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Phase 3b/Finals revision > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

When should intraosseous access be considered

A

If attempts (usually >2 minutes) at IV are unsuccessful, or IV is not feasible

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2
Q

Sign in

A

Conducted prior to induction of anaesthesia
Patient confirms identity, nature of procedure, and reiterates consent

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3
Q

Sign out

A

Before patient or surgical team leaves OR
Inventory of surgical equipment, surgeon reports on procedure, and any concerns regarding recovery are recorded

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4
Q

Time out

A

Done before first skin incision is made
Equipment checked + concerns regarding intra-operative complications are recorded

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5
Q

Alternative to LMWH in patients with chronic kidney disease

A

Unfractionated heparin

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6
Q

Elective hip replacement VTE prophylaxis

A

LMWH for 10 days followed by aspirin (75 or 150 mg) for a further 28 days;

or LMWH for 28 days combined with anti-embolism stockings until discharge;

or Rivaroxaban

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7
Q

Elective knee replacement VTE prophylaxis

A

Aspirin (75 or 150 mg) for 14 days;

or LMWH for 14 days combined with anti-embolism stockings until discharge;

or Rivaroxaban

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8
Q

Management of local anaesthetic toxicity

A

IV 20% lipid emulsion e.g. intralipid

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9
Q

Risk factors/causes of local anaesthetic toxicity

A

IV administration
Excess usage
Liver dysfunction
Low protein state

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10
Q

Presentation of local anaesthetic toxicity

A

Initial overactivity of CNS
Then depression of CNS
Cardiac arrhythmias

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11
Q

One technique to reduce risk of local anaesthetic toxicity

A

Higher doses given with adrenaline to reduce systemic absorption - prolongs duration of action at site of injection (does not work with bupivicaine)

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12
Q

Maximum 1% lignocaine plain dose

A

3mg/kg - 200mg (20ml)
Based on ideal bodyweight

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13
Q

Maximum 1% lignocaine with 1 in 200,000 adrenaline

A

7mg/kg - 500mg (50mL)
Based on ideal bodyweight

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14
Q

Maximum bupivicaine 0.5% dose

A

2mg/kg - 150mg (30mL)
Based on ideal bodyweight

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15
Q

Substance used to clean surgical wounds in first 48 hours

A

Sterile saline

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16
Q

When can patients with surgical wounds shower safely

A

48 hours after surgery

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17
Q

Substance used to clean surgical wounds after 48 hours

A

If surgical wound separated, or opened to drain pus –> tap water

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18
Q

When is a tracheostomy useful

A

In facilitating long-term weaning
Often used in ITU

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19
Q

Early causes of post-operative pyrexia (0-5 days)

A

Blood transfusion
Cellulitis
UTI
Physiological systemic inflammatory reaction (usually within a day)
Pulmonary atelectasis

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20
Q

Late causes of post-operative pyrexia (>5 days)

A

VTE
Pneumonia
Wound infection
Anastomotic leak

21
Q

When should drugs containing oestrogen be stopped prior to surgery

A

4 weeks

22
Q

Name 5 muscle relaxant drugs

A

Suxamethonium
Atracurium
Vecuronium
Pancuronium
Rocuronium

23
Q

Which of the muscle relaxants is depolarising

A

Suxamethonium

24
Q

Action of suxamethonium

A

Competitively binds to ACh receptors in motor end plate –> paralysis

25
Q

How do non-depolarising muscle relaxants work

A

Antagonise nicotinic ACh receptors in motor end plate –> paralysis

26
Q

Relative onset + duration of action of muscle relaxants

A

Suxamethonium - fastest onset + shortest duration
Atracurium + vecuronium - duration of 30-40(45 for at) minutes
Pancuronium - onset = 2-3 minutes, duration up to 2 hours

27
Q

Reversal for muscle relaxants

A

(Suxamethonium - sugammadex)
Others - neostigmine

28
Q

ASA I

A

A normal, healthy patient eg. non-smoker, minimal alcohol use

29
Q

ASA II

A

A patient with mild systemic disease, without substantial functional limitations e.g. smoker, well-controlled diabetes mellitus, mild lung disease

30
Q

ASA III

A

A patient with severe systemic disease, with substantive functional limitations; one or more moderate to severe diseases e.g. poorly controlled DM or hypertension, COPD, morbid obesity etc.

31
Q

ASA IV

A

A patient with severe systemic disease that is a constant threat to life e.g. recent MI, ongoing cardiac ischaemia etc.

32
Q

ASA V

A

A moribund patient who is not expected to survive without the operation e.g. ruptured AAA, massive trauma etc.

33
Q

ASA VI

A

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

34
Q

Known adverse effects for depolarising muscle relaxants e.g. suxamethonium

A

Malignant hyperthermia
Hyperkalaemia (usually transient)

35
Q

Contraindications to suxamethonium

A

Patients with penetrating eye injuries or acute narrow angle glaucoma as it increases intra-ocular pressure

36
Q

Adverse effects of non-depolarising muscle relaxants

A

Hypotension

37
Q

Neuromuscular blocking agent of choice for rapid sequence intubation

A

Usually suxamethonium - due to rapid onset
Other option = rocuronium (risk of allergy)

38
Q

Features of malignant hyperthermia

A

Increased end-tidal carbon dioxide (hypercapnia)
Tachycardia
Muscle rigidity
Rhabdomyolysis
Hyperthermia
Arrhythmia

39
Q

Treatment of anaesthetic-induced malignant hyperthermia

A

IV dantrolene

40
Q

Mechanism of action of propofol

A

GABA receptor agonist

41
Q

Mechanism of action of ketamine

A

NMDA receptor antagonist

42
Q

Which IV induction agents cause myocardial depression

A

Propofol - moderate
Sodium thiopentone - marked

43
Q

Fluids before surgery

A

Clear foods until 2 hours before - can reduce headaches, N+V post-op
Fast from non-clear liquids/foods for minimum 6 hours before

44
Q

Adverse effects of volatile liquid anaesthetics

A

Myocardial depression
Malignant hyperthermia
Halothane = hepatotoxic

45
Q

Adverse effects of propofol

A

Pain on injection - due to activation of pain receptro TRPA1
Hypotension

46
Q

Adverse effects of thiopental

A

Laryngospasm
NB: highly lipid-soluble so quickly affects the brain

47
Q

Adverse effects of etomidate

A

Primary adrenal supression
Myoclonus

48
Q

Adverse effects of ketamine

A

Disorientation
Hallucinations

49
Q

Inheritance of susceptibility to malignant hyperthermia

A

Autosomal dominant

Phase 3b/Finals revision (17 decks)

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