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UL Surgery > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

what are the 2 types of anaesthesia?

A
  • general

- regional

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2
Q

what is true NBM pre-operatively?

A
  • 6h no food

- 2h no clear fluids

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3
Q

which medications can be offered pre-op? give the indication for each one

A
  • BDZ, e.g. midazolam (anxiolytic)
  • opiates, e.g. alfentanil (reduces pain and HTN in response to laryngoscope)
  • alpha-2-adrenergic agonists, e.g. clonidine (sedation and pain relief)
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4
Q

why and when is rapid sequence induction used?

A
  • to gain airway control as quickly and safely as possible
  • emergencies
  • GORD
  • pregnancy
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5
Q

key complication in RSI? how can this be avoided?

A
  • aspiration of stomach contents into lungs

- apply cricoid pressure

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6
Q

what is the triad of GA?

A
  • hypnosis
  • muscle relaxation
  • analgesia
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7
Q

what is the role of hypnotic agents in GA?

A

to make the pt unconscious

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8
Q

hypnotic agents which can be administered IV?

A

used to induce LOC:

  • propofol
  • ketamine
  • thiopental sodium
  • etomidate (rare)
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9
Q

hypnotic agents which are inhaled?

A

mostly used to maintain LOC

volatile:

  • sevoflurane
  • desflurane
  • isoflurane

non-volatile:
- nitrous oxide

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10
Q

where do muscle relaxants act?

A

NMJ

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11
Q

name a depolarising muscle relaxant

A

suxamethonium

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12
Q

name a non-depolarising muscle relaxant

A
  • rocuronium

- atracurium

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13
Q

how can a muscle relaxant’s actions be reversed?

A
  • neostigmine

- sugammadex (only for non-depolarising ones)

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14
Q

give examples of analgesic agents used in GA?

A

all opiates:

  • fentanyl
  • alfentanil
  • remifentanil
  • morphine
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15
Q

which antiemetics are used prophylactically post-op?

A
  • ondansetron
  • dexamethasone
  • cyclizine
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16
Q

drug class of ondansetron?

A

5HT3 (serotonin) receptor antagonist

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17
Q

drug class of dexamethasone?

A

corticosteroid

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18
Q

drug class of cyclizine?

A

H1 (histamine) receptor antagonist

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19
Q

who should cyclizine be used with caution in?

A
  • pts with HF

- elderly

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20
Q

who should dexamethasone be used with caution in?

A
  • pts with DM

- immunocompromised pts

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21
Q

how can you test if the muscle stimulant has worn off?

A
  • train-of-four stimulation
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22
Q

describe train-of-four stimulation

A
  • try to stimulate a nerve 4 times

- if the muscle responses get weaker with each stimulation, it means the relaxant has not yet worn off

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23
Q

what is malignant hyperthermia?

A

rare but dangerous hypermetabolic response to anaesthesia

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24
Q

which agents carry a risk of malignant hyperthermia?

A
  • volatile anaesthetics (isoflurane, sevoflurane, desflurane)
  • suxamethonium
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25
Q

presentation of malignant hyperthermia?

A
  • increased body temp LMAO
  • increased CO2 exhalation
  • high HR
  • muscle rigidity
  • acidosis
  • high K+
26
Q

management of malignant hyperthermia?

A

dantrolene

27
Q

how is a peripheral nerve block carried out?

A
  • LA injected under ultrasound guidance
  • pt remains conscious
  • usually done to numb a single limb
28
Q

indications for a spinal block?

A
  • C-sections
  • TURP
  • hip fracture repairs
29
Q

how is a spinal block carried out?

A
  • LA injected into subarachnoid space in CSF
  • anywhere between L3 and L5
  • all nerves below level of injection are numbed
  • cold spray used to test if it has worked
30
Q

typical indication for an epidural?

A

woman in labour with vaginal delivery

31
Q

how is an epidural carried out?

A
  • catheter inserted into epidural space (OUTSIDE of CSF and spinal cord)
  • levobupivacaine inserted +/- fentanyl
32
Q

key risks of using epidural in labour?

A
  • prolonged second stage of labour

- increased chances of needing instrumental delivery

33
Q

why is it important that a pt is able to do a straight leg raise under epidural anaesthesia?

A
  • if not, catheter may be in subarachnoid space

- needs urgent anaesthetic review

34
Q

example of LA?

A

lidocaine

35
Q

examples of indications for LA use?

A
  • skin sutures in A&E
  • dental procedures
  • carpal tunnel syndrome surgery
  • inserting central line
  • PCI
36
Q

indications for a tracheostomy?

A
  • resp failure where long-term ventilation will be needed (e.g. following brain injury)
  • prolonged weaning from mechanical ventilation
  • upper airway obstruction
  • to manage resp secretions
  • to reduce risk of aspiration (in unsafe swallow)
37
Q

what can an arterial line be used for?

A
  • measuring BP
  • getting ABG samples
  • NEVER to give drugs
38
Q

where might a central venous catheter (central line) be inserted?

A
  • internal jugular vein
  • subclavian vein
  • femoral vein
39
Q

define chronic pain

A

pain that has been present for 3+ months

40
Q

what is allodynia?

A

when pain is experienced with sensory inputs which should not cause pain, e.g. light touch

41
Q

features of neuropathic pain?

A
  • burning
  • tingling
  • pins and needles
  • electric shocks
  • loss of touch sensation in affected area
42
Q

what are the 3 steps of the WHO analgesic ladder?

A
  1. non-opioids (paracetamol, NSAIDs)
  2. weak opioids (codeine, tramadol)
  3. strong opioids (morphine, oxycodone, fentanyl, buprenorphine)
43
Q

which adjuvants can be used to treat neuropathic pain?

A
  • amitriptyline
  • duloxetine
  • gabapentin
  • pregabalin
  • capsaicin cream
44
Q

common side effects of NSAIDs?

A
  • indigestion
  • stomach ulcers
  • asthma exacerbations
  • HTN
  • renal impairment
  • CAD, HF strokes (rare)
45
Q

in which pts are NSAIDs inappropriate / contraindicated?

A
  • asthma
  • CKD
  • heart disease
  • uncontrolled HTN
  • pts with stomach ulcers
46
Q

which drugs are co-prescribed with NSAIDs?

A

PPIs (e.g. omeprazole)

47
Q

key side effects of opioids?

A
  • constipation
  • pruritus
  • nausea
  • altered mental state
  • resp depression
48
Q

how is opioid overdose reversed?

A

naloxone

49
Q

how are opioids prescribed in palliative care?

A
  • background opioids

- plus rescue doses for breakthrough pain

50
Q

how is the rescue dose of an opioid calculated for palliative care?

A

rescue dose = 1/6 of total background dose over 24 hrs

51
Q

how is bradycardia secondary to patient-controlled analgesia overuse managed?

A

atropine

52
Q

common areas affected by chronic pain?

A
  • headaches
  • lower back pain
  • neck pain
  • knee / hip pain
53
Q

describe the analgesic ladder for treating pain secondary to OA

A
  1. PO paracetamol + topical NSAIDs
  2. add PO NSAIDs (+PPI)
  3. consider opioids
54
Q

which 4 medications are used first-line in the treatment of neuropathic pain?

A
  • amitriptyline
  • duloxetine
  • gabapentin
  • pregabalin
55
Q

1st line treatment for trigeminal neuralgia?

A

carbamazepine (different to other neuropathic pain conditions!)

56
Q

describe the different “levels” of patient care needs in a hospital

A
  • level 1 = ward-based care
  • level 2 = HDU
  • level 3 = ICU (highest level of support needed)
57
Q

common reasons for ICU admission?

A
  • following major surgery, e.g. AAA repair
  • severe sepsis
  • major trauma
  • following CPR
  • acute resp / renal / liver failure
58
Q

how can enteral nutrition be given in the ICU setting?

A
  • orally
  • NG tube
  • PEG
59
Q

why is TPN given via central line rather than a cannula?

A
  • it irritates peripheral veins

- causes thrombophlebitis

60
Q

complications of mechanical ventilation?

A
  • alveolar damage from over-inflation
  • barotrauma
  • pneumonia
  • cor pulmonale
61
Q

which drug can be administered to treat agitated pts with delirium in ICU setting?

A

dexmedetomidine

UL Surgery (7 decks)

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