Anaesthetics Flashcards
What is neuroleptic malignant syndrome?
This is a condition seen following adminstration of anaesthetic agents halothane or suxamethonium.
It is characterised by hyperpyrexia and muscle rigidity. Due to excessive Ca2+ release from sarcopasmic riticulum of skeletal muscle due to autosomal dominant defect.
What are the investigations in malignant hyperthermia?
- CK (raised)
- Contracture tests with halothane and caffeine
Which drug is key in management of malignant hyperthermia?
Dantrolene IV (prevents Ca2+ release from sarcoplasmic reticulum.
For which procedures is pharmacolociage VTE prophylaxis recommended for all patients?
Elective Hip:
- LMWH for 10 days followed by aspirin (75mg) for a further 28 days
- OR LMWH for 28 days + TED stockings
- OR Rivaroxiban
Elective knee:
- Aspirin for 14 days
- OR LMWH for 14 days combined wtih TED stockings
- OR Rivaroxiban
Fragility fractures of pelvis, hip, proximal femur:
- LMWH or fondaparinux until the person no longer has reduced mobility
What type of surgery is ring block used in?
Ring block refers to anaesthetic technique used to numb a finger, e.g. for ingrown nail operations. the nerves on both sides of the finger are infiltrated, leading to a “ring-like” blockage.
If a patient is steroid dependent and takes regular prednisolone, how do you alter the dose during surgery?
Patients that are steroid dependent taking prednisolone should have hydrocortisone. Rule of thumb:
- Minor procedure under local: no supplementation required
- Moderate procedure: 50mg hydrocortisone before induction and 25mg every 8h for 24h
- Major surgery: 100mg hydrocortisone before induction and 50mg every 8h for 24h, thereafter halving dose every 24h until maintenance dose reached.
What is the most common site for intraosseus access?
Proximal tibia
How long prior to surger should the COCP be disoncinued?
When can it be restarted?
Should be stopped 4 weeks before, can be restared 2 weeks after.
Which muscle relaxant is used in rapid sequence induction of anaesthesia?
A depolarising muscle relaxant such as suxamethonium is used for rapid sequence induction, as it has the fastest onset.
What is a rapid sequence induction and give an example for when it is used.
Rapid sequnce induction is where th patients is not ventilated form administration of the drugs to tracheal intubateion.
This is used when the stomach hasn’t been emptied (e.g. in trauma surgery) as it reduces the risk of aspiration.
What is a contraindication to use suxamethonium?
- Suxamethonium is contraindicated for patients with penetrating eye injuries or acute narrow angle glaucoma, as suxamethonium increases intra-ocular pressure.
- Patients with high potassium: suxamethonium may cause hyperkalaemia. It is therefore often containdicated in burns/trauma patients.
When is ketamine used as an anesthetic agent?
Ketamine may be used for induction of anaesthesia in patients that are haemodynamically unstable as it produces little myocardial depression.
t may be used for emergency procedures outside the hospital environment to induce anaesthesia for procedures such as emergency amputation.
How many units of blood should be corssmatched for open cystectomy?
How many for laparoscopic cystectomy?
4-6 depending on local guidelines.
Laparoscopic: G&S is enough.
How many units of blood should be corssmatched for AAA repair?
4-6 depending on local guidelines.
How many units of blood should be corssmatched for salpingectopy, ruptured ectopic, total hip replacement?
2 units
