Anaesthetics Flashcards
How long must someone be fasted from food before surgery?
6h for solid foods
A patient with grade 3 COPD is undergoing a laparotomy for a bowel perforation. What is the ASA grade, surgical grade, and CEPOD classification of the surgery?
ASA grade = 3. Patient has COPD which severely impacts their life.
Surgical grade = 3/4. Major surgery as opening abdomen.
CEPOD classification = urgent. Needs to take place within hours, but there is time to resuscitate patient before surgery.
What are the fasting requirements regarding clear fluids?
Must be fasted 2h before surgery. Clear fluids include water and weak squash.
Any liquids ingested nearer the time, e.g. to take tablets must be <30ml
How long must breast-fed babies be fasted?
4h
What things must you assess when examining the airway in pre-op assessment?
Mallampatti score
Thyromental distance
jaw protrusion
Neck & mouth movement, tongue size, beard, teeth
Weight of patient - use oxford pillow to prop neck?
What investigations might you want to perform pre-operatively in a patient who has had a previous MI?
Echo + ECG
What is the dose of propofol?
Approx 1.5-2.5mg/kg
Why is propofol used so much these days?
Lower incidence of PONV, good recovery, suppresses airway reflexes well
Why is thiopentone recommended for RSI?
Rapid onset so less chance aspiration.
How do thio and propofol effect HR & BP?
Both drop BP. Propofol also drops HR, whereas thio increases HR
Which induction agent is associated with anterograde amnesia & profound analgesia?
Ketamine - these Sx are dissociative anaesthesia. Pt doesnt actually lose consciousness.
Which induction agent cannot be used in porphyria?
Thiopentone
What effects does ketamine have on HR & BP?
Increases them both
Where is a spinal block injected in to?
Subarachnoid space between pia and arachnoid, around level L2/3, 3/4
How can you tell you are in the correct space during spinal?
Hear 2 pops with needle going in -
- Through big flavour + dura
- Through arachnoid
