Anaesthetics Flashcards
where should diabetes patients be put on the list
first
diabetic patients managed with insulin who will be missing a meal
VRII
diabetic medications the day before surgery
take all as normal
reduce once daily insulin by 20%
diabetic medications on the day of surgery
take metformin as normal unless TDS then omit lunch dose
omit sulfonylureas
half biphasic insulin and reduce once daily by 20%
ASA classification
1: healthy
2: mild disease (smoker, BMI 30-40, controlled asthma/DM, social drinker or pregnant)
3: severe disease (BMI over 40, uncontrolled COPD/DM, dialysis, PMHx MI, pacemaker, dialysis)
4: disease that threatens life (MI, sepsis, DIC, ESRD with no dialysis)
5: not expected to survive (massive trauma, AAA)
6: brain dead
when do you stop clear fluids/food
clear fluids 2 hours before
food 6 hours before
what classes as a clear fluid
water, tea/coffee with no milk, ice lolly, fruit juice with no pulp
blood products needed if unlikely, likely and definite chance of transfusion
unlikely: group and save
likely: cross match 2 units
definite: cross match 4-6 units
chance of transfusion if hysterectomy, appendix, elective c-section, cholecystectomy, thyroid
unlikely
chance of transfusion if ruptured ectopic or hip replacement
likely
chance of transfusion if gastrectomy, oophrectomy, AAA, hepatectomy, oesophagectomy
definite
isolated fever within 24 hours post op
physiological reaction to surgery
complication of poor post op pain management
pneumonia
what does intraoperative hypothermia increase the risk of
bleeding
which anaesthetic agent is used in haemodynamically unstable patients
ketamine
which anaesthetic agent has a high analgesic effect
ketamine
which anaesthetic agent causes hypotension but also acts as an anti-emetic
propofol
which anaesthetic agent should you use with caution in haemothorax
nitrous oxide
which anaesthetic agent can cause hepatotoxicity
halothane
which anaesthetic agent can cause adrenal suppression
etomidate
where should you place an IO
proximal tibia
where would you find a keloid scar
beyond the incision
what is isoflurane an example of
a volatile anaesthetic agent
unwell patient with mottled skin, diaphoresis and increased end tidal volume who has just been given isoflurane or suxamethonium
malignant hyperthermia
inheritance for malignant hyperthermia
autosomal dominant
treatment for malignant hyperthermia
dantrolene
what is the muscle relaxant of choice for rapid sequence inducation
suxamethonium
when is suxamethonium contraindicated
penetrating eye injuries or glaucoma
moa of lidocaine
blocks sodium channels
treatment of local anaesthetic toxicity
20% lipid emulsion
TED stockings and dalteparin post hip op
6 hours
why should you avoid hypotonic saline in paeds
risk of hyponatremic encephalopathy
patients on prednisolone for addisons need what pre op
hydrocortisone
management of an anastomotic leak
immediate return to theatre and CT
cause of post op AF
anastamotic leak
RUQ pain and bilious fluid in drain post cholecystectomy
bile leak
management of a post op ileus after colorectal surgery
NBM and NG tube decompression
monitor U+E
how do you clean wounds post op
sterile saline to 48hrs then shower
post op fever and systemically unwell
infection
