Anaesthetics

Question 1

Role of the anaesthetic nurse

Answer 1

• Cares for the patient in the immediate time period prior to, during and after surgery.
• Provides nursing care to the patient and procedural support to the anaesthetic team during the preparation for and induction of anaesthesia, throughout maintenance of anaesthesia and during emergence from anaesthesia.

Question 2

Anaesthetic nursing responsibilities (WSPCM)

Answer 2

• Works collaboratively
  
  • Supports the anaesthesia care delivered by the anaesthetist.
  • Patient advocate
• contributes to monitoring, and interventional care.
• Minimum of one designated anaesthesia nurse

Question 3

Emergency surgery definition

Answer 3

An unplanned nature of identification of the need for surgery, and a relative urgency for surgical intervention, without which the patients health may deteriorate and risk poor clinical outcomes. Including loss of life, limb or function or reduce quality of life.

Question 4

patient assessment

Answer 4

• collection of objective (physical assessment) and subjective (history) data

Question 5

Adults having elective procedure - pre-op fasting

Answer 5

• Solid food may be taken up to 6 hours prior to anaesthesia
• Clear fluids up to 2 hours prior to anaesthesia

Question 6

Children 6 months + having elective procedure - pre-op fasting

Answer 6

• Breast milk/formula, limited solid food up to 6 hours prior to
• Clear fluids up to one hour prior to

Question 7

Infants under 6 months having an elective procedure

Answer 7

• Formula up to 4 hours prior
• Breast milk 3 hours prior
• Clear fluids (no more than 3ml/kg/hr) up to 1 hour prior to

Question 8

ACE inhibitors with anaesthesia

Answer 8

Can cause severe hypotension at induction of during maintenance of anaesthesia

Question 9

Diuretics with anaesthesia

Answer 9

Can cause hypokalaemia which may potentiate the effects of muscle relaxants.

Question 10

Lithium with anaesthesia

Answer 10

Potentiates non-depolarising muscle relaxants

Question 11

Anticoagulants with anaesthesia

Answer 11

Increased risk of bleeding or surgical haemorrhage.

Question 12

Oral contraceptive pill with anaesthesia

Answer 12

Increased risk of thromboembolic complications

Question 13

Benzo’s with anaesthesia

Answer 13

Potentiate action of intravenous anaesthetic agents and opioids

Question 14

Calcium channel blockers (Verapamil) with anaesthesia

Answer 14

Interacts with volatile anaesthetic agents leading to arrhythmias and decreased cardiac output

Question 15

Garlic with anaesthesia

Answer 15

Potential for irreversible inhibition of platelet function

Question 16

Grapefruit/ cranberry with anaesthesia

Answer 16

Interacts with warfarin

Question 17

Valerian and Kava with anaesthesia

Answer 17

Potentiate GABA mediated systems, interfering with inhalation anaesthetics which work on GABA receptors.

Question 18

St John’s Wort with anaesthesia

Answer 18

May potentiate or prolong anaesthetic agent effect

Question 19

Ginkgo Biloba with anaesthesia

Answer 19

May increase bleeding

Question 20

Ginger with anaesthesia

Answer 20

Potent inhibitor of thromboxane synthetase enzyme that can prolong bleeding time.

Question 21

Echinacea with anaesthesia

Answer 21

Increases the risks of poor wound healing and opportunistic infections post surgery.

Question 22

Negligence

Answer 22

Not informed about all of the risks associated with the treatment/

Question 23

Trespass

Answer 23

Either assault/ battery and false imprisonment if pt is not informed of broad nature and effects of proposed treatment.

Question 24

Nurses and consent

Answer 24

• Verify the consent and pt ID
  
  • Nurses can only witness the pt signature on consent form
  • Ensure a valid consent is obtained prior to all procedural/ research activities
• Identify instances when guardian relative or attorney should be consulted regarding pt consent,.

Question 25

Airway assessment

Answer 25

Identify predictable problems with the maintenance of oxygenation during airway management and to formulate an airway plan in the event of the unexpected difficult airway or emergency airway management.
- body habitus and obesity
- characteristics of the neck
- shortness or a lack of mobility
- characteristics of the jaw, including a receding jaw or limited ability to open the mouth and dentition of lose or protruding teeth.

Question 26

Components of airway assessment (PPPBMMTUTC)

Answer 26

1. Previous hx of previous anaesthesia issues including difficult intubation
   
   2. Presence of gastroesophageal reflux
   3. Presence of obstructive sleep apnoea
   4. BMI
   5. Mouth opening and interincisor gap (IIG)
   6. Modified Mallampati score
   7. Teeth examination
   8. Upper lip bite test (ULBT)/ Mandible protrusion test
   9. Thyromental distance (TMD)
2. Cervical spine movement

Question 27

Mallampati Score

Answer 27

A simple scoring system relating to the amount of mouth opening to the size of the tongue and provides an estimate of space available for oral intubation by direct laryngoscopy.

Question 28

Thyromental distance

Answer 28

Used to estimate mandibular space.

Question 29

Simplified Airway Risk Index Assessment (SARI)

Answer 29

Multivariate risk score for predicting difficult tracheal intubation.
- Combines the criteria as set out by the ANZCA.
- Score ranges from 0-12
- E.g., SARI score of 4+ indicates difficult intubation.

Question 30

Factors affecting airway choice:

Answer 30

• Age
  
  • Type of procedure, including pt positioning
  • Length of procedure
  • Medical condition
  • Fasting status of pt
• Type of anaesthetic being administered