Anaesthetics Flashcards
What is the MOA of suxamethonium and when is it used clinically?
A depolarising neuromuscular block (nAchR) used to generate a brief period of muscular relaxation for, e.g. intubation
What are the contraindications to Suxamethonium?
Penetrating eye injuries/narrow angle glaucoma (causes raised IOP)
Hyperkalaemia
Burn injuries
What are the side effects of suxamethonium?
Hyperkalaemia
Malignent hyperthermia
What cardiovascular complication might an anastomotic leak precipitate after GI surgery?
AF
How long post op would an anastomotic leak present?
5-7 days
What is a contraindication to nasopharyngeal airway insertion?
Skull base fracture
What are the features of a keloid scar?
Dark shiny tissue which extends beyond the limits of the incision
What are the features of a hypertrophic scar?
Excessive collagen resulting in nodules and parallel fibre formation which remains confined to the boundaries of the wound
What are the causes of early post op pyrexia (0-5 days)?
Blood transfusion Cellulitis UTI Physiological SIRS Atelectasis
What are the causes of late post op pyrexia (>5 days)?
VTE
Pneumonia
Wound infection
Anastomotic leak
What is the ASA classification and outline its grades
Used to determine a prospective surgical patient’s current health
ASA1 - Normal healthy
ASA2 - Mild systemic disease
ASA3 - Severe systemic disease
ASA4 - Severe systemic disease that is a constant threat to life (inc <3month hx of e.g. MI/CVA)
ASA5 - Moribund, not expected to survive without the procedure
ASA6 - Braindead
What is thge mechanism of lidocaine?
Blockage of axonal Na channels, disrupting action potential
What is a Hickmann line and when is it commonly used?
A tunneled line inserted into the IJV used for patients with long term therapeutic requirements, e.g. chemotherapy
What effect does intra-operative hypothermia have on bleeding during surgery?
May cause bleeding levels to increase due to defunctioning of clotting factors etc.
Which anaesthetic agent has anti-emetic properties?
Propofol
What is the use of propofol?
Used especially for maintaining sedation on ITU, total IV anaesthesia, and for daycase surgery
What is the use and beneficial effect of ketamine?
Used for induction of anaestheaia
Strong analgesic properties
What is a contraindication to LMA insertion?
Non-fasted patients due to risk of aspiration
What agent is given as an antidote to benzodiazepine toxicity?
Flumazenil
Which anaesthetic agent is hepatotoxic?
Halothane
What metabolic disturbance would excessive administration of 0.9% saline cause?
Hyperchloraemic acidosis
What are the timings for NBM for theatre?
Foods/solids >6 hours before
Clear fluids >2 hours before
How long post op should prophylactic LMWH be started?
6-12 hours
What is the management of local anaesthetic toxicity?
20% lipid emulsion IV
What is used to reverse a heparin overdose/
IV PROTAMINE SULFATE
What is the underlying abnormality in AD inherited suxamethonium apnoea?
Pesudocholinesterase deficiency
What is a potentially fatal complication of poor post operative pain management?
Pneumonia
What type of feeding aid should be used in a patient who has just undergone oesophagectomy?
Feeding jejunostomy
What is the antidote for malignant hyperthermia secondary to suxamethonium hypersensitivity?
IV dantrolene
What should be used for wound cleansing up to and after 48 hours post op?
Up to - sterile saline
After - shower
How long before surgery should the COCP be stopped?
4 weeks prior
How shouyld TPN be administered?
Via a central line
What is a cvomplication of long term mechanical ventilation in trauma patients, and how might it present?
Tracheo-oesophageal fistula formation which would present with abdominal distension on ventilation
Should you cannulate the foot of a known diabetic?
No
What are the different cannula colour, sizes and flow rates?
Orange - 14G - 270ml/min Grey - 16G - 180ml/min Green - 18G - 80ml/min Pink - 20G - 54ml/min Blue - 22G - 33ml/min
What are the risk factors for post op urinary retention?
TWOC Constipation Immobility Opiate analgesia Infection Haematuria BPH
What imaging modality would you use to diagnose an anastomotic leak?
Abdo CT
What should be given to patients taking prednisolone before surgery?
Hydrocortisone - as pred suppresses the HPA axis such that the adrenal response to the stress of surgery would be impaired
What should be given in the event of DIC?
FFP
What should be done to manage post op paralytic ileus?
Drip and suck
Which drugs slow the wound healing process?
NSAIDs
Steroids
Immunosuppressive/cancer therapy
What bowel prep should be given before colonoscopy?
Laxatives the day before and dont eat for 24 hours before the exam
