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Year 4 > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

A patient has mild pyrexia following a surgcial proceedure. What should be done?

A

Nothing, this is normal

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2
Q

How much fluid should be given to a burns patient (calculation)

A

4 x weigth (kg) x %burn = ml fluid required in first 24 hours

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3
Q

What kind of burns warrant referral to burns unit in the hospital

A

Partial thickness (>10%), full thickness (>5%) and if young or elderly

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4
Q

Management of a cluster headache

A

100% nasal oxygen and sumatriptan

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5
Q

How long before surgery should clopidogrel be stopped

A

7 days before

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6
Q

When should ACEi be stopped before surgery

A

1 day

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7
Q

When should warfarin be stopped before surgery

A

5 days

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8
Q

When after surgery can COCP be restarted

A

2 weeks

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9
Q

Where is epidural anaesthesia inserted at

A

L3-L4

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10
Q

Side effect of epidural anaesthesia

A

Hypotension of the mother

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11
Q

What systolic BP indicates a need for fluid resus

A

<100mmHg

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12
Q

What HR indicates fluid resus

A

> 90

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13
Q

WHat capillary refill indicates needing fluid resus

A

> 2s

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14
Q

What resp rate indicates a need for fluid resus

A

> 20

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15
Q

What NEWS score indicates a need for fluid resus

A

> 5

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16
Q

What fluid resus is used in dehydration

A

500ml crystaloid over 15 minutes

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17
Q

What is a crystalloid fluid

A

Solution containing sodium, chloride

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18
Q

What is a colloid IV fluid

A

SOlutions containing albumin and other large molecules

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19
Q

What is the maintenance fluid given to people

A

25-30mg/kg/d water
1mmol/kg/day for na, k and chloride

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20
Q

When should a bolus fluid of 250ml be used over 500ml

A

If there is cardiac disease or elderly (increased risk of pulmonary oedema)

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21
Q

What is the max amount of fluid that should be given in fluid resus

A

2000ml

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22
Q

What can cause lactic acidosis

A

Tissue hypoxia (e..g, shock, ischaemia, anaemia and excercise)

Metabolism of lactate issues (e.g., Diabetic Ketoacidosis and liverdisease)

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23
Q

What drugs can cause lactic acidosis

A

Metformin
Aspirin

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24
Q

First step management of local anaesthetic toxicity

A

STOP anaesthetic

ABCDE
ECG

Lipid emulsion (20% intralipid) every 3 minutes up to 3ml/kg

0.25ml/kg/min

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25
Q

What types of anaesthetic drugs cause malignant hyperthermia

A

Inhaled (Sevo) or Suxamethonium

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26
Q

What genetic predisposition results in malignant hyperthermia

A

mutation in ryanodine receptor 1 (increases calcium levels in the sarcoplasmic reticulum)

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27
Q

Management of melignant hyperthermia

A

Stop agent

IV Dantrolene (ryanodine receptor antagonist)

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28
Q

How do we confirm NG tube placement

A

pH of NG tube aspirate:

pH <5 is okay

or

Erect Chest X-Ray (tip must be below the diaphragm)

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29
Q

What is CPAP used for

A

Type 1 resp failure (hypoxia and no hypercapnia)

Keeps alveoli open to facilitate gas exchange

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30
Q

What is BiPAP used for

A

Type II resp failure

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31
Q

WHen should Non invasive ventilation be used

A

Patient is awake and co-operative

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32
Q

COntraindications for NIV

A

Vomiting
Pneumothorax
Haeodynamically unstable
Refusal

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33
Q

When is oral iron indicated in perioperative anaemia

A

> 6 weeks until planned surgery

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34
Q

When should IV iron be given in periopertaive anaemia

A

<6 weeks until surgery

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35
Q

What else should be given alongside iron in perioperative anaemia

A

B12 and folate
Erythropoiesis stimulating egent

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36
Q

Perioperative management of people on steroids

A

Switch oral to IV hydrocortisone

Add in fludrocortisone if hypotensive

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37
Q

When can people be switched form IV hydrocortisone to oral after surgery

A

Sratight away, major - wait 72 horus

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38
Q

HOW DOES LIDOCAINE WORK

A

BLACKS SODIUM CHANNELS

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39
Q

What advice should be given regarding food before surgery

A

No fofod for 6 hours and no clear fluids for 2 hours

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40
Q

What screening tool is used to check for potential obstructive apnoea before surgery

A

STOPP-BANG s

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41
Q

What is the problem with GA in someone with COPD

A

ANyone who might have obstructive bretahing issues, and thus making extubation worse - remember opiates are used in GA and can supress respiration

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42
Q

What is the benefit of spinal anaesthesia over GA

A

Faster recovery, more likely to be discharged.

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43
Q

What should be done to someone who is on long term oral steroids on the day of the surgery

A

Double their oral dose and then switch to IV hydrocortisone during surgery

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44
Q

If someone is being weaned off steroids, pserioperatively what should be done

A

Nothing, continue as normal as long as the dose is below 10mg

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45
Q

How long should we wait after giving LMWH to give spinal anaesthesia

A

12 hours

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46
Q

How long after giving LMWH heparin should we remove the indwelling catheter that puts spinal anaesthesia in

A

12 horus

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47
Q

What is the conversion from oral steroids to hydrocortisone

A

10mg -> 40mg

1:4

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48
Q

Why are all diabetic drugs stopped the morning of surgery

A

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

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49
Q

What is the perio-operative management of diabetes

A

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

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50
Q

When should someone with Diabetes be switched from sliding scale to normal insulin regimen post-operatively

A

Around their first meal

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51
Q

When is sliding scale insulin indicated

A

When you miss at least one meal

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52
Q

Why should patients with diabetes be placed first on the list

A

So that they only miss one meal

53
Q

Should long acting insulin be continued in T1DM people

A

Yes

54
Q

What is VRIII replacing in patients

A

Just the fast atcinng insulin that people inject after meals

55
Q

Management of hypoglycaemia in T1DM post operatively

A

STOP variable rate insulin

Start dextrose

56
Q

If a patient has no IV access and is hypoglycaemic, what should be done

A

IM glucagon

57
Q

How does emergency surgery differ from elective surgery when managing patients with
diabetes?

A

You don’t have time to optimise the blood glucose in emergency.

58
Q

Effects of hyperglycaemia in surgical patients

A

Can worsen wound healing and cause infections (bacteria like sugar)

59
Q

Causes of post-operatiev nausea and vomiting

A

Infection
Hypovolaemia
Pain
Paralytic Ileus
Drugs

60
Q

None pharmacological treatment of post-operative nausea and vomiting

A

Minimise patient movement
Analgesia
IV Fluids

61
Q

Pharmacological management of post-operative neausea and vomiting

A

5HT3 receptor antagonist - Odansetron

H1 receptor antagonist - cyclizine

D2 receptor antagonist - prochlorperazine

62
Q

Indications for rapid sequence induction

A

Method of co ordinating rapid acting anaesthetics and opening the wairways to reduce risk of aspiration in people at risk

63
Q

Name thre first three sequences of RSI

A

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)

64
Q

Name the three steps DURING rapid sequence induction

A

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

65
Q

What is Systemic Inflammatory response syndrome criteria

A

Temp > 38 or <36
HR > 90
RR > 20
ECC > 12 or <4

66
Q

When is thiopentone indicated as the inducing agent

A

If a ptient is prone to seizures

67
Q

IN trauma patients, why is ketamine given as first line induction agent

A

It does not affect BP

68
Q

What is the induction agent of choice in children or someone with LD

A

Sevoflourin (induction and maintenance) as it’s not as distressing as putting a cannula in

69
Q

What induction agent as anti-emetic properties

A

Propofol

70
Q

How does propofol work

A

GABA receptor agonist

71
Q

What is the agent of choice for induction in RSI

A

Sodium Thiopentone

72
Q

Pharmacology of Ketamine

A

NMDA receptor antagonist

73
Q

What drug slows bone healing

A

NSAIDs

74
Q

What score is used to predict the ease of endotracheal intubation

A

Mallampati score

75
Q

What scote is used to assess airway patency

A

Wilson’s

76
Q

What does a wilson score <5 indicate

A

Easy Laryngoscopy

77
Q

How long should St John’s wart be stopped before surgery

A

2 weeks

78
Q

Name three premedications that are given

A

Midazolam to reduce anxiety

Opiates to reduce pain and reduce hypertensive response to the laryngoscope

Clondine to help with sedation (alpha 2 agonist)

79
Q

What i sthe role of cricoid pressure during RSI

A

COmpress oesophagus to prevent stomach contents from refluxing into the pharynx.

80
Q

What is the most common anaesthetic used in TIVA

A

Propofol

81
Q

Name a depolarising muscle relaxant

A

Suxamethonium

82
Q

Name two non-depolarising muscle relaxants

A

Rocuronium and atracurium

83
Q

What medication can reverse the effects of neurmuscular blocking medictaions

A

Neostigmine (ach inhibitors)

84
Q

What is the role of Sugammadex

A

Reverse the effects of non-depolarising muscle relaxants

85
Q

When is Odansetron contraindicated

A

Patients at risk of prolongued QT

86
Q

What test is used to check if muscle relaxants have warn off

A

Ulnar nerve timulator

87
Q

What is the most common epidural anaesthesia used

A

Levobupivacaine with or without fentanyl

88
Q

What local anaesthetic is used in surgery

A

Lidocaine

89
Q

When is a tracheostomy indicated

A

IN emergencies if there is respiratory failrue or upper aiways obstruction during surgery

90
Q

Outine the difficult airway stages for intubation

A

Plan 1 - Laryngosocpy + tracheal intubation

Plan 2 - Supraglottic airway device

Plan 3 - Face mask ventilation + wake up

Plan 4 - Cricothyroidotomy

91
Q

What is the role of Vas Catch

A

Central veonus catheter used for haemodialysis during surgery

92
Q

What is a PICC line (peripherally inserted central catheter)

A

A long thin tube inserted into aperipheral cein until it reaches a central vein (IVF)

93
Q

What is a Hickman line

A

A long thin catheter entering the skin on the chest, travels through subcuntaneous tissue into the sublavian or jugular vein

94
Q

Examples of type 1 respiratory failure

A

COPD
Pneumonia
Pulmonary Fibrosis
Asthma
Pneumothorax
PE

95
Q

Examples of type 2 respiratory failure

A

COPD
Asthma
Myasthenia Gravis
Polyneuropathy
Hypothyroidism

96
Q

What is the most comonly obstained site for INtraosseous lines

A

Proximal tibia

97
Q

Management of hypotension (<60)

A

Give Glycopyrrolate

98
Q

Role of glycopyrrolate

A

Anticholinergic drug

99
Q

If HR >100 and sinus rhythm, how should we manage hypotension

A

IV Fluids only

100
Q

Management of peri-operative hyperthermia

A

Give BDZs for shivering + consider tracheal intubation and muscle paralysis

101
Q

Management of serotonin syndrome if suspected

A

Chlorpromazine

102
Q

What Hb threshold is targeted if there is massive blood loss

A

80Hb

103
Q

First line management of bronchospasming

A

Nebulised salbutamol

Second Line: IV Salbutamol

104
Q

Management of laryngospasming

A

Give CPAP

105
Q

Management of Malignant Hyperthermia

A

Dantrolene

106
Q

Symptoms of high central neuraxial blocks

A

Hypotension and bradycardia

107
Q

What is high central neuraxial block

A

Accidental injection into the Subarachnoid space

108
Q

Management of high central neuraxial block

A

Bradycardia: Atropine

Hypotension: Phenylephrine

109
Q

By how much should long-acting insulin be reduced on the day of surgery

A

By 20%

110
Q

What is a side effect of Etomidate

A

Adrenal suppression

111
Q

What is a side-effect of Ketamine

A

Hallucinations

112
Q

What is the earliest sign of local anaesthetic toxicity

A

Perioral numbness

113
Q

What is NO used for

A

Maintenance of anaesthesia

114
Q

What anaesthetic can precipitate pneumothoraces

A

NO

115
Q

What is the first line anaesthetic agent used in Lung trauma

A

Morphine as it is more predictable

116
Q

Other than metformin, what other drug can be continued on the day of surgery for diabetes

A

Sitagliptin (GLP-1 analogues)

117
Q

What investigation should be considered in patients over the age of 65 before surgery

A

ECG

118
Q

What investigation needs to be done in patients with renal disease before surgery

A

FBC

119
Q

What investigation should be considered before surgery in people with diabetes

A

ECG

120
Q

What physiological change contributes to paralytic ileus

A

Deranged electrolytes

121
Q

Management of paralytic ileus

A

IV fluids, Total parenteral nutrition and nil by mouth

122
Q

What substance is used to clean wounds

A

Sterile Saline

123
Q

What operations require Cross-matching of 4-6 blood units

A

AAA repair
Cystectomy (all the ectomies)

124
Q

What is a group and save

A

Consists of blood group and antibody screen to determine patient grou[ and if they have antibodies against certain bloods

125
Q

What metabolic disturbance can be caused by suxomethonium

A

Hyperkalaemia

126
Q

How do we diagnose an anastomotic leak

A

Abdominal CT

127
Q

When is a thoracostomy indicated over cricothyroidotomy

A

Cricothyroidtomy - ACUTE

Thoracostomy - Chronic respiratory depression

128
Q

When is Suxomethonium contraindicated

A

Glaucoma or increased intracranial pressure

Year 4 (16 decks)

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