Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

What is Bier’s block?

A

IV Regional anaesthesia. Local anaesthetic is injected IV into extremities that have been exsanguinated by compression/gravity and torniqued to separate it from central circulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where is local anaesthetic injected in a transversus abdominal plane nerve block?

A

Between IO and TA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where is spinal anaesthesia delivered? What does it anaesthetise?

A

Into the subarachnoid space, L3/L4. Anaesthetises the spinal roots.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should you do if the patient you have just given spinal anaesthesia develops low BP?

A

Give crystalloid +/- vasopressors (-> constriction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the signs of total spinal shock?

A

Low BP, Low HR, anxiety, apnoea, LOC, headache, urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where is epidural anaesthesia injected into?

A

Into the extradural space at L3/L4.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When would a blood patch be necessary in someone who has had a dural puncture?

A

If headache lasts over 24/48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where do you inject caudal (sacral epidural)?

A

Sacral canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name 4 absolute contraindications for all neuraxial anaesthesia

A

1) Anticoagulant states
2) Local sepsis
3) Shock/hypovolaemia
4) High ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List 8 premedications

A

1) Analgesia
2) Anxiolysis (benzos)
3) Amnesia
4) Anti-emesis
5) Antibiotics
6) Anti-autonomic
7) Antacids (e.g. Ranitidine)
8) Steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When should antacids be given to a patient who is going to have surgery?

A

The night before and 2 hours pre-op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Does Propofol have analgesic effects?

A

NO!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What IV anaesthesia would you give to a trauma patient and why?

A

Etomidate. Avoidance of hypotension is important (Propofol can cause hypotension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where do neuromuscular blockers work?

A

Post-synaptic receptors at the NMJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is suxamethonium?

A

A partial agonist for acetylcholine receptor - a depolarizing agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which muscle relaxant causes initial fasciculations and how? How does this lead to paralysis?

A

Suxamethonium - It depolarizes post-synaptic membranes and then causes paralysis by inhibiting restoration of normal membrane polarity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What rapidly inactivates suxamethonium?

A

Plasma cholinesterases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the muscle relaxant of choice in rapid sequence induction?

A

Suxamethonium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Name 3 side effects of suxamethonium

A

1) Hyperkalaemia
2) Increased intra-ocular pressure
3) Bradycardia (treat with atropine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why does suxamethonium apnoea occur?

A

When pt is incapable of metabolising suxamethonium quickly enough due to abnormal cholinesterase - they remain paralysed as there is prolonged drug effect for 2 - 24 hrs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do non-depolarizing agents work? Do you get fasciculations?

A

They are competitive antagonists of ACh but without initial depolarisation - so no fasiciculations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can be used to reverse non-depolarizing?

A

Anticholinesterases (e.g. neostigmine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Name 2 examples of non-depolarizing agents

A

Rocuronium

Atracurium (for renal and liver failure - Hoffman elimination)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do patients with Myasthenia Gravis react to muscle relaxants?

A

They are resistant to suxamethonium BUT v sensitive to non-depolarizing agents so lower doses may be needed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Name 2 drugs that can be used as co-induction agents in IV induction?

A

Fentanyl/midazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What gaseous medication is used during gaseous induction?

A

Sevoflurane in O2 or NO

27
Q

What is the size of endotracheal tube you should use in most men?

A

8.5 mm

28
Q

What is the size of endotracheal tube you should use in most women?

A

7.5 mm

29
Q

List at least 4 signs you may see in a patient with a lack/inappropriate levels of general anaesthetic in their blood?

A
  • High heart rate and/ or BP
  • Dilated pupils
  • Lacrimations
  • Movement of laryngospasm
30
Q

When would atelectasis begin after induction? What increases a patient’s risk of atelectasis? What is the treatment?

A

Atelectasis begins within minutes of induction.
It is partially caused by using 100% oxygen.
TX = analgesia, physio

31
Q

What are the treatment options for bronchospasm?

A
  • Withdraw tube slightly as carina stimulation may be the cause
  • Check for pneumothorax
  • Ventilate with 100% oxygen
  • Increase concentration of volatile agent (e.g. Sevoflurane) - they’re good bronchodilators
  • Salbutamol +/- aminophylline IV
  • MgSO4 IV
  • Hydrocortisone IV
32
Q

What treatment would you give for laryngospasm?

A

100% oxygen. Deepen anaesthesia and attempt to ventilate.

33
Q

Is malignant hyperthermia dominant or recessive? What is it triggered by?

A

Dominant.

Triggered by suxamethonium or volatile anaesthetics

34
Q

What 4 signs should make you suspect malignant hyperthermia?

A

1) Unexpected increased oxygen consumption
2) Hypercapnia
3) Tachycardia
4) Rapid temperature increase (late sign)

35
Q

How would you manage a patient with malignant hyperthermia?

A
  • Hyperventilate with 100% oxygen
  • Maintain anaesthesia with IV agent
  • Abandon surgery
  • Non-depolarising muscle relaxant
  • Dantrolene IV bolus (muscle relaxant)
  • ITU
36
Q

How would you manage a patient with suxamethonium apnoea?

A

Ventilate and sedate the patient

Consider FFP

37
Q

What pharmacological treatment can you give to a patient who is shivering during surgery?

A

Tramadol or nefopam

38
Q

Which form of airway adjunct is aspiration more likely to occur in?

A

LMA

39
Q

Name 4 risk factors for aspiration during surgery

A

1) Emergency surgery
2) Pregnancy
3) Diabetes
4) Hiatus hernia

40
Q

How would you manage a patient who has aspirated?

A
  • Apply cricoid pressure
  • Suction mouth and upper airway
  • Endotracheal intubation
  • NGT to empty stomach
  • Pt head down and left lateral position
  • Cancel surgery
  • CXR
41
Q

What medication is used to reverse XS opioids?

A

Naloxone

42
Q

Describe how pain can lead to delayed wound healing

A

Pain –> autonomic activation –> increased adrenergic activity –> arteriolar vasoconstriction –> decreased wound perfusion –> decreased tissue oxygenation –> delayed wound healing

43
Q

Where must you not use lignocaine w/ adrenaline?

A

In areas with an end-arterial supply e.g. fingers

44
Q

What is a normal heart rate?

A

60 - 100 bpm

45
Q

What is a normal respiratory rate?

A

12 - 16/ min

46
Q

What is a normal urine output?

A

800 - 2000mls/day

47
Q

What does an ASA score of 1 mean?

A

Patient is normally healthy

48
Q

What does an ASA score of 2 mean?

A

Mild systemic disease but with no limitation of activity

49
Q

What does an ASA score of 3 mean?

A

Severe systemic disease that limits activity; no incapacitating

50
Q

What does an ASA score of 4 mean?

A

Incapacitating systemic disease which poses a threat to life.

51
Q

What does an ASA score of 5 mean?

A

Moribund. Not expected to survive 24 hrs even with operation.

52
Q

What does an ASA score of 6 mean?

A

Brain-dead patient whose organs are being removed for donor purposes.

53
Q

What are the problems with pulse oximetry?

A
  • Light contamination: finger probe ill-fitting; painted nails
  • Oximeters detect pulsatile Hb - problem if patient’s peripheral circulation is sluggish: shock, local hypothermia, shivering, tremor, finger moving excessively
  • SpO2 doesn’t show how well the patient is ventilating or information on the cellular environment
54
Q

List 3 things that make non-invasive blood pressure monitoring less accurate?

A
  • Patient is dysrhythmic/ hypovolaemic
  • Cuff is too small –> high BP
  • Underestimates high blood pressure and overestimates low blood pressure
55
Q

What ASA grade of a patient would you have to do pulmonary function tests +/- arterial blood gas?

A

If they are ASA grade 3/4

56
Q

How soon before surgery should you stop taking clopidogrel, prasugrel and tixagrelor?

A

Stop 5 - 7 days before surgery

57
Q

What advice should you give to insulin-dependent diabetics who are due for surgery in regards of their insulin?

A

Continue their long-acting (basal) insulin, even when on a sliding scale.
Omit oral hypoglycaemics on morning of surgery.

58
Q

What should you do in terms of gas given to a patient after anaesthesia?

A

100% of oxygen

59
Q

How would you check for residual muscle paralysis after surgery? What can you do to reverse this?

A

Use a peripheral nerve stimulator

Reverse any residual muscle paralysis with neostigmine and an anticholingeric

60
Q

Describe some features of the enhanced recovery programme?

A
  • Carbohydrate drinks 2 hours prior to surgery to avoid metabolic state linked with fasting
  • Early mobilisation
  • Prompt return to normal nutrition
61
Q

What should be done regarding a patient on anticoagulation who is due for surgery?

A

Check their INR and if needed, switch to warfarin to heparin preoperatively

62
Q

Can NSAIDs be continued on the morning of surgery and why?

A

Discontinue due to renal and anti-pH effects

63
Q

What blood test should you do for patients due for surgery who are on diuretics and what are you looking for?

A

U&Es and check for hypokalaemia and hypovolaemia

Medicine (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions