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Surgery > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

Fasting prior to anaesthesia?

A

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

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2
Q

Risks of non-fasting?

A

aspiration pneumonitis
pneumonia

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3
Q

Purpose of pre-oxygenation?

A

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

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4
Q

Examples of pre-medications?

A

benzos
opiates
alpha-2-adrenergic agonists

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5
Q

When is Rapid Sequence Induction used?

A

in emergencies
in high risk patients such as GORD or pregnancy

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6
Q

Triad of general anaesthesia?

A

hypnosis
muscle relaxant
analgesia

+ antiemetics

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7
Q

Examples of hypnotic agents?

A

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)

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8
Q

Use of hypnotics?

A

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

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9
Q

Examples of muscle relaxants?

A

depolarising:
suxamethonium

non-depolarising:
rocuronium
atacurium

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10
Q

Reversal of muscle relaxants?

A

neostigmine
sugamaddex (non-depolarising)

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11
Q

Examples of analgesic agents?

A

opiates:
fentanyl
alfentanil
remifentanil
morphine

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12
Q

Examples of prophylactic antiemetics?

A

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

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13
Q

Risks of general anaesthesia?

A

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

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14
Q

What is malignant hyperthermia?

A

rare but potentially fatal hypermetabolic response to certain anaesthetic agents

volatile anaesthetics
suxamethonium

inherited in an autosomal dominant pattern

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15
Q

Features of malignant hyperthermia?

A

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

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16
Q

Treatment of malignant hyperthermia?

A

dantrolene

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17
Q

Drugs that cause malignant hyperthermia?

A

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

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18
Q

Types of regional anaesthesia?

A

peripheral nerve block
spinal anaesthesia
epidural anaesthesia
local anaesthesia

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19
Q

What is a peripheral nerve block?

A

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

may be used in combo with general anaesthesia

20
Q

When is spinal anaesthesia used?

A

C section
TURP
Hip fracture repairs

21
Q

What is spinal anaesthesia?

A

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

22
Q

Epidural vs Spinal anaesthesia?

A

epidural space vs subarachnoid space

23
Q

Most common use of epidural?

A

labour

24
Q

Adverse effects of epidural anaesthesia?

A

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

25
Q

Indications for local anaesthesia?

A

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

26
Q

Contraindication to nasopharyngeal airway?

A

base of skull fracture

27
Q

Indications for a tracheostomy?

A

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

28
Q

4 stages in unexpected difficult airway?

A

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

29
Q

WHO analgesic ladder?

A

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

30
Q

Mx of neuropathic pain?

A

duloxetine
amitriptyline
gabapentin
pregabalin

(trigeminal neuralgia -> carbamazepine)

31
Q

Side effects of NSAIDs?

A

gastritis
dyspepsia
stomach ulcers
exacerbation of asthma
hypertension
renal impairment
coronary artery disease (rare)

PPIs should be co-prescribed

32
Q

Side effects of opiates?

A

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

33
Q

Reversal of opiates?

A

naloxone

34
Q

Use of opioids in palliative care?

A

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

35
Q

Importance of adequate analgesia post-op?

A

mobilisation
ventilation
adequate oral intake

36
Q

What is chronic pain?

A

pain > 3 months

common sites include headache, lower back pain, joint pain, neck pain

37
Q

Types of chronic pain?

A

primary
secondary (underlying condition)

38
Q

Causes of secondary chronic pain?

A

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

39
Q

Medication to prescribe in primary chronic pain?

A

antidepressants

no place for analgesia

40
Q

Complications of ICU admission?

A

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

41
Q

Oxygen support options?

A

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

42
Q

What is ARDS?

A

acute respiratory distress syndrome

collapse of alveoli (atelectasis)
pulmonary oedema
decreased lung compliance
fibrosis (>10 days)

43
Q

Clinical features of ARDS?

A

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

44
Q

Mx of ARDS?

A

supportive therapy
prone positioning
PEEP
fluid management

45
Q

Benefits of central venous line?

A

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

46
Q

Benefits of arterial line?

A

measure ABGs
beat to beat measurement of BP

Surgery (10 decks)

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