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3b > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

Drugs not to be taken before surgery

A 
Morning of
Anticoagulants/Aspririn/Clopidogrel 
NSAIDS
Diuretics
Insulin

Longer before
COCP/HRT
Opthalmic drugs

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2
Q

ASA status

A
  1. Fit and well
  2. Mild systemic disease
  3. Severe systemic disease
  4. Incapacitating systemic disease
  5. Not expected to survive 24hrs
  6. Brain dead
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3
Q

WHO safety list (9)

A 
Identity
Procedure 
Consent
Equipment check
Site check 
Allergies
Anticipated blood loss
Team introduction
Patient specific concerns
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4
Q

Premedications (4As)

A 
Analgesia - Reduces pain post op
Antacids - Ranitidine/Omeprazole
Antibiotic prophylaxis
Antiemetics 
Steroids
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5
Q

Sign of general anaesthesia taken

A

Loss of blinking reflex when top eyelashes are stroked.

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6
Q

3 agents used for sedation

A

Midazolam
Propofol
Ketamine

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7
Q

Inhaled anaesthetic agents

A

Sevoflurane
Desflurane
Isoflurane

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8
Q

Propafol contraindications

A

Egg or soy allergy
<17yr (sedation only)
Extremes of age
Compromised airway

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9
Q

Muscle relaxant types and egs

A

Depolarising
Suxamethonium - Causes fasiculations as is partial agonist for Ach receptors. Very quick so useful for RSI

Non Depolarising
Rocuronium - Lasts 20mins and causes no fasiculations. Can be reversed with Neostigmine/Sugammadex
Atrocurium

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10
Q

Drugs in TIVA

A

Propofol/Remifenitel

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11
Q

Causes of difficult intubation

A 
Obese 
Limited neck movement
Short neck
Receding chin
Limited mouth opening
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12
Q

Modes of ventilation

A

IPPV - Controls on tidal volume, RR, pressure needed to inflate lungs - Can be pressure or volume controlled.
SIMV - Detects spontaneous breathing then delivers a breath
PEEP - Blast of air at the end of expiration to splint alveoi open

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13
Q

Malignant hypothermia

A

Rare, autosomal dominant condition.
Due to exposure to Suxamethonium/volatile anaesthetics
Increase O2 consumption, hypercapnia, tachycardia, Temp rise >2oc is a late sign.
Give 100% O2 and Dantrolene maintaining anaesthetic with IV agent

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14
Q

Rapid sequence induction

A 
Pre oxygenate for 3 mins
Cricothyroid pressure
Induction agenet + Muscle relaxant (Sux)
Intubation
New longer acting muscle relaxant
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15
Q

Post-op N&V risk factors

A

Female
Previous history
Obesity

Opiods
No2
Volatile agents

GI/GU/Gyne/Neuro/Middle ear sugery

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16
Q

Aprepitant

A

New more effective antiemetic for 3 hours pre surgery

17
Q

Spinal anaesthesia

A

Anaesthesia into the sub arachnoid space.
Bupivacaine + glucose = Heavy so sinks
Monitor BP as may drop = Ephedrine/fluids

18
Q

Epidural anaesthesia

A

Anaesthesia into the extradural space

19
Q

Contraindications to regional anaesthesia

A

Raised ICP
Anticoagulation
Local sepsis
Mitral/Aortic stenosis

20
Q

Antiemetics
Serotonin
Histamine (H1)
Dopamine (D2)

A

Ondansetron (PONV)
Cyclizine
Domperidone (Pre medication of surgery), metoplopramide, prochlorperazine

21
Q

Key aspects of anaesthetic history (4)

A

Malignant hyperpyrexia - Hyperkalaemia, hypoxia, temperature, rhabdomyolysis
Suxamethonium apnoea - Patient does not have enzyme to break down therefore use propofol
Previous airway problems
PONV

22
Q

At which GCS level are you unable to maintain airway ?

23
Q

Opioid side effects

A 
CNS - Sedation, miosis
CVS - Bradycardia, hypotension
Resp - Bradypnoea, apnoea
GI - Nausea + vomiting, constipation
Urinary - Retention
Skin - Itching
24
Q

NIV
Hypoxia without hypercapnia
Hypoxia with hypercapnia

A

CPAP continuous

NPPV (BiPAP biphasic)

25
Q

3 ways to determine correct placement of ET tube?

A

Mask misting
Chest rising and falling
Co2 trace

26
Q

Induction agents

A

Propofol - painful on injection
Sevofluorane - minimal vasodilation, almost zero metabolism (taken up by and excreted via lungs), irritant, taken up in fat tissue -> prolonged drowsiness
Nitrous oxide - analgesic properties, low solubility -> rapid onset and offset
Opioids - may cause resp depression
- Remifentanil - Tiny doses, breaks down spontaneously in 10-15s, used in TIVA
- Alfentanyl Potent, rapid onset, duration 2-3 mins
- Fentanyl Onset 1-2 mins, duration 10-15 mins

27
Q 
Pre op drugs
ACEI
A2RB
Ranitidine
Warfarin
Inhalers
Clopidogrel
Beta blockers
PPIs
Aspirin
Steroids
A

ACEI - Stop as anaesthetic will drop BP
A2RB - Stop 24 hours before
Ranitidine - Increases pH therefore if aspirate = less bad. Continue
Warfarin - Stop - if AF = use LMWH, if thrombophilia use bridging protocol
Inhalers - Continue
Clopidogrel - Stop 5d before
Beta blockers - Continue
PPIs - Continue
Aspirin - Stop high dose (200mg), can continue 75mg for spinal/epidural)
Steroids - Continue

3b (15 decks)

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