Anaesthetics

Question 1

What is the triad of anaesthesia?

Answer 1

Muscle relaxation
Analgesia
Hypnosis

Question 2

Aside from the classic triad of anaesthesia, what else do anaesthetics monitor?

Answer 2

Temperature control
Fluid balance
Nausea

Question 3

What are some major complications in anaesthetics?

Answer 3

Loss of airway
Malignant hyperthermia
Anaphylaxis
Catastrophic haemorrhage

Question 4

What is an ASA score?

Answer 4

Score given to surgical pts to classify risk for anaesthetics

Question 5

What is ASA 1?

Answer 5

A normal healthy pt

Question 6

What is ASA 2?

Answer 6

A pt with mild systemic disease with no effect on daily life (i.e. well controlled disease)

Includes pt with BMI 30-40, smokers, and social drinkers

Question 7

What is ASA 3?

Answer 7

A pt with severe systemic disease

Question 8

What is ASA 4?

Answer 8

A pt with severe systemic disease that is a constant threat to life

Question 9

What is ASA 5?

Answer 9

A pt who is not expected to survive without the operation

Question 10

What is ASA 6?

Answer 10

Declared brain-dead pt whose organs are being removed for donor purposes

Question 11

What analgesia do we give for short procedures?

Answer 11

Entonox
Fentanyl
Ketamine

Question 12

What are the types of anaesthetic?

Answer 12

Local
General
Regional

Question 13

What is the WHO checklist?

Answer 13

Safer surgery checklist performed outloud for all staff in theatre, done before, during, and after surgery

Question 14

What does propofol do?

Answer 14

Induction agent so puts pt to sleep/hypnosis

Question 15

What are the ADRs of propofol?

Answer 15

Respiratory depression (-> death if untreated)

Question 16

What do we use for local anaesthetic?

Answer 16

Lidnocaine

Question 17

Which drugs can potentially cause malignant hyperthermia?

Answer 17

Some volatile anaesthetic gases e.g. halothane

Muscle relaxants e.g. Suxamethonium and decamethonium

Question 18

Post op, what is important to the pt that we need to manage?

Answer 18

PONV

Question 19

Apart from “because its nasty for the patient”, why is PONV important to get on top of?

Answer 19

It can cause wound dehiscence, esophageal rupture, aspiration, dehydration, increased intracranial pressure, and pneumothorax.

Question 20

What are the broad categories for causes of PONV?

Answer 20

Drugs
Central stimulation
Peripheral stimulation

Question 21

What drugs can cause PONV?

Answer 21

Opiods and anaesthetics

Question 22

What peripheral stimulation can cause PONV?

Answer 22

Direct gastric stimulation
Bowel surgery and blood in the gastrointestinal tract from oral or ear, nose, and throat surgery
Vagal nerve stimulation

Question 23

What central stimulation can cause PONV?

Answer 23

Fear, pain, anxiety, conditioned nausea related to environmental cues, and stimulation of the vestibular system

Question 24

How do we prevent PONV?

Answer 24

Treat according to risk of PONV with:

• Adjusted anaesthetic technique
• Anti-emetics at end of surgery
• Post-op pain control
• Adequate hydration
• Rescue anti-emetics

Question 25

What are some of the risk factors for PONV?

Answer 25

``` Female Younger age Hx of PONV/motion sickness Opiod use in surgery Non-smoker Surgical and anaesthetic factors also ```

Question 26

What agent is given at induction to prevent PONV?

Answer 26

Dexamathasone

Question 27

How do we decide which anti-emetic to use?

Answer 27

According to what we think the cause of the N+V is

Question 28

When should a pro-kinetic antiemetic be used?

Answer 28

Impaired gastric emptying or gastric stasis (as long as no bowel obstruction)

Question 29

What prokinetic agent can we use?

Answer 29

Metoclopramide

Question 30

If a pt has bowel obstruction, which agent can we use for PONV prevention? What does it do?

Answer 30

Hyoscine - antimuscarinic that reduces secretions

Question 31

What do we use for opiod-induced N&V?

Answer 31

Ondansetron or cyclizine

Question 32

What is lignocaine?

Answer 32

AKA lidocaine Local anaesthetic agent

Question 33

What is bupivicaine?

Answer 33

Na channel blocker anaesthetic agent used for topical wound infiltration

Question 34

Why is adrenaline given with local anaesthetics?

Answer 34

It prolongs the duration of action at the site of injection and allows higher doses to be used as it limits systemic absorption.