Anaesthetics Flashcards
Why are history taking, examination and routine investigations important in assessing and preparing patients for surgery?
History: analyse known or unknown comorbidities severity and control, determine ability to withstand stress eg ETT, drugs and allergies, FH, previous surgeries and anaesthesia
Investigations: detect, diagnose any conditions or complications, assess severity of known disease, establish a baseline, assess risk and guides management and allows for documentation of improvement
Examination: usually airway assessment
What are the possible effects of concurrent medical disease on the progress of anaesthesia and surgery and how should this tailor further investigation?
Disease may cause increase in risk due to systemic disturbance, decreased fitness and ability to withstand stress (should aim to optimise patients pre operatively eg control of condition, lifestyle changes, prehabilitate)
Investigations should be specific, tailored to the patient, sensitive and target those at risk and decrease iatrogenic risk of harm
What is the role of preoperative investigation and it’s advantages and disadvantages?
Their role is mainly to assess risk (ASA grade, surgery grade, co morbidities. Safety 1-6.
They include: ECG +/- ETT, ECHO, saturations, ABG, CXR, lung function tests, CT chest
Why should pain be treated and what are the consequences of not doing so?
Pain should be treated as 1/4 live with it, it is a basic human right, and lower back pain is the #1 cause of years lost off life due to disability
Benefits of doing so include: better sleep, appetite, functioning in society, decreases medical complications, suffering, depression, anxiety, health costs
What are the differences in different kinds of pain and how are they best managed?
Acute, chronic, acute on chronic
Cancer or non cancer
Nociceptive (sharp+/- dull, localised), neuropathic (burning, shooting +/- numb, poorly localised)
Management of pain uses RAT approach
R- recognise
A- assess ?severity, type, other factors
T- treat ?non pharmacological, pharmacological
What are the different therapies available for the management of pain?
Non pharmacological: RICE (rest, ice, compress, elevate), nursing care, surgery, acupuncture, massage, TENS, psychological
Pharmacological:
- nociceptive (uses WHO Pain Ladder) = mild (paracetamol +/- NSAIDs) to moderate (paracetamol +/- NSAIDs + codeine/alternative) to severe (paracetamol +/- NSAIDs + morphine
- neuropathic (WHO pain ladder often not applicable) = use other drugs early eg amitriptyline, gabapentin, duloxetine
What are the practicalities involved in the delivery of pain relief in the clinical setting?
X
What is the role of scoring systems in the practical delivery of analgesia?
Can be used to assess the pain
Examples include: verbal rating, numerical rating, visual analogue scale, smiling faces, abbey pain scale, functional pain
What is the difference between acute and chronic pain?
Acute pain states: cause usually known, short, we,l characterised, treatment is to resolve underlying cause, usually self limited (patient is AFFLICTED with pain)
Chronic pain states: cause often unknown, persists after healing >3m, treatment is for underlying cause and pain disorder, usually pain control not cure (patient is TRANSFORMED to pain)
What is the mechanism of, action and pharmacological kinetics of: Local anaesthetic agents General anaesthetic agents Opiates Muscle relaxants?
X
What is the triad of anaesthesia?
- Analgesia (removal of perception)
- Relaxation (immbolise)
- Hypnosis (sleep)
Give rise to anaesthesia
1+2 = local anaesthesia
1+2+3 = general anaesthesia
What are the physiological effects of general and regional anaesthesia and how may they interact with patients underlying illness?
Interfere with neuronal ion channels
Cerebral function is lost “top down”
Depress CV centre, vasodilate, venodilate
Decrease tidal volume, paralyse cilia, decrease hypoxic and hypercarbic drive
What are the basic phases of general anaesthesia?
Induction -> Maintenance -> Resucitation
Usually done via IV and uses propofol
What are the priorities involved in and skills required for the care of the unconscious patient?
Monitor conscious level eg loss of verbal contact, movement, respiratory pattern, processed EEG, “planes” of anaesthesia
Airway management is important to avoid tongue obstructing the back of the throat. Usually done via triple airway manoeuvre (head tilt, chin lift, jaw thrust)
What is critical illness?
Illness which requires critical care: organ system support due to multiple or single organ failure.
Usually for patients who are in a life threatening but treatable condition
Uses an ABCDE approach
