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CP3 Surgery > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

What effect does GA have on CV + Resp systems?

A

CV:
Reduced contractility (CO/Hypotension)
Arrhythmia

Resp:
Resp depression
Reduced ventilator response to hypoxia/hypercapnia
Laryngospasm

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2
Q

What should be included in pre-op assessment in:
Pre-existing CV disease
Pre-existing resp

A

CV: Risk peri-op MI
• ECG ± ECHO

Resp: Higher risk post-op comps
• ABG
• CXR
• Pulm function

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3
Q

What are the common/major risks assoc w. GA (5)

A 
PONV (post-op N+V)
Awareness under GA
Anaphylaxis
Cardio-resp issues
Aspiration
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4
Q

What are the common/major risks assoc w. Spinal (6)

A 
PONV (if opiates used)
Cardio-resp issues
Neurological damage
Spinal headaches
High spinal block (brainstem depression)
Urinary retention
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5
Q

Outline the WHO pain ladder

A
  1. Non-opioid ± adjuvant (e.g. para ± NSAID)
  2. Weak opioid ± non-opioid ± adjuvant
  3. Strong opioid ± non-opioid ± adjuvant
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6
Q

What factors allow for a reduced dose of paracetamol? (4)

A

<50kg
Old age
Alcoholism
Poor nutrition

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7
Q

List the COX-1 SEs (6)

A 
Dyspepsia/ulceration
Bronchospasm
Reduced platelets
Cardiotoxicity
Nephrotoxicity
Skin reactions
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8
Q

List absolute CIs (2) to NSAIDs

List relative CIs/Cautions with NSAIDs (3)

A

Absolute:
Severe HF
H/o GI bleed / ulceration

Relative:
Elderly
Asthma
Coagulopathy

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9
Q

What are COX-2 selective inhibitors used?

+ main ADR

A

e.g. celecoxib
For RA/OA
Esp if thrombocytopenia / UGI complications

Main ADR: risk serious cardiac event

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10
Q

What are the absolute CIs to opiate use (4)

A

Acute resp deo
Acute alcoholism
Raised ICP
Risk paralytic ileus

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11
Q

What is the management of opiate overdose

A

Pts >12:

  1. 400micrograms IV naloxone
  2. No response 1min – 800mcg
  3. No response 2mins – 800mcg

If severely poisoned: 2mg/4mg doses

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12
Q

What is the triad of GA?

A

Relaxtion
Analgesia
Narcosis

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13
Q

What are the advantages of TIVA? (total IV anaesthetic)

A

if PMH/FH malignant hyperthermia
to reduce PONV
for more control over depth of analgesia

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14
Q

What inhalation agents are available? (4) + which 2 are the ones mainly used

A

Halothane
Isoflurane
Sevoflurane*
Desflurane*

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15
Q

Why is halothane not used anymore?

A

Complication of hepatitis

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16
Q

Advantages of sevo/desflurane?

A

Sevo: combo of low irritant + fast onset-offset

Des: rapid onset
Low absorption into fat (used in morbidly obese)
However more of a resp irritant

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17
Q

What IV anaesthetic agents are available? (4)

A

Propofol
Thiopental sodium
Etomidate
Ketamine

18
Q

Uses of Propofol (3)

Usual doses

A

Uses:
•Induction/maintenance of GA
•Sedation (regionals / short procedures)
•Sedation in ITU

Usual doses:
Induction: 2mg/kg IV at 2-4mg/sec
Maintenance: 4-12mg/kg/hr

19
Q

CIs of Propofol (3)

Problems with Propofol (1)

A

CI:
• Extremes of age (<17 + elderly)
• Egg/soy allergy
• Compromised airway

Problems:
• Pain on injection (40%)

20
Q

Uses of thiopental (2)

Problems with thiopental (not CIs)

A 
GD induction
Potent anticonvulsant (one of last resort in status epilepticus)

–ve inotrope; CO drops by 20%
Poss bronchoconstriction

21
Q

Advantages of propofol over other IV agents?

A

Smooth induction
Stable haemodynamic parameters
Rapid recovery

22
Q

CIs if thiopental (6)

A

Airway obstrn
Compromised airway

Hypovol / low BP
Fixed CO states (e.g. mitral stenosis)

Barbiturate allergy
Porphyria

23
Q

Advantages/uses of etomidate

Problems with etomidate

A 
Safe CV profile
Easy dosing (0.15-0.3mg/kg)
Non-apnoeic
No histamine release
THEREFORE protects from myocard/cerebral ischaemia
Good for trauma/head injury pts
Probs:
Invol mm movements
Nausea
Adrenal supp
Local thrombophlebitis
24
Q

Advantages / problems with Ketamine

A

No change to CO (good analgesia w/o compounding shock)

Probs:
Slow recovery
Emergence delirium
Maintenance of laryngeal reflexes
Avoid in HTN/Stroke/Raised ICP
25
Q

What is the maximum safe dose of lignocaine?

A

3mg/kg

26
Q

What monitoring must be done for a spinal/epidural anaesthesia?

A 
Continuous:
ECG
BP (sympathetic blockade = hypotension)
RR 
SpO2
27
Q

What are the CIs to spinal anaesthesia (5)

A 
Raised ICP
Hypovolaemia
Local/systemic infection
Surgery above thorax
Procedures >2hrs
28
Q

Complications of spinal/epidural

A

Hypotension
Resp dep

CSF/Dural puncture (epidural)
= total spinal effect / headache

29
Q

Advantages of regional anaesthesia over GA (4)

A

Reduced risk LRTI
Reduced risk CV complications (inc. DVT)
Reduced PONV
Reduced post-op pain

30
Q

What are the risks / extra considerations for Anaesthetic and pre-existing CV disease

A

Risk peri-op MI

Pre-Op must inc thorough CV assessment (inc ECG ± ECHO)

31
Q

What are the risks / extra considerations for Anaesthetic and pre-existing resp disease

A

Risk post-op comps (e.g. LRTI)

Pre-op must inc thorough resp assessment (CXR/ABG/Spirometry)

32
Q

What are the common/major risks assoc w. GA (5)

A 
Aspiration
Anaphylaxis
Awareness under GA
Cardio-resp issues
PONV
33
Q

What are the common/major risks assoc w. Spinal Anaesthesia (6)

A

Cardio-resp issues
PONV (if using +opiate)

High-spinal block (brainstem depression)
Neuro trauma
Spinal headache

Urinary retention

34
Q

What routine bloods are done pre-op? (+why) (7)

A

FBC: all pts (anaemia)
U+Es: all pts (risk post-op AKI)
G+S: all pts

INR/Coag: bleeding tendency / on anticoag

Glucose: DM / long-term steroids

TFTs: if on thyroxine

LFTs: known hx hepatic / alc / metastatic / malnutrition

35
Q

What other routine Ix (non-bloods) are done Pre-op? (5)

A

ECG: all pts >40 or cardiac hx

CXR: cardio-resp disease / poss ICU needed
ECHO: Valvular/IHD pts

C-Spine XR: RA pts / major trauma / difficult intubation

Spirometry: any dyspnoea / COPD / asthma

36
Q

Describe the ASA classifications (6)

A

ASA1: normal healthy
ASA2: mild systemic disease
(e.g. smoker/preg/obese/ well-cont DM/HTN/lung)

ASA3: severe systemic, restrictive not incapacitating
(e.g. alc / morb obese / poor-cont DM/HTN/COPD/ESRD)

ASA4: severe systemic, threat to life
(e.g. sepsis / recent MI/CVA/TIA/CAD stent)

ASA5: pt will die in 24hr w/o op (e.g. ruptured aneurysm)
ASA6: brain dead, organ harvest

37
Q

What other causes for PONV must be excluded?

A

Hypovol
Infection
Bradycardia
Pain

38
Q

What are the RFs for PONV in the Apfel scoring? (4)

A 
Apfel
Female 
Non-smoker
H/o PONV/Motion sickness
Post-op opiates

If ≥2 = high-risk PONV

Other RFs:
Procedure type (gynae / ENT / abdo)
Anaesthetic (GA / inhalations / duration)
Post-op (pain / opiates / dehyd / hypotension)

39
Q

Which conditions should ___ not be used?

a) Cyclizine
b) Ondansetron
c) Prochlorpromazine
d) Dexamethasone

A

a) heart failure / hepatic / renal impairment / BPH
b) hepatic impairment / QT prolongation
c) parkinsons
d) lymphoma (risk tumour lysis syndrome)

40
Q

What anti-emetics are generally given
Pre-op?
Intra-op?
Post-op?

A

Pre: oral cyclizine/ondansetron/prochlorpromazine
Intra: IV cyclizine/ondansetron
Pre/Intra-Op given for high-risk pts

Post: Oral/IV cyclizine/ondansetron / IM prochlor

NB can also give IV dexa at any time

CP3 Surgery (10 decks)

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