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SBA passmed Flashcards > anaesthetics > Flashcards

anaesthetics Flashcards

1
Q

how often before surgery should the oral contraceptive be stopped?

A

4 weeks prior

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2
Q

what is suxamethonium apnoea ? how is it managed

A

Autosomal dominant mutation, leading to a lack of specific acetylcholistenerase in the plasma which acts to break down suxamethonium which terminates its muscle relaxant effect.

managed with mechanical ventilation and observation in ITU until effects of suxamethonium wear off

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3
Q

what are the two categories of muscle relaxants used in anaesthetics? give examples of each

A

Depolarising muscle relaxants - suxamethonium
Non depolarising muscle relaxants - atracurium, vecuronium, pancuronium

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4
Q

which anaesthetic agent is best for haemodynamically unstable patients and why?

A

Ketamine as it preserves blood pressure and does not cause cardio suppression

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5
Q

which anaesthetic is the choice for rapid sequence induction?

A

sodium thiopentone

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6
Q

what is the complication of excess infusion of sodium chloride?

A

Hyper-chloraemic acidosis

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7
Q

what is a common complication after surgery involving the bowel ? what are its features? what blood marker should be checked? How is it managed?

A

Post-operative ileus - reduced bowel peristaltis resulting in pseudo-obstruction.

features :

abdominal distension, pain , nausea and vomiting, inability to flatus

deranged electrolytes

management -

NBM
NG tube if vomiting
IV fluids
total parenteral nutrition

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8
Q

what is the ASA classification?

A

I : normal healthy, non smoker + minimal alcohol
II : mild systemic : smoker, social alcohol, pregnancy, obesity ( BMI 30-40) , Well controlled DM/ HTN, mild lung disease
III : severe systemic illness : substantive functional limitations - poorly controlled DM, HTN, COPD , morbid obesity ( BMI > 40) , esrd W dialysis, history of > 3 months of MI, Cerebrovascular accidents
IV : constant threat to life - sepsis, ongoing ischaemia, MI <3 m
V : not expected to survive without operation
VI : declared brain dead patient who’s organs are being removed for donor purposes

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9
Q

oral fluids / fasting rules re surgery

A

fluids 2h before ( clear fluids) , 6h for solids/ non-clear liquids

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10
Q

mx of patients on insulin undergoing minor procedures

A

good glycaemic control - adjustment of usual insulin regime ( defined as HbA1C < 69)

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11
Q

in what circumstances should a VRII be used

A

more than one meal is to be missed
patients with poor glycaemic control
risk of renal injury - low eGFR/ contrast

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12
Q

metformin - day before surgery, day of surgery ( morning) and day of surgery ( afternoon)

A

before - normal
morning - od, bd : normal
afternoon - od bd normal

basically for metformin the only time u make any changes is when the medication is being taken TDS - in which case lunchtime dose is omitted

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13
Q

sulfonylureas - day before surgery, day of surgery ( morning) and day of surgery ( afternoon)

A

day before - normal
morning surgery - omit morning dose , take evening dose if BD
afternoon surgery - omit everything regardless of od, bd

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14
Q

sglt-2 surgery rules

A

omit on day only

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15
Q

insulin surgery rules

A

once daily regimens - reduce dose by 20% ( before, day of)
twice daily regimens - half morning dose on day of surgery

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16
Q

what are the three phases of an operation

A

before induction of an anaesthesia - sign in
before incision of the skin - time out
before patient leaves the operating room- sign out

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17
Q

what is the checklist confirmed before proceeding with an operation

A

Patient has confirmed: Site, identity, procedure, consent
Site is marked
Anaesthesia safety check completed
Pulse oximeter is on patient and functioning
Does the patient have a known allergy?
Is there a difficult airway/aspiration risk?
Is there a risk of > 500ml blood loss (7ml/kg in children)?

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18
Q

Abdominal pain, bloating and vomiting following bowel surgery

A

postoperative ileus

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19
Q

what is the bowel prep required before a colonoscopy

A

laxatives the day before the examination
patients required not to eat 24h before colonoscopy

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20
Q

what medication should be prescribed prior to surgery for patients taking prednisolone

A

hydrocortisone supplementation

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21
Q

how should total parenteral nutrition be administered

A

central vein like subclavian line

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22
Q

which anaesthetic has inherent anti emetic properties

A

propofol

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23
Q

how do you manage severe anaemia prior to surgery

A

pre-operative blood transfusion

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24
Q

how is local anaesthetic toxicity managed

A

IV lipid emulsion

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25
Q

how long post total hip replacement should low molecular weight heparin be commenced

A

6-12 hours after surgery

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26
Q

what is the action of lidocaine

A

blocking of sodium channels

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27
Q

what is a cause of AF following gi surgery

A

anastomotic leak - presenting about 5 days post op

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28
Q

mx of anastomotic leak

A

back to theate

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29
Q

when should the following feeding options be used

ng feeding
naso jejunal
pec
parenteral

A

ng feeding - impaired swallow, c/ i in head injury
naso-jejunal feeding - avoids aspiration, safe post oesophagogastric surgery
feeding jejunostomy - long term feeding, post upper GI surgery
percutaneous endoscopic gastrotomy - in patients who cannot undergo endoscopy

total parenteral nutritional - enteral feeding c/i

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30
Q

what are the adverse effects of depolarising anaesthetics

A

malignant hyperthermia
hyperkalaemia

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31
Q

what is malignant hyperthermia , how is managed

A

serious recognised side effect of suxamethonium presenting with tachycardia, muscle rigidity , rhabdomyolysis, hyperthermia and arryhtmia - to be managed with IV dantrolene

32
Q

what is the contraindication to nasopharyngeal airway

A

base of skull fracture

33
Q

what are some consequences of impaired thermo-regulation during surgery

A

bleeding
intra operative hypothermia

34
Q

how is an anastomotic leak diagnosed

A

abdominal ct

35
Q

when is suxamethonium c/i

A

in trauma / burns patients as they increase the risk of hyperkalaemia

36
Q

what is the action of non depolarising muscle relaxants ? how are they reversed

A

Competitive antagonist of nicotinic acetylcholine receptors

reversed using acetylcholinesterase inhibitors

37
Q

what are the most common causes of post- operative fever?

A

day 1-2 : wind ( pneumonia, aspiration ,PE)
day 3-5 : water UTI
day 5-7 : wound surgical site infection
day 5 walking : dvt/ pe

anytime - drugs, transfusion reactions, sepsis, line contamination

38
Q

what reverses the action of benzos

A

flumazenil

39
Q

which anaesthetic is associated with hepatotoxicity

A

halothane

40
Q

what is the s/e of long term total parenteral use

A

fatty liver and deranged LFT’s

41
Q

in which procedures would addition of adrenaline to local anaesthetic be c/i

A

procedures with risk of digital ischaemia

42
Q

in which procedures is group and save performed

A

Hysterectomy (simple), appendicectomy, thyroidectomy, elective lower segment caesarean section, laparoscopic cholecystectomy

43
Q

Cross-match 2 units - which procedures

A

Salpingectomy for ruptured ectopic pregnancy, total hip replacement

44
Q

Cross-match 4-6 units

A

Salpingectomy for ruptured ectopic pregnancy, total hip replacement

45
Q

Cross-match 4-6 units

A

Total gastrectomy, oophorectomy, oesophagectomy
Elective AAA repair, cystectomy, hepatectomy

46
Q

what are the symptoms of bile leak post cholecystectomy

A

RUQ tenderness
bilious fluid

47
Q

what can cause hyponatraemic encephalopathy in paediatric patients

A

hypotonic agents (0.45%)

48
Q

what can be done to minimize complications of poor BM control in patients requiring surgery

A

patient should be first on list

49
Q

A 22-year-old fit and well male undergoes an emergency appendicectomy. He is given suxamethonium. An inflamed appendix is removed and the patient is returned to recovery. One hour post operatively the patient develops a tachycardia of 120 bpm and a temperature of 40 ºC. He has generalised muscular rigidity. What is the most likely diagnosis?

A

malignant hyperthermia

50
Q

what intervention can reduce the risk of intra-abdominal adhesions

A

laparoscopy over open surgery

51
Q

what are the causes of post-operative surgical site infections

A

enterobacter
staph aureus

52
Q

which agent has moderate- strong analgesic properties

A

ketamine

53
Q

which agent is contraindicated in patients with penetrating eye injuries or acute narrow angle glaucoma

A

suxamethonium - increases intraocular pressure

54
Q

what are early causes of post-op pyrexia

A

blood transfusion
cellulitis
uti
physiological systemic inflammatory reaction
pulmonary etelectasis

0-5 days

55
Q

what are the late causes of post op pyrexia

A

Venous thromboembolism
Pneumonia
Wound infection
Anastomotic leak

56
Q

when are the following recommended pre-op

ecg
fbc

A

> 65 may need ECG before surgery
renal disease - fbc and ecg before intermediate surgery
diabetes- ecg before intermediate surgery

57
Q

which positional manouvres to open the airway are recommended if there is concern about cervical spine injury

A

jaw thrust

58
Q

which anaesthetic agent causes fasciculations

A

suxamethonium

59
Q

which airway provides the poorest control against reflux of gastric contents ?

A

laryngeal mask

60
Q

which airway is best to prevent high risk of reflux

A

endotracheal tube

61
Q

what is the management of pre operative anticoagulation

A

stop warfarin 5 days before, switch to low molecular weight heparin and stop that before surgery

62
Q

which medication can slow bone healing

A

Non steroidal anti inflammatory drugs
Steroids
Immunosupressive agents
Anti neoplastic drugs

63
Q

what can be used to identify accidental oesophageal intubation

A

end tidal carbon dioxide monitoring

64
Q

what is a complication of long term mechanical ventilation

A

trans-oesophageal fistula formation

65
Q

Dropping sats following intubation → ?

A

oesophageal intubation

66
Q

what airway is recommended in slow weaning

A

tracheostomy

67
Q

which airway is used for day surgery procedures

A

laryngeal mask

68
Q

what should be used with caution in patients with pneumothoraz

A

nitrous oxide

69
Q

which anaesthetic can cause adrenal suppression

A

adomidate

70
Q

which anaesthetic can cause laryngospasm

A

Thiopental

71
Q

Volatile liquid anaesthetics
(isoflurane, desflurane, sevoflurane) s/e

A

malignant hyperthermia

72
Q

what are hypertrophic scars caused by

A

excessive amounts of collagen

73
Q

what are the advice for post-operative wound

A

Use sterile saline for wound cleansing up to 48 hours after surgery.

Advise patients that they may shower safely 48 hours after surgery.

Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to drain pus.

74
Q

Intraosseous access is most commonly obtained at the

A

proximal tibia

75
Q
A

SBA passmed Flashcards (30 decks)

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