Anaesthetics Flashcards
Which drugs should NOT be taken the morning of surgery?
Anticoagulants: Know the indication. INR < 2 before surgery. Avoid epidural and spinal blocks.
Aspirin: Controversial, type of surgery?
Clopidogrel: Stop 5-7 days prior
DAPT: Postpone until 1 year post stent operation to reduce risk of stent thrombosis
NSAIDs
Diuretics: Hypokalaemia and hypovolaemia. Check U+E
Insulin: Continue long acting, omit oral hypoglycaemics
Which drugs should you consider stopping early?
OCP and HRT
SSRIs: 3 wks prior to CNS surgery
Opthalmic drugs: Anticholinesterases (used to treat glaucoma) can prolong duration of drugs metabolised by cholinesterases e.g. suxamethonium. Stop Beta blocker eye drops and alpha blockers (floppy iris syndrome)
What is included in the anaesthetic past history screen?
MI or IHD Asthma / COPD Hypertension Rheumatic fever Epilepsy Liver / renal disease Dental problems Neck problems GI reflux and vomiting Past anaesthesia / problems (e.g. intubation difficulty/PONV) Recent GA?
What questions should you ask around family history preoperatively?
Malignant hyperthermia? Dystrophia myotonica Porphyria Previous problems with muscle relaxants Sickle cell disease Any specific worries?
When should you check U+E’s preoperatively?
If on diuretics Diabetes Burns victim Major trauma Hepatic / renal disease Intestinal obstruction / ileus Parenteral nutrition
What are the 7A’s of premedication?
Analgesia Anxiolysis Amnesia Antacid Anti-emesis Antibiotics Anti-autonomic
What is the rationale for pre-op analgesia?
Pre-emptive analgesia in elective patients dampens the pain pathways before the signals start to arrive, thus modulating longer-term pain response. (Gabapentin prior to knee/hip op - unlicensed)
What are the most common reasons for admission after day surgery?
PONV
Uncontrolled pain
Lack of social care at home
What are some common reasons for operation cancellation?
Insufficient ITU/ward beds, staff, theatre, time or logistics
Current resp tract infection or exacerbation of medical illness
Pt not in optimum condition
Recent MI (within 3 months)
U+E imbalance
Inadequate preparation
Preoperative anaesthetic assessment?
Past anaesthetic history (+FH) i.e. PONV Medical problems (CV and Resp) Functional status (walking, stairs in one go?) Pregnancy? Drug History + Allergies Starved? Reflux? - Risk of aspiration Dental - loose teeth, caps and crowns Airway - MP score, neck movement, mouth opening, jaw protrusion Investigations? ASA grade
What is the definition of sedation?
A range of depressed conscious levels from relief to anxiety (minimal sedation) to general anaesthesia.
What is minimal sedation?
Drug-induced state where the pt is still able to respond to speech. Cognitive function and coordination are impaired but airway, breathing and CV system are unaffected.
What is moderate sedation?
Drug-induced reduction of consciousness during which the patient is able to make a purposeful response to voice or light touch. Response to pain only indicates deeper sedation. At this level of sedation no airway adjuncts are required, breathing and CV function should be adequate.
