Anaesthetics

Question 1

How long before an operation should a patient be fasted of food and drink?

Answer 1

6 hours of no food or feeds before the operation
2 hours of no clear fluids (fully “nil by mouth”)

Question 2

what is the biggest concern during rapid sequence induction?

Answer 2

aspiration of stomach contents into the lungs

Question 3

what is the triad of anaesthesia?

Answer 3

Hypnosis
Muscle relaxation
Analgesia

Question 4

State 3 IV hypnotic agents

Answer 4

Propofol (the most commonly used)
Ketamine
Thiopental sodium (less common)

Question 5

State 2 inhaled hypnotic agents

Answer 5

Sevoflurane (the most commonly used)
Desflurane (less favourable as bad for the environment)
Isoflurane (very rarely used)
Nitrous oxide (combined with other anaesthetic medications – may be used for gas induction in children)

Question 6

what are the 2 categories of muscle relaxant and give an example of each

Answer 6

Depolarising (e.g., suxamethonium)
Non-depolarising (e.g., rocuronium and atracurium)

Question 7

what are the most common agents used for analgesia in anaesthetics?

Answer 7

Fentanyl
Alfentanil
Remifentanil
Morphine

Question 8

state 3 prophylactic anti-emetics that may be given at the end of an operation and their contraindications

Answer 8

Ondansetron (5HT3 receptor antagonist) – avoided in patients at risk of prolonged QT interval
Dexamethasone (corticosteroid) – used with caution in diabetic or immunocompromised patients
Cyclizine (histamine (H1) receptor antagonist) – caution with heart failure and elderly patients

Question 9

what drug can reverse the effect of non-depolarising relaxants?

Answer 9

Sugammadex

Question 10

Name some significant risks of general anaesthesia

Answer 10

Accidental awareness (waking during the anaesthetic)
Aspiration
Dental injury
Anaphylaxis
Cardiovascular events
Malignant hyperthermia
Death

Question 11

what are the features of malignant hyperthermia?

Answer 11

Increased body temperature (hyperthermia)
Increased carbon dioxide production
Tachycardia
Muscle rigidity
Acidosis
Hyperkalaemia

Question 12

what drug is used to treat malignant hyperthermia?

Answer 12

dantrolene

Question 13

name 3 procedures where a spinal anaesthetic may be used

Answer 13

Caesarean sections
Transurethral resection of the prostate (TURP)
Hip fracture repairs

Question 14

state 3 adverse effects of an epidural

Answer 14

Headache if the dura is punctured, creating a hole for CSF to leak from (“dural tap”)
Hypotension
Motor weakness in the legs
Nerve damage (rare)
Infection, including meningitis
Haematoma (may cause spinal cord compression)

Question 15

what is a common complication of mechanical ventilation?

Answer 15

Ventilator-associated lung injury

Question 16

list the options for respiratory support from least to most invasive

Answer 16

Oxygen therapy
High-flow nasal cannula
Non-invasive ventilation
Intubation and mechanical ventilation
Extracorporeal membrane oxygenation (ECMO)

Question 17

Acute respiratory distress syndrome presents with an acute onset of:

Answer 17

Collapse of the alveoli and lung tissue (atelectasis)
Pulmonary oedema (not related to heart failure or fluid overload)
Decreased lung compliance
Fibrosis of the lung tissue (typically after 10 days or more)

Question 18

clinically what are the signs of acute respiratory distress?

Answer 18

Acute respiratory distress
Hypoxia with an inadequate response to oxygen therapy
Bilateral infiltrates on a chest x-ray

Question 19

what is the management of ARDS?

Answer 19

Respiratory support
Prone positioning (lying on their front)
Careful fluid management to avoid excess fluid collecting in the lungs
Positive end-expiratory pressure

Question 20

what is the concentration of oxygen via a nasal cannula?

Answer 20

24 – 44% oxygen

Question 21

what is the concentration of oxygen via a simple face mask?

Answer 21

40 – 60% oxygen

Question 22

what are inotropes?

Answer 22

medications that alter the contractility of the heart

Question 23

what are vasopressors?

Answer 23

medications that cause vasoconstriction (narrowing of blood vessels). This increases the systemic vascular resistance and consequently mean arterial pressure (MAP)

Question 24

state 4 indications for acute dialysis

Answer 24

A – Acidosis (severe and not responding to treatment)
E – Electrolyte abnormalities (treatment-resistant hyperkalaemia)
I – Intoxication (overdose of certain medications)
O – Oedema (severe and unresponsive pulmonary oedema)
U – Uraemia symptoms such as seizures or reduced consciousness