Anaesthetics Flashcards
Depolarising neuromuscular blockers - when you’d use them
side effects
Contrainidcations
Suxamethonium, fastest onset of NMBs <1 min therefore used for RSI
malignant hyperthermia, hyperkalaemia, prolonged apnoea
penetrating eye injuries or acute narrow angle glaucoma
Non-depolarising neuromuscular blockers and when you’d use them
side effects
vecuronium, pancuronium, rocuronium
NMB in lower aspiration risk anaesthetics
hypotension
Procedure unlikely to require transfusion - action and examples (5)
Group and save
Hysterectomy (simple), appendicectomy, thyroidectomy, elective lower segment caesarean section, laparoscopic cholecystectomy
Procedure likely to require transfusion - action and examples (2)
Cross-match 2 units
Salpingectomy for ruptured ectopic pregnancy, total hip replacement
The procedure will definitely require transfusion - action and examples (6)
Cross-match 4-6 units
Total gastrectomy, oophorectomy, oesophagectomy
Elective AAA repair, cystectomy, hepatectomy
Maximum dose of Lignocaine 1% plain -
3mg/ Kg - 200mg (20ml)
Maximum dose of Lignocaine 1% with 1 in 200,000 adrenaline -
7mg/Kg - 500mg (50ml)
Maximum dose of Bupivicaine 0.5% -
2mg/kg- 150mg (30ml)
Use of adrenaline with local anaesthetics
2 benefits
2 CIs
1 avoid
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
Duration of VTE prophylaxis for elective hip replacement
LMWH 10 days followed by aspirin 75 or 150 for 28 days
Duration of VTE prophylaxis post elective knee replacement
LMWH or Aspirin for 14 days
DUration of VTE prophylaxis following hip fracture
Until able to mobilise
Three points in theatre where WHO checklist should be applied
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).
ASA Grades
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
Excessive infusion of 0.9% Saline - what’s the likely consequence?
Hypercholoraemic acidosis
When to start VTE after elective hip replacement
6 to 12 hours post-op
Drugs which impair the rate of wound and bone healing
Non-steroidal anti-inflammatory drugs
Steroids
Immunosuppressive agents
Antineoplastic drugs
Ix and Mx of DIC
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.
How does lidocaine work?
Blocks sodium channels thus disrupting generation of action potential
treatment of local anaesthetic OD
Local anesthetic toxicity can be treated with IV 20% lipid emulsion
Propofol
5 things
3 places commonly used
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
Sodium thiopentone
5 things
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
Ketamine
1 use
2 things
1 side effecr
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
Etomidate
2 good things
2 bad things
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
benzodiazapine antidote
flumazenil
Mx of malignant hyperthermia
Dantrolene
