Anaesthetics

Question 1

Depolarising neuromuscular blockers - when you’d use them
side effects
Contrainidcations

Answer 1

Suxamethonium, fastest onset of NMBs <1 min therefore used for RSI
malignant hyperthermia, hyperkalaemia, prolonged apnoea
penetrating eye injuries or acute narrow angle glaucoma

Question 2

Non-depolarising neuromuscular blockers and when you’d use them
side effects

Answer 2

vecuronium, pancuronium, rocuronium
NMB in lower aspiration risk anaesthetics
hypotension

Question 3

Procedure unlikely to require transfusion - action and examples (5)

Answer 3

Group and save
Hysterectomy (simple), appendicectomy, thyroidectomy, elective lower segment caesarean section, laparoscopic cholecystectomy

Question 4

Procedure likely to require transfusion - action and examples (2)

Answer 4

Cross-match 2 units

Salpingectomy for ruptured ectopic pregnancy, total hip replacement

Question 5

The procedure will definitely require transfusion - action and examples (6)

Answer 5

Cross-match 4-6 units
Total gastrectomy, oophorectomy, oesophagectomy
Elective AAA repair, cystectomy, hepatectomy

Question 6

Maximum dose of Lignocaine 1% plain -

Answer 6

3mg/ Kg - 200mg (20ml)

Question 7

Maximum dose of Lignocaine 1% with 1 in 200,000 adrenaline -

Answer 7

7mg/Kg - 500mg (50ml)

Question 8

Maximum dose of Bupivicaine 0.5% -

Answer 8

2mg/kg- 150mg (30ml)

Question 9

Use of adrenaline with local anaesthetics
2 benefits
2 CIs
1 avoid

Answer 9

Prolongs the duration of action at the site of injection and permits usage of higher doses of lignocaine.
Contra-indicated in patients taking MAOI’s or tricyclic antidepressants
Avoid use in areas with end arteries due to risk of ischaemia e.g. in digits

Question 10

Duration of VTE prophylaxis for elective hip replacement

Answer 10

LMWH 10 days followed by aspirin 75 or 150 for 28 days

Question 11

Duration of VTE prophylaxis post elective knee replacement

Answer 11

LMWH or Aspirin for 14 days

Question 12

DUration of VTE prophylaxis following hip fracture

Answer 12

Until able to mobilise

Question 13

Three points in theatre where WHO checklist should be applied

Answer 13

1) Before the induction of anaesthesia (sign in)
2) Before the incision of the skin (time out)
3) Before the patient leaves the operating room (sign out).

Question 14

ASA Grades

Answer 14

I Healthy individual
II Mild disease
III Moderate to severe disease (includes dialysis pts)
IV Severe disease which is a constant threat to life
V A Moribund patient who will die without surgical
intervention
VI brain dead patient being operated on for organ
donation purposes

Question 15

Excessive infusion of 0.9% Saline - what’s the likely consequence?

Answer 15

Hypercholoraemic acidosis

Question 16

When to start VTE after elective hip replacement

Answer 16

6 to 12 hours post-op

Question 17

Drugs which impair the rate of wound and bone healing

Answer 17

Non-steroidal anti-inflammatory drugs
Steroids
Immunosuppressive agents
Antineoplastic drugs

Question 18

Ix and Mx of DIC

Answer 18

Clotting studies, platelet count and haematology advice urgently.
Up to 4 units of FFP and 10 units of cryoprecipitate may be given whilst awaiting the results of the coagulation studies.

Question 19

How does lidocaine work?

Answer 19

Blocks sodium channels thus disrupting generation of action potential

Question 20

treatment of local anaesthetic OD

Answer 20

Local anesthetic toxicity can be treated with IV 20% lipid emulsion

Question 21

Propofol
5 things
3 places commonly used

Answer 21

Rapid onset of anaesthesia
Pain on IV injection
Rapidly metabolised with little accumulation of metabolites
Proven anti emetic properties
Moderate myocardial depression
maintaining sedation on ITU, total IV anaesthesia and for daycase surgery

Question 22

Sodium thiopentone

5 things

Answer 22

Extremely rapid onset of action making it the agent of choice for rapid sequence of induction
Marked myocardial depression may occur
Metabolites build up quickly
Unsuitable for maintenance infusion
Little analgesic effects

Question 23

Ketamine
1 use
2 things
1 side effecr

Answer 23

May be used for induction of anaesthesia
Has moderate to strong analgesic properties
Produces little myocardial depression making it a suitable agent for anaesthesia in those who are haemodynamically unstable
May induce state of dissociative anaesthesia resulting in nightmares

Question 24

Etomidate
2 good things
2 bad things

Answer 24

Has favorable cardiac safety profile with very little haemodynamic instability
No analgesic properties
Unsuitable for maintaining sedation as prolonged use may result in adrenal suppression
Post operative vomiting is common

Question 25

benzodiazapine antidote

Answer 25

flumazenil

Question 26

Mx of malignant hyperthermia

Answer 26

Dantrolene