Anaesthetics

Question 1

Fasting prior to anaesthesia?

Answer 1

6 hours for food
2 hours for clear liquids (water)

Question 2

Risks of non-fasting?

Answer 2

aspiration pneumonitis
pneumonia

Question 3

Purpose of pre-oxygenation?

Answer 3

to give the patient a reserve of oxygen between when they lose consciousness and when their airway is established

Question 4

Examples of pre-medications?

Answer 4

benzos
opiates
alpha-2-adrenergic agonists

Question 5

When is Rapid Sequence Induction used?

Answer 5

in emergencies
in high risk patients such as GORD or pregnancy

Question 6

Triad of general anaesthesia?

Answer 6

hypnosis
muscle relaxant
analgesia

+ antiemetics

Question 7

Examples of hypnotic agents?

Answer 7

IV:
propofol (most common)
ketamine (good in hypotension)
thiopental (less common)
etomidate (rare)

inhaled:
sevoflurane (most common)
desflurane (bad for environment)
isoflurane (rare)
nitrous oxide (combination, pregnancy, children)

Question 8

Use of hypnotics?

Answer 8

often IV induction and inhaled maintenance
or TIVA (usually with propofol)

Question 9

Examples of muscle relaxants?

Answer 9

depolarising:
suxamethonium

non-depolarising:
rocuronium
atacurium

Question 10

Reversal of muscle relaxants?

Answer 10

neostigmine
sugamaddex (non-depolarising)

Question 11

Examples of analgesic agents?

Answer 11

opiates:
fentanyl
alfentanil
remifentanil
morphine

Question 12

Examples of prophylactic antiemetics?

Answer 12

ondansetron (caution in long QT syndrome)
dexamethasone (caution in diabetics, immunocompromised)
cyclizine (caution in HF or elderly)

Question 13

Risks of general anaesthesia?

Answer 13

sore throat
post-op N&V
accidental awareness
aspiration
dental injury
anaphylaxis
cardiovascular events
malignant hyperthermia
death

Question 14

What is malignant hyperthermia?

Answer 14

rare but potentially fatal hypermetabolic response to certain anaesthetic agents

volatile anaesthetics
suxamethonium

inherited in an autosomal dominant pattern

Question 15

Features of malignant hyperthermia?

Answer 15

hyperthermia
incr. CO2 production
tachycardia
tachypnoea
hypertension
muscle rigidity
acidosis
hyperkalaemia

Question 16

Treatment of malignant hyperthermia?

Answer 16

dantrolene

Question 17

Drugs that cause malignant hyperthermia?

Answer 17

volatile anaesthetics (sevoflurane, desflurane, isoflurane)
suxamethonium (depolarising muscle relaxant)

Question 18

Types of regional anaesthesia?

Answer 18

peripheral nerve block
spinal anaesthesia
epidural anaesthesia
local anaesthesia

Question 19

What is a peripheral nerve block?

Answer 19

type of regional anaesthesia
injecting local anaesthetic around certain nerves using US guidance

may be used in combo with general anaesthesia

Question 20

When is spinal anaesthesia used?

Answer 20

C section
TURP
Hip fracture repairs

Question 21

What is spinal anaesthesia?

Answer 21

spinal block
local anaesthetic into the subarachnoid space CSF below the spinal cord to avoid spinal cord damage

Question 22

Epidural vs Spinal anaesthesia?

Answer 22

epidural space vs subarachnoid space

Question 23

Most common use of epidural?

Answer 23

labour

Question 24

Adverse effects of epidural anaesthesia?

Answer 24

headache if dura is punctured
hypotension
motor weakness in legs
nerve damage
infection (including meningitis)
haematoma

prolonged second stage of labour
incr. probability of instrumental delivery

Question 25

Indications for local anaesthesia?

Answer 25

skin sutures minor surgery dental procedures hand surgery performing LP inserting central line percutaneous procedures

Question 26

Contraindication to nasopharyngeal airway?

Answer 26

base of skull fracture

Question 27

Indications for a tracheostomy?

Answer 27

respiratory failure where long-term ventilation is necessary prolonged weaning from mechanical ventilation upper airway obstruction management of respiratory secretions reducing the risk of aspiration

Question 28

4 stages in unexpected difficult airway?

Answer 28

Plan A - laryngoscopy with tracheal intubation Plan B - supraglottic airway device Plan C - face mask ventilation and wake patient up Plan D - cricothyroidotomy

Question 29

WHO analgesic ladder?

Answer 29

Step 1 - NSAIDs and paracetamol Step 2 - weak opioids (tramadol, codeine) Step 3 - strong opioids (fentanyl, oxycodone, morphine)

Question 30

Mx of neuropathic pain?

Answer 30

duloxetine amitriptyline gabapentin pregabalin (trigeminal neuralgia -> carbamazepine)

Question 31

Side effects of NSAIDs?

Answer 31

gastritis dyspepsia stomach ulcers exacerbation of asthma hypertension renal impairment coronary artery disease (rare) PPIs should be co-prescribed

Question 32

Side effects of opiates?

Answer 32

constipation pruritus medication overuse headache nausea altered mental state respiratory depression dependence

Question 33

Reversal of opiates?

Answer 33

naloxone

Question 34

Use of opioids in palliative care?

Answer 34

background opioids rescue breakthrough dose (1/6 of daily dose)

Question 35

Importance of adequate analgesia post-op?

Answer 35

mobilisation ventilation adequate oral intake

Question 36

What is chronic pain?

Answer 36

pain > 3 months common sites include headache, lower back pain, joint pain, neck pain

Question 37

Types of chronic pain?

Answer 37

primary secondary (underlying condition)

Question 38

Causes of secondary chronic pain?

Answer 38

osteoarthritis lasting pain after trauma migraine IBS endometriosis cancer neuropathic pain complex regional pain syndrome

Question 39

Medication to prescribe in primary chronic pain?

Answer 39

antidepressants no place for analgesia

Question 40

Complications of ICU admission?

Answer 40

ventilator-associated lung injury ventilator-associated pneumonia catheter-related bloodstream infections catheter-related urinary tract infections stress-related mucosal disease delirium VTE critical illness myopathy critical illness neuropathy

Question 41

Oxygen support options?

Answer 41

oxygen therapy high-flow nasal cannula non-invasive ventilation intubation and mechanical ventilation ECMO

Question 42

What is ARDS?

Answer 42

acute respiratory distress syndrome collapse of alveoli (atelectasis) pulmonary oedema decreased lung compliance fibrosis (>10 days)

Question 43

Clinical features of ARDS?

Answer 43

hypoxia with inadequate response to O2 bilateral infiltrates on CXR acute respiratory distress

Question 44

Mx of ARDS?

Answer 44

supportive therapy prone positioning PEEP fluid management

Question 45

Benefits of central venous line?

Answer 45

administration of TPN and inotropes monitor volume status with continuous monitoring of central venous pressure

Question 46

Benefits of arterial line?

Answer 46

measure ABGs beat to beat measurement of BP