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Sheff 3b > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

Name some anti emetics ?

Which is best for post op nausea / vomiting?

vertigo?

travel sickness ?

A 
ondansetron 
cyclizine 
domperidone 
metoclopramide
prochlorperazine

ondansetron
prochlorperazine
cyclizine

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2
Q

what things do you need to do pre op?

A 
Optimise medical conditions
Adjust medication
Check investigations
Check weight
EXPLAIN AND CONSENT
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3
Q

parts of relevant anaesthetic Hx ?

A

previous anaesthetics, FHx
Airway problems
PONV

Malignant hyperpyrexia - this is a dangerous complication of anaesthesia due to an underlying muscular disorder.
(Inherited skeletal muscle disorder. May reverse with Dantralene. Triggered by volatiles and suxamethonium.Hyperkalaemia, hypoxia, temperature, rhabdomyolysis)

Suxamethonium apnea 
(Patient does not have enzyme to break down therefore use propofol (Inherited disorder of acetylcholinesterase)

Allergies
Anaesthetic agents, analgesics, antibiotics, latex and eggs (propofol)

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4
Q

What to do for pt on warfarin for AF for operation

A

Stop and use LMWH

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5
Q

What features could make a difficult airway?

A

Anatomical
small mouth, small chin, large tounge, big neck

Lack of movement in neck / mouth

poor dentition

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6
Q

What 3 tests can be used to assess airway for intubation

A

mallampati (oropharynx) - open mouth and see differing amounts of the airway

extention of upper cervical spine
(<90 degrees)

thyromental test 
(Distance from tip of thyroid to tip of mandible at gull extension	Normal > 6.5cm, under 6cm = difficult laryngoscopy)
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7
Q

3 parts of anaesthetic triad

A

anaesthesia
analgesia
muscle relaxation

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8
Q

With GA what 2 options of route are there?

A

IV - propofol

Inhaled (iso/sevo/desfluorane) @young children/ needle phobics

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9
Q

During induction of GA what should you do?

A

pre oxygenate / oxygenate

secure / manage airway

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10
Q

What drug is usually given with propofol for maintenance of GA

A

Remifentanil

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11
Q

What level of GCS do you need to provide airway control

A

Under 8

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12
Q

Physical manoeuvres for airway control

A

head tilt
chin lift
jaw thrust

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13
Q

When would be cautious using a nasopharyngeal tube?

A

base of skull fracture

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14
Q

3 ways to determine correct placement of ET tube?

A

Chest movement
Misting of mask
Trace on capnography

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15
Q

2 places an ET tube can go thats wrong

A 
oesophagus 
1 bronchus (too far in)
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16
Q

which local anaesthetic only lasts for a short period of time?

A

lidocaine

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17
Q

which local anaesthetic can provide 2 hours anaestheia and 12 hours of analgesia

A

bupivocaine

use for regional blocks

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18
Q

advantages of regional anaestheisa over GA

A 
Avoids GA
Can be awake
Avoid airway problems
Less nausea and vomiting
Better peri-operative pain control
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19
Q

Where does an epidural go? spinal ?

A

between ligaments and dura

through dura

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20
Q

3 reasons muscle relaxants are used for surgery ?

A

Relax opening to trachea (glottis)

Relax muscles for surgery

Patients do not fight ventilators

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21
Q

Egs of muscle relaxants

A

suxamethonium - used for emergencies

Atracurium, rocuronium, vecuronium

22
Q

Reversal of muscle relaxants

A

neostigmine

23
Q

How do NSAIDS work ?

A

Inhibit cyclo-oxygenase

24
Q

Side effects of opiodss

A 
CNS - sedation, miosis
CVS- bradycardia, hypotension
Resp - brady / apnoea 
GI - N+V, constipation
Urinary - retention 
Skin - itching
25
Q

Egs of weak opiods

A

codeine

tramadol

26
Q

rule of 1/3s for fluids

A

2/3 intracellular (28L)
(Na/Cl poor, K rich)

1/3 extracellular (14L)
(Na/cl rich, K poor)
- 2/3 interstitial
- 1/3 intravascular

27
Q

Egs of crystaloid fluids

A

NaCl
dextrose
hartmanns

28
Q

What is a crystaloid fliod? colloid?

A

Ions or small molecules dissolved in water

Larger insoluble molecules retained within plasma for longer

29
Q

Egs of synthetic colloid fluids

A

blood, albumin

Synthetic
(starch
gelatin - these are never used)

risk of anaphylaxis!

30
Q

Difference between t1/2 resp failure and mx with NIV

A

1
Hypoxia without hypercapnia
CPAP continuous

2
Hypoxia with hypercapnia
NPPV (BiPAP biphasic)

31
Q

CPAP vs NPPV

A

CPAP
Increases intrathoracic pressure by maintaining a positive end expiratory pressure allowing the alveoli to stay open rather than collapse.

improves FRC and oxygenation
reverse resp acid

NPPV
increase tidal volume by giving the breath an extra push whilst also painting PEEP. This increased breath allows for better CO2 clearance

32
Q

What happens in T1 resp failure - how does CPAP help

A

V/Q missmatch

Inadequate oxygenation

  • Alveolar collapse (pneumonia
  • Fluid in alveoli (L heart failure)

CPAP - maintains minimum airway pressure alveolus held open fluid forced from lung

33
Q

Eg of 2 causes of t2 resp faulure ?

How does BiPAP help

A

COPD, Muscular dystrophy

Inadequate ventilation(effect of dead space)
-> limited alveolar expansion

at inspiration adds inspiratory pressure (IPAP)
and EPAP at expiration
(further expands lung holds open collapsing increases ventilation airway)

34
Q

DDx for resp failure - Name a couple

A

Pneumonia

Atelectasis (collapsed units), pneumothorax

Pulmonary oedema

Thromboembolic disease

Bronchospasm/obstruction, pre-existing, ARDS, increased metabolic demand

Central respiratory depression

35
Q

Complications of invasive ventilation

A

VAP (ventilator associated pneum)

VALI (lung injury)

Need sedation and muscle relaxant

Immobility + TED stocking

Oxygen toxicity

36
Q

What is involved in the pre-op assessment?

A 
History of presenting compaint
Surgical, anaesthetic and medical history
Systems review
Drug history and allergies
Social history

ASA SCORE

37
Q

ASA score

A

1 - normal
2 - mild systemic disease with no limitation of activity
3 - severe systemic disease with limitation of activity
4 - incapacitating
5
6

38
Q

NCEPOD - how quickly you have to do surgery

A

1 - minutes
2 - hours
3 - days
4 - planned

39
Q

Pre-op drug changes

A

Steroids - continue
Diuretics - drop say before
ACEi - stop if major surgery or if blood loss anticipated
BBs - always continue
Diabetic meds - sliding scale over night
Warfarin - stop 4 days before and monitor INR
cOCP - supposed to stop 4 weeks before and re-start 2 weeks after

40
Q

Cancelation reasons

A 
URTI
recent MI
poor control of drugs
poor bloodworm - electrolyte abnormalities
inadequate prep - consent, fasting
uncontrolled AF
41
Q

CHECKLIST FOR SAFETY

A 
IDENTITY
PROCEDURE
CONSENT
EQUIPTMENT
SITE MARKED
ALLERGIES
ASPIRATION RISK
42
Q

Post op

A

stop vapours
give o2
throat suction
reverse muscle relaxation - neostigmine

43
Q

Causes of post-op N&V

A

Patient - female, previous post-op n&v, anxious

Anaesthetic - opioids, NO2, dehydration

Surgery - laparotomy, gynaecology, abdo neuro, ENT, eye

44
Q

Intra and post op antiemetics

A

intra - dex, ond
post- cyclizine
wrist thing

45
Q

Dose of lidocaine

SEs of toxicity and management

A

3mg/kg, 7 with adrenaline

Toxicity –> numbness of tongue, lightheadedness, visual and auditory disturbances —> go on to really bad ones

Management
Stop injecting LA
A-E

REVERSAL –> intralipid

46
Q

Differences between spinal and epidural

A

Spinal

  • subdural space
  • less amount
  • 5-10 min onset

epidural

  • into epidural potential space
  • larger volume
  • 15-30 min headache

Contraindications:

  • neuro disease
  • hypovolaemia
  • anticoagulants
47
Q

Resp acidosis cause

A

severe asthma, COPD, hypoventilation

48
Q

Resp alkalosis cause

A

hyperventilation, panic attack

49
Q

Met acidosis cause

A

DKA, lactic acidosis

50
Q

Met alkalosis cause

A

loss of acid (severe vomiting), NG drain

51
Q

RISK OF FLUIDS

A

pulmonary oedema

52
Q

Sx of raised ICP

A

headache - worse in morning, coughing, bending down
vomiting - without nausea
papilloedema
Cushing’s triad - increased systolic BP, bradycardia, Cheyne-Stoke respiration

Sheff 3b (33 decks)

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