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Year 4 Final > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

What to do to insulin day prior to admission for surgery?

A

Reduce dose by 20%

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2
Q

What is Suxamethonium

A

Depolarising neuromuscular blocker
Inhibits action of acetylcholine at the neuromuscular junction
Degraded by plasma cholinesterase and acetylcholinesterase

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3
Q

What airway is relatively contraindicated in base of skull fractures?

A

Nasopharyngeal airways

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4
Q

What is suxamethonium apnoea?

A

lack of the specific acetylcholinesterase in the plasma which acts to break down suxamethonium, terminating its muscle relaxant effect. Therefore, the effects of suxamethonium are prolonged and the patient needs to be mechanically ventilated and observed in ITU until the effects of suxamethonium wear off.

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5
Q

Treatment of malignant hyperthermia in suxamethonium use?

A

Dantrolene

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6
Q

When is suxamethonium contraindicated?

A

For patients with penetrating eye injuries or acute narrow angle glaucoma, as suxamethonium increases intra-ocular pressure

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7
Q

What bloods should be done in post operative ileus?

A

Deranged electrolytes can contribute to the development of postoperative ileus, so it is important to check potassium, magnesium and phosphate.

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8
Q

What is lidocaine?

A

Local anaesthetic and a less commonly used antiarrhythmic (affects Na channels in the axon)

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9
Q

Most common site for IO?

A

Proximal tibia

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10
Q

Drugs which impair wound healing?

A

Non steroidal anti inflammatory drugs
Steroids
Immunosupressive agents
Anti neoplastic drugs

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11
Q

How long before surgery should you stop oral contraceptive pill?

A

4 weeks

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12
Q

What is ASA IV?

A

A patient with severe systemic disease that is a constant threat to life

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13
Q

What is ASA V?

A

A moribund patient who is not expected to survive without the operation

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14
Q

What is ASA VI?

A

A declared brain-dead patient whose organs are being removed for donor purposes

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15
Q

Which anaesthetic agent has inherent anti-emetic properties?

A

Propofol

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16
Q

The following timeline can be used as a broad rule of thumb when determining the most likely cause of postoperative fever:

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.

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17
Q

Adverse effects of suxamethonium?

A

Malignant hyperthermia
Hyperkalaemia (normally transient)

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18
Q

What is the phsyiological problems with a ileus following gastrointestinal surgery?

A

Fluid sequestration and loss of electrolytes

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19
Q

General risk factors for VTE?

A

active cancer/chemotherapy
aged over 60
known blood clotting disorder (e.g. thrombophilia)
BMI over 35
dehydration
one or more significant medical comorbidities (e.g. heart disease; metabolic/endocrine pathologies; respiratory disease; acute infectious disease and inflammatory conditions)
critical care admission
use of hormone replacement therapy (HRT)
use of the combined oral contraceptive pill
varicose veins
pregnant or less than 6 weeks post-partum

20
Q

Mechanism of action of Etomidate?

A

Potentiates GABA

21
Q

Adverse effects of etomidate?

A

Primary adrenal suppression (secondary to reversibly inhibiting 11β-hydroxylase)
* Myoclonus

22
Q

Management of post-operative ileus?

A

onservative with nasogastric tube insertion for stomach decompression for symptom control and placing the patient nil by mouth to allow bowel rest. The recommencement of fluids/light diet should be in stages and guided by the clinical state of the patient.

23
Q

What do patient’s taking prednisolone require during surgery?

A

Hydrocortisone to prevent an addisonian crisis

24
Q

Adverse effects of nitrous oxide?

A

May diffuse into gas-filled body compartments → increase in pressure. Should therefore be avoided in certain conditions e.g. pneumothorax

25
Q

A 2% strength liquid medicine means what?

A

2g of the drug are dissolved in 100ml

26
Q

Adverse effects of volatile liquid anaesthetics?

A
  • Myocardial depression
  • Malignant hyperthermia
  • Halothane (not commonly used now) is hepatotoxic
27
Q

Which anaesthetic agent has a favorable cardiac safety profile with very little haemodynamic instability

A

Etomidate

28
Q

What agent reverses the action of benzodiazepines?

A

Flumazenil

29
Q

What inhaled agent is associated with hepatoxocicity

A

Halothane

30
Q

Local anesthetic toxicity can be treated with what?

A

IV 20% lipid emulsion

31
Q

What to do with patients on sulfonylureas on day of surgery if morning operation?

A

If taken once daily in the morning - omit the dose that
day
If taken twice daily - omit the morning dose that day

32
Q

What can CT scans identifiy as post op complications?

A

identification of intra-abdominal abscesses, air and if luminal contrast is used an anastamotic leak

33
Q

Things to think about in airway when giving anaesthetics

A

Teeth
GORD
Not fasting- 6 hours food, 2 hours fluid
Delayed emptying- Parasympathetic and sympathetic. Drugs could delay, some people. Rest and digest- So stress causes delay

34
Q

Important conditions to think about in pre op

A

DM
COPD/Asthma
Increased BP
Arrythmias
IHD- Make sure on optimal medication. Supply and demand.
HF
Coagulation disorer

35
Q

What is important in relation to IHD in anaesthetics?

A

Want to continue medications that dilate the coronary arteries- Isobridde mononitrate
Also want to be continuing other drugs like CCB as they dilate the heart
Beta blockers

36
Q

Management of diabetes in surgry?

A

Switch to sliding scale insulin as been fasted so could cause hypoglycaemia
Also due to stress could cause hyperglycaemia

37
Q

What to do with epipletics in seziures?

A

Need to consider decreased seizure threshold so consider anti epileptics

38
Q

Genetic conditions to be concerned about in surgery?

A

Suxamethonium Apnoea
Malignant hyperthermia

39
Q

What happens at an NMJ?

A

AP fires until gets to threshold.
Calcium comes in. Breaks troponin bind with Acetylcholine. Acetylcholine diffuses across the synapse and opens channels at other end of channel. Then get depolarisation. So ion channel releases in sarcoplasmic reticulum, calcium stores get out and then bind to troponin

40
Q

What does the sarcoplasmic reticulum store

A

Calcium

41
Q

What is missing in malignant hyperthermia?

A

Channel in sarcoplasmic reticiulum that takes calcium back in

42
Q

What are the types of masks

A
43
Q

Important things to remeber about fluid therapy

A

Give oral over IV

44
Q

When to give iv fluids?

A

Routine maintaince
Replacement
Resuscitation
Review

45
Q

Oral fluids before surgery fasting?

A

patients having surgery may drink clear fluids until 2 hours before their operation
clear fluids are water, fruit juice without pulp, coffee or tea without milk and ice lollies
Patients are generally advised to fast from non-clear liquids/food for at least 6 hours before surgery.

Year 4 Final (39 decks)

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