Anaesthetics

Question 1

What fluids are used for maintenance and resuscitation?

Answer 1

Crystalloids contain small molecules like sodium (dextrose and saline used for maintenance)
Colloids have large molecules like starch or albumin (plasmalyte) and this means that the fluid stays in the vascular tree longer so has a larger effect

Question 2

What effect does endotracheal tube have on the lungs?

Answer 2

Long term intubation can lead to ARDS

Question 3

What are the three aspects of anaesthetics?

Answer 3

Analgesia
Hypnosis
Relaxation

Question 4

Why do IV anaesthetics wear off quick if given in a bolus?

Answer 4

They are redistributed from the brain and blood rich organs into the skeletal muscle and fat
Target controlled infusion pump combats this by allowing accurate constant infusion

Question 5

What compounds are inhaled anaesthetics?

Answer 5

Halogenated hydrocarbons

Question 6

What is MAC in association with inhaled anaesthetics?

Answer 6

Maximum alveolar concentration is the max amount of a drug to be able to have enough of a pressure to be pushed into the blood and have an effect

Question 7

What effects do anaesthetics have on the CVS?

Answer 7

Vasodilators
Chronotropic effect
Venodilator

Question 8

What effects do anaesthetics have on the respiratory system?

Answer 8

Depress it as they paralyse the cilia

Question 9

What are signs of local anaesthetic toxicity?

Answer 9

Circumoral and lingual numbness and tingling
Light-headedness
Tinnitus,  visual disturbances
Muscular twitching
Drowsiness
Cardiovascular depression
Convulsions
Coma
Cardiorespiratory arrest

Question 10

What IV anaesthetics are commonly used to induce anaesthesia?

Answer 10

Propofol

Thiopentone

Question 11

What can be used to monitor conscious level?

Answer 11

Loss of Verbal Contact
Movement
Respiratory Pattern
Processed EEG

Question 12

What is laryngospasm?

Answer 12

Forced vocal cord adduction commoner in smaller lungs and can cause a blocked airway so is best to be prevented with good timings

Question 13

What is the difference between maintaining and protecting an airway?

Answer 13

The airway is maintained if it is open and unobstructed

Only a cuffed tube in the trachea protects the airway from contamination

Question 14

What reasons are there to carry out endotracheal intubation?

Answer 14

Protect airway from gastric contents
e.g. full stomach in an unfasted emergency patient
Need for muscle relaxation  artificial ventilation
e.g. laparotomy (muscle relaxants are not selective!)
Shared airway with risk of blood contamination
e.g. tonsillectomy in ENT
Need for tight control of blood gases
especially CO2 levels in Neurosurgery
Restricted access to airway
e.g. Maxillo-facial surgery

Question 15

What is the ASA grading in pre operative assessment ij anaesthetics?

Answer 15

ASA1	Otherwise healthy patient 
ASA2	Mild to moderate systemic disturbance
ASA3	Severe systemic disturbance 
ASA4	Life threatening disease 
ASA5 	Moribund patient 
(ASA6 	Organ retrieval)

Question 16

What levels are there for exercise tolerance in terms of METS?

Answer 16

Can you do the following activities without getting breathless;
Walk around the house-2 METS
Do light housework-3 METS
Walk 100-200 metres on the flat-4 METS
Climb a flight of stairs or walk up a hill-5 METS
Walk on the flat at a brisk pace-6 METS
Play golf, mountain walk dance, or any form of exercise-7 METS
Run a short distance-8 METS
Do either strenuous exercise or heavy physical work-9 METS

Question 17

What is pre habilitation?

Answer 17

Prehabilitation is the practice of enhancing a patient’s functional capacity before surgery, with the aim of improving postoperative outcomes.
Can do this by prescribing exercise

Question 18

What medicines cannot be continued during surgery?

Answer 18

Anti-diabetic medication

Anticoagulants

Question 19

What are the differences between nociceptive and neuropathic pain?

Answer 19

Nociceptive:
-Obvious tissue injury or illness
-Also called physiological or inflammatory pain
-Protective function
-Sharp or dull
-Well localised
Neuropathic:
-Nervous system damage or abnormality
-Tissue injury may not be obvious
-Does not have a protective function
-Burning, shooting, numbness, pins and needles
Not well localised

Question 20

What is the gate theory of pain?

Answer 20

That providing a distracting stimulus (rubbing) an injury activates the large A peripheral nerve fibres which in turn switches off the small C pain fibres.

Question 21

Name some opiods

Answer 21

Mild-Codeine, Dihydrocodeine

Strong-Morphine, Oxycodone, Fentanyl

Question 22

What are disadvantages of codeine?

Answer 22

Constipation

Addictive

Question 23

What is the disadvantage of amitriptyline?

Answer 23

Anticholinergic effects (urine retention and glaucoma)

Question 24

What is the RAT approach to treating pain?

Answer 24

Recognize
Assess
-Severity
-Type
-Other factors
Treat
-Non-drug treatments
-Drug treatments

Question 25

What are some non pharmacological treatments for pain?

Answer 25

RICE-Rest, ice, compression, elevation of injuries

Surgery, acupuncture, massage, TENS

Question 26

What is the drug ladder for treatment of nociceptive pain?

Answer 26

Mild-Paracetamol (± NSAIDs)
Moderate-Paracetamol (± NSAIDs) + codeine/ alternative
Severe-Paracetamol (± NSAIDs) + morphine