralytic Ileus
Drugs
None pharmacological treatment of post-operative nausea and vomiting
Minimise patient movement
Analgesia
IV Fluids
Pharmacological management of post-operative neausea and vomiting
5HT3 receptor antagonist - Odansetron
H1 receptor antagonist - cyclizine
D2 receptor antagonist - prochlorperazine
Indications for rapid sequence induction
Method of co ordinating rapid acting anaesthetics and opening the wairways to reduce risk of aspiration in people at risk
Name thre first three sequences of RSI
Preparation (ensure environment is optimised, staff are ready, equipment available)
Preoxygenation (high flow O2 for 5 minutes prior)
Pretreatment (opiate analgesia or fluid bolus to counteract hypotensive effects of anaesthesia)
Name the three steps DURING rapid sequence induction
Paralysis (propofol or Thiopentone as induction agents) and then a muscle paralysing agent (suxomethonium or rocuronium)
Protection and position (adding cricoid pressure to protect airways)
Placement (intubation via laryngoscopy + proof)
Post intubation management - start mechanical ventilation and tape tube down
What is Systemic Inflammatory response syndrome criteria
Temp > 38 or <36
HR > 90
RR > 20
ECC > 12 or <4
When is thiopentone indicated as the inducing agent
If a ptient is prone to seizures
IN trauma patients, why is ketamine given as first line induction agent
It does not affect BP
What is the induction agent of choice in children or someone with LD
Sevoflourin (induction and maintenance) as it’s not as distressing as putting a cannula in
What induction agent as anti-emetic properties
Propofol
How does propofol work
GABA receptor agonist
What is the agent of choice for induction in RSI
Sodium Thiopentone
Pharmacology of Ketamine
NMDA receptor antagonist
What drug slows bone healing
NSAIDs
What score is used to predict the ease of endotracheal intubation
Mallampati score
What scote is used to assess airway patency
Wilson’s
What does a wilson score <5 indicate
Easy Laryngoscopy
How long should St John’s wart be stopped before surgery
2 weeks
Name three premedications that are given
Midazolam to reduce anxiety
Opiates to reduce pain and reduce hypertensive response to the laryngoscope
Clondine to help with sedation (alpha 2 agonist)
What i sthe role of cricoid pressure during RSI
COmpress oesophagus to prevent stomach contents from refluxing into the pharynx.
What is the most common anaesthetic used in TIVA
Propofol
Name a depolarising muscle relaxant
Suxamethonium
Name two non-depolarising muscle relaxants
Rocuronium and atracurium
What medication can reverse the effects of neurmuscular blocking medictaions
Neostigmine (ach inhibitors)
What is the role of Sugammadex
Reverse the effects of non-depolarising muscle relaxants
When is Odansetron contraindicated
Patients at risk of prolongued QT
What test is used to check if muscle relaxants have warn off
Ulnar nerve timulator
What is the most common epidural anaesthesia used
Levobupivacaine with or without fentanyl
What local anaesthetic is used in surgery
Lidocaine
When is a tracheostomy indicated
IN emergencies if there is respiratory failrue or upper aiways obstruction during surgery
Outine the difficult airway stages for intubation
Plan 1 - Laryngosocpy + tracheal intubation
Plan 2 - Supraglottic airway device
Plan 3 - Face mask ventilation + wake up
Plan 4 - Cricothyroidotomy
What is the role of Vas Catch
Central veonus catheter used for haemodialysis during surgery
What is a PICC line (peripherally inserted central catheter)
A long thin tube inserted into aperipheral cein until it reaches a central vein (IVF)
What is a Hickman line
A long thin catheter entering the skin on the chest, travels through subcuntaneous tissue into the sublavian or jugular vein
Examples of type 1 respiratory failure
COPD
Pneumonia
Pulmonary Fibrosis
Asthma
Pneumothorax
PE
Examples of type 2 respiratory failure
COPD
Asthma
Myasthenia Gravis
Polyneuropathy
Hypothyroidism
What is the most comonly obstained site for INtraosseous lines
Proximal tibia
Management of hypotension (<60)
Give Glycopyrrolate
Role of glycopyrrolate
Anticholinergic drug
If HR >100 and sinus rhythm, how should we manage hypotension
IV Fluids only
Management of peri-operative hyperthermia
Give BDZs for shivering + consider tracheal intubation and muscle paralysis
Management of serotonin syndrome if suspected
Chlorpromazine
What Hb threshold is targeted if there is massive blood loss
80Hb
First line management of bronchospasming
Nebulised salbutamol
Second Line: IV Salbutamol
Management of laryngospasming
Give CPAP
Management of Malignant Hyperthermia
Dantrolene
Symptoms of high central neuraxial blocks
Hypotension and bradycardia
What is high central neuraxial block
Accidental injection into the Subarachnoid space
Management of high central neuraxial block
Bradycardia: Atropine
Hypotension: Phenylephrine
By how much should long-acting insulin be reduced on the day of surgery
By 20%
What is a side effect of Etomidate
Adrenal suppression
What is a side-effect of Ketamine
Hallucinations
What is the earliest sign of local anaesthetic toxicity
Perioral numbness
What is NO used for
Maintenance of anaesthesia
What anaesthetic can precipitate pneumothoraces
NO
What is the first line anaesthetic agent used in Lung trauma
Morphine as it is more predictable
Other than metformin, what other drug can be continued on the day of surgery for diabetes
Sitagliptin (GLP-1 analogues)
What investigation should be considered in patients over the age of 65 before surgery
ECG
What investigation needs to be done in patients with renal disease before surgery
FBC
What investigation should be considered before surgery in people with diabetes
ECG
What physiological change contributes to paralytic ileus
Deranged electrolytes
Management of paralytic ileus
IV fluids, Total parenteral nutrition and nil by mouth
What substance is used to clean wounds
Sterile Saline
What operations require Cross-matching of 4-6 blood units
AAA repair
Cystectomy (all the ectomies)
What is a group and save
Consists of blood group and antibody screen to determine patient grou[ and if they have antibodies against certain bloods
What metabolic disturbance can be caused by suxomethonium
Hyperkalaemia
How do we diagnose an anastomotic leak
Abdominal CT
When is a thoracostomy indicated over cricothyroidotomy
Cricothyroidtomy - ACUTE
Thoracostomy - Chronic respiratory depression
When is Suxomethonium contraindicated
Glaucoma or increased intracranial pressure
