Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

T/F glass shows up on xray

A

T. It’s radio-opaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Best anaesthetic for short procedure?

A

Lidocaine & bupivicaine are both commonly used local anaesthetics, but lidocaine has a faster onset and shorter duration of action, making it more suitable for short procedures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Initial pain relief for suturing

A

Lidocaine and paracetemol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can cold spray be used for

A

Cold spray is a volatile compound which evaporates to cool the skin and relieve pain. Cold spray can be useful in closed injuries, but should not be used on an open wound.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which nerve fibres are affected by local anaesthetics

A

They act on small unmyelinated C fibres, which transmit pain and temperature sensation, before the larger A fibres, which transmit touch and power.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What channels do local anaesthetics act on

A

Local anaesthetics inhibit the influx of sodium into the cell.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the time of onset of lidocaine

What is the duration of action

A

4 minutes onset

2hrs duration of action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can lidocaine be made more effective, and less painful on injection

A

More effective: The addition of adrenaline causes local vasoconstriction and delays anaesthetic washout into the circulation, so that its effect can last longer. There is also less bleeding.

Less painful on injection: Subcutaneous injection is made less painful by using anaesthetic warmed to room temperature, and injecting slowly through a small needle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When must you not add adrenaline to local anaesthetic

A

When injecting into digits, you should not add adrenaline to your local anaesthetic as it can cause ischaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the potential side effects of local anaesthetics

A

Can affect neural processes in the cardiovascular and central nervous systems, causing cardiac arrhythmias, neurotoxicity and central respiratory depression.

They can also cause allergic reactions, resulting in minor urticaria or in the worse scenario, anaphylaxis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lidocaine overdose affects which system at lower and higher concentration

What about bupivocaine

A

Primarily affects CNS:

  • light-headedness,
  • dizziness,
  • drowsiness

Secondarily, and at higher plasma levels, the cardiovascular system:

  • myocardial depression,
  • peripheral vasodilatation -> hypotension and bradycardia)

Bupivocaine is actually cardiotoxic so is worse for the cardiovascular effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Symptoms of lidocaine overdose

A

Light headiness
Convulsions
Perioral Paraesthesia
Hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of molecule is lidocaine

A

Lidocaine is an amide-based local anaesthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the mechanism of action of lidocaine

A

It penetrates the interior of an axon and then reversibly blocks the sodium channels by binding to a receptor in those channels.

This prevents the generation of action potentials when a critical number of the channels are blocked.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where is lidocaine metabolised

A

In the liver, and is excreted in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Order the nerve fibres in terms of which are first affected by lidocaine, through to last

A

Pain fibres
Autonomic fibres
Coarse touch
Motor

Related to fibre diameter i.e. smaller the most sensitive, as few channels need to be blocked to reach the analgesic threshold. Thus, light touch may still be preserved even when the patient cannot feel pain. Motor nerves are the last to be blocked.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is regional anaesthetic?

A

Using local anaesthetic to anaesthetise a specific body region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is spinal anaesthetic

A

A regional anaesthetic:

Spinal where local anaesthetic is injected into the intrathecal space at the lower lumbar region – usually L3/4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is epidural anaesthetic

A

A regional anaesthetic:

Epidural where local anaesthetic is injected into the epidural space, usually via a catheter inserted into and left in the space for at least the duration of surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a field block

A

A regional anaesthetic:

Field block where local anaesthetic is infiltrated into the inguinal region before and during surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a Bier’s block and brachial plexus block

A

Regional anaesthetic techniques

A Bier’s block is a regional technique for anaesthetising the forearm and Brachial plexus blocks are for shoulder and upper limb surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

T/F regional anaesthetic agents have no effect on the CNS

A

True, unless:

1) Overdose
2) Spinal anaesthesia (other than this, it affects the peripheral nerves)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

T/F patients undergoing surgery with regional anaesthesia are always awake

A

F.

Patients undergoing surgery under regional anaesthesia are often given sedative drugs or the technique is combined with a general anaesthetic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the most frequently used regional anaesthesia and why

A

Bupivacaine (often known by it’s trade name Marcaine) is the most frequently used local anaesthetic agent in regional anaesthesia because of its long duration of action

(compare this to lidocaine (=lignocaine) which is used in short suturing procedures due to its shorter duration of action)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the time of onset and the duration of action of bupivacaine

A

Onset: 5-10 minutes
Action: 4-8hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is xylocaine

A

Xylocaine is the trade name for a mixture of lignocaine and adrenaline and is used for local anaesthetic infiltration only

(NOT FOR USE IN EXTREMETIES!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Ketamine is what type of anaesthetic

A

General anaesthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

T/F. Spinal anaesthetic affects CVS more than respiratory problem

A

True.

It is good for patients with resp conditions (APART from the fact that they have to be able to lie flat)

But it has an effect on BP particularly in younger patients

You wouldn’t use it for someone with an outflow obstruction (e.g AS) , for example

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why does the spinal anaesthetic affect the CVS

A

Because it also blocks autonomic fibres as well as the c fibres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When you inject a spinal anaesthetic, how comes it doesn’t go everywhere and paralyse you everywhere

A

Because it settles in the CSF. It is given with a glucose solution.

So it tends not to affect the cervical cord as much

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What type of local anaesthetics are most commonly used in anaesthetics

A

Mostly amides, as it’s more stable and has less side effects.

Esters, e.g. cocaine, are LAs and are sometimes used in ENT surgery. They are very good at vasoconstricting the nose (which is why some celebs have lost their nasal bridge!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What anaesthetic is found in the magic cream for blood taking in kids.

When else is it used

A

Amethocaine.

Also used in eye surgery to numb the cornea (good for eyedrops after too)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is pKa

A

The pKa is the pH at which a soltuion is 50% ionised and 50% unionised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the pKa of lidocaine vs bupivocaine and what is the effect

A

pKa of lidocaine is 7.4, which is the same as the physiological pH

So the 50% unionised is what will get through the lipid layers of the nerves.

Bupivoicaine has a pKa of 8.1 so at physiological pH, most of the molecules are in the ionised form, so it takes a lot longer for it to penetrate the nerve fibres

So pKa is related to speed of onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Why is bupivocaine more potent than lidocaine

A

Because it’s more lipid soluble so you need less of it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the standard dose of bupivocaine vs lidocaine

A

10ml 0.5% (50mg) - Bupivocaine

10ml 2% (200mg)- lidocaine

Bupivocaine is much more potent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Does bupivocaine or lidocaine last longer

And why

A

Bupivoicaine

Bupivocaine has more ‘claws’. It holds on tighter to the local proteins so it doesn’t get pulled away from the blood stream as quickly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the maximum dose of lidocaine.

What happens when you add adrenaline

A

4mg/Kg

But when you add adrenaline, that increases to 7mg/Kg (because it vasoconstricts so less gets into systemic circulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which lifestyle changes are important before anaesthetic

A

atients should be advised to stop smoking as this increases the risk of both anaesthetic and surgical complications.

Patients who quit for more than four weeks prior to surgery have a decreased risk of complications.

However patients who quit for shorter periods may paradoxically have an increased risk of complications in comparison to those who continue to smoke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When should antihypertensives be stopped before surgery

A

In most cases antihypertensive medication should be continued up till the day (including the morning) of surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When are prophylactic antibiotics given before surgert

A

Antibiotics for surgical prophylaxis are given as a single dose close to the time of skin incision, usually at induction of anaesthesia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What if you find that your patient is anaemic in a pre-operative assessment

A

Anaemic patients should be investigated and treated before non-urgent surgery.

Evidence suggests correcting anaemia leads to improved post-operative outcomes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What Hb concentration should trigger transfusion in patients WITHOUT cardiovascular disease

A

In the absence of cardiovascular disease, it is accepted that there is no clear benefit in transfusing patients unless the Hb concentration is less than 80 g/l. Some institutions accept an even lower trigger of 70 g/l.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

t/f if there is no cardiovascular compromise you should give patients o neg

A

f

n absence of cardiovascular compromise, there is time to administer blood that has been appropriately cross matched to the patients blood group. Therefore, a group and save should be obtained. 2 units should be cross matched and administered the patient, rather than receiving emergency O negative blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How can blood loss in surgery be minimised

A
  • Use regional anaesthesia where possible (e.g. in orthapaedic surgery)
  • Haemagolbin levels should be measured during preoperative assessment and should be corrected preoperatively where possible to avoid post-operative transfusion
  • Using intraoperative cell salvage techniques
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What happens to white cells in blood in the UK

A

In the UK all blood undergoes leukodepletion, where the donor blood is filtered to remove white cells to minimise risk of transmission of vCJD. Blood may also be irradiated, which destroys the DNA in the white cells and prevents graft versus host disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is cryoprecipitate

A

Cryoprecipitate is a blood component rich in fibrinogen and used specifically when a patient has low levels, which can occur in massive haemorrhage or Disseminated Intravascular Coagulation (DIC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is fresh frozen plasma

A

Fresh frozen plasma is used to replace clotting factors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the cause of early postoperative fever

A

Early postoperative fever (within the first 24 hours after surgery) is most likely to be due to the systemic inflammatory response to surgical trauma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the management of early posteroperative fever if clinical examination does not point to an infective cause

A

There is no indication to do anything else at this point other than symptom management.

Prescribe an antipyretic agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

If a patient conitnues to have fever after 48hrs following the operation, what should you do

A

Sepsis screen, at least blood cultures, sputum and urine samples.

Urinary and respiratory tract infections are common causes of HAI.

Antibiotics should not routinely be prescribed for postoperative pyrexia. Evidence for infection must be present or highly suspected and cultures obtained prior to starting antibiotics.

The routine use of cephalosporins has been shown to increase the rates of MRSA and Clostridium Difficille infection and should be avoided.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How does a post-operative urinary tract infection usually present

A

Urinary tract infection may be the cause of postoperative fever, but the condition is usually asymptomatic. Therefore, investigations of postoperative fever should always include urinalysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Why are perioperative patients hypovolaemic

A

Both absolute and relative hypovolaemia:

ABSOLUTE: Blood and fluid losses and preoperative starvation

RELATIVE: Vasodilating effects of anaesthesia and the inflammatory response to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How would you investigate a hypotensive per-operative patient to assess whether they are hypovolaemic

A

The only appropriate test in this list is to attempt to elevate the legs.

This should increased venous return to the heart and increase the stroke volume which will increase the BP.

An increase in blood pressure may indicate hypovolaemia although a negative response does not rule out hypovolaemia.

You shouldn’t stand them up, as it may cause them to faint.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What effect would poorly controlled pain have on the BP

A

Pain is likely to increase the patient’s blood pressure. Good analgesia is essential, relief of pain normally causes blood pressure to fall.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the use of MAP?

A

MAP is considered to be a useful number to represent the perfusion of organs in the body.

As a general rule a MAP above 60 is required to sustain adequate organ perfusion in a fit patient.

Patients who are hypertensive may require a higher MAP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How is MAP calculated

A

Mean arterial blood pressure (MAP) = diastolic pressure + 1/3 (pulse pressure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How is pulse pressure measured

A

ulse pressure = systolic pressure–diastolic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

When is hydrocortisone used

A

ydrocortisone is indicated as a second line drug for hypotension secondary to an anaphylactiod reaction, which is not the case here.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is POAF

A

Postoperative atrial fibrillation (POAF) is common after surgery

61
Q

What are the complications of POAF

A

Even though POAF can be self-limiting, it may be associated with:

  • hemodynamic derangements,
  • postoperative stroke,
  • perioperative myocardial infarction,
  • ventricular arrhythmias or
  • heart failure.
62
Q

How might AF be managed post-operatively

A

ECG, regular obs, IV access and bloods.

Ascertain RFs, to calculate CHADVASc to assess need for thromboembolism prophylaxis

Call cardiology registrar

If stable: 
Rhythm control (amiodarone, digoxin) 
Rate control (b blocker)

If unstable, may require electric cardioversion (see AF management in cardio!)

63
Q

What is the atmospheric pressure

A

100kPa

64
Q

What is atmospheric pressure of oxygen

A

21kPa

65
Q

What is the pressure of oxygen in the alveolus

A

16kPa

66
Q

What account for the difference in the pressure of oxygen between the air and the alveoli

A

We humidify the air we breathe in, displacing some of the o2 with water, taking it from 21kPa and 16kPa

67
Q

What is the difference between the pressure of oxygen in the alveoli, vs in the pulmonary arterioles

A

It is not very different at all, both are at around 16kPa.

That’s because the transfer of oxygen across the alveolar wall is extremely efficient

68
Q

What is the difference between the pressure of oxygen in the blood of the pulmonary veins and the blood in the ABG. What causes this difference

A

The blood in the pulmonary veins before it gets back to the heart is 16kPa.

The blood in the artery that you measure in ABG will be at around 10-13kPa normally.

There is a difference here because there is some physiological shunting of blood in the lungs (i.e. not all the blood that travels through the pulmonary circulation gets oxygenated, even in a normal person). This is due to the VQ mismatch.

Also, some deoxygenated blood that has come from the myocardium drains straight into the left side of the heart. So this will bring down the pressure of oxygen in the arterial blood too, compared to the pulmonary vein blood.

69
Q

Why does the pressure of oxygen in the ABG reduce in pneumonia

A

Because the lobe affected by pneumonia will poorly oxygenate the blood passing around it.

This is because of the fluid in the lobe.

So there is more shunting

70
Q

A patient in A and E has a high pH, a normal o2 and and high Co2.

Can you be sure that they’re just anxious

A

You need to know if they’re on any oxygen.

If they’re on oxygen, yet they have a normal oxgyen ABG, it probably means they’re hypoxic without the added oxygen

71
Q

T/F aspirin and anticoagulants MUST be stopped before operation

A

T, they need to be stopped >5 days preoperative

72
Q

NICE pre-operative guidelines

A

//

73
Q

What must you ask all women about before surgery

A

On the day of surgery, sensitively ask all women of childbearing potential whether there is any possibility they could be pregnant.

Carry out a pregnancy test with the woman’s consent if there is any doubt about whether she could be pregnant.

74
Q

T/F you should routinely test for sickle cell disease and sickle cell trait before surgery

A

F

Do not routinely offer testing for sickle cell disease or sickle cell trait before surgery.

Ask the person having surgery if they or any member of their family have sickle cell disease.

75
Q

T/F there is no need to routinely test HbA1c in non-diabetics, but if they are a diabetic, they need an up to date HbA1c

A

T

1.5.1Do not routinely offer HbA1c testing before surgery to people without diagnosed diabetes.

.6.1People with diabetes who are being referred for surgical consultation from primary care should have their most recent HbA1c test results included in their referral information.

1.6.2Offer HbA1c testing to people with diabetes having surgery if they have not been tested in the last 3 month

76
Q

T/F Chest x rays should be done before all surgery

A

F

1.8.1Do not routinely offer chest X‑rays before surgery.

77
Q

T/F ECG should be routinely done before surgery

A

Do not routinely offer resting echocardiography before surgery.

1.9.2Consider resting echocardiography if the person has:

a heart murmur and any cardiac symptom (including breathlessness, pre‑syncope, syncope or chest pain) or

signs or symptoms of heart failure.

78
Q

tonsillectomy counts as what type of surgery according to NICE surgery grade

A

Intermediate

79
Q

Excising skin lesions is what kind os surgeyr

A

Minor

80
Q

Total joint replacement is which kind of surgery

A

Major/complex

81
Q

What do the ASA1-4 mean

A

ASA 1

A normal healthy patient

ASA 2

A patient with mild systemic disease

ASA 3

A patient with severe systemic disease

ASA 4

A patient with severe systemic disease that is a constant threat to life

ASA 5

Patient would die very soon without surgery

ASA 6

Brain-dead patient (organ harvesting

+
E to any of the above if it’s an emergency op

82
Q

Before major surgery, all ASA levels should have FBCs and haemostasis

A

F……

Only FBCs

83
Q

What is possum score

A

The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) assesses morbidity and mortality for general surgery.

It derives an accurate prediction of mortality

84
Q

What does possum not include

A

The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) assesses morbidity and mortality for general surgery.

Helps patients to make informed decision about surgery

85
Q

What are the key risk factors for surgery

A

Age (due to comorbodities such as cognitive and functional impairement, malnutrition and frailty)

Exercise capacity

Family history

Medication history (alcohol, smoking, illicit drug use and also prescribed, over the counter and alternative drugs)

86
Q

What family history is important to know about for surgery

A

Complications of anaesthesia (may have malignant hyperthermia, which is an inherited complication, autosomal dominant)

87
Q

What is the rule of thumb for medications and surgery

A

Most should be taken up to the morning of surgery, apart from some key exceptions

88
Q

When should MAOi be stopped before surgery and why

A

2 weeks.

It can have drug-drug interaction with the anaesthetic agents used in surgery

89
Q

When should SSRI be stopped and why

A

It should be stopped 3 weeks before CNS surgery

90
Q

Should oral contraceptive pill be stopped before surgery

A

It is usually stopped 4-6 weeks before planned surgery, especially in patients with high VTE risk (due to risk of VTE)

91
Q

When should aspirin be stopped before surgery, what about clopi

A

Aspirin- 7days, clopi- 5 days

unless extremely high cardiovascular risk

92
Q

When shoudl warfarin be stopped before surgery

A

> 5 days

93
Q

Do you need to stop taking COX-2 inhibitors/non-aspirin NSAIDS before surgery

A

If there is not a significant bleeding risk in surgery, then no.

But is there is, then it should be discontinued before the operation, timing depending on the NSAID

94
Q

What lung function tests would show a risk factor for surgery `

A

FEV1 <70% or FEV1/FVC <65% or predicted are risk factors for complications aftery surgery

95
Q

What are the criteria for day-case surgery

A

SELECTION OF PATIENTS:

  • Social factors (carer after at least 24hrs including to take them home)
  • Medical factors (determined by functional status, not ASA, obesity doesn’t preclude from day surgery).
  • Surgical factors (proceudre should not carry a risk of serious postoperative complications e.g. haemorrhage or cardiovascular instability, controllable post op symptoms, mobile)
96
Q

t/f day case surgery suitability depends on ASA

A

F… it depends on functional capacity not the ASA status

97
Q

What medications should be avoided in those with obstructive sleep apnoea

A

Avoidance of
postoperative opioid medication in these patients is
advised.

The optimal technique, if possible, is regional
anaesthesia

They are identified using the STOP-Bang questionnaire

98
Q

What are the conditions for patients being discharged from the surgical day case unit

A

Patients should be able to mobilise before
discharge, for example, walking with an arm in plaster, but if
full mobilisation is not possible, appropriate venous
thromboembolism prophylaxis should be instituted and
maintained

99
Q

What level of mortality risk would necessitate admission to HDU/ITU

A

More than 5% risk of death

100
Q

What optimisation and perioperative control is needed for:

Diabetes

A

Optimisation:
Glycolayted Hb

Peri-operative control:
When to use insulin sliding scales

101
Q

What optimisation and perioperative control is needed for:

HTN

A

Optimisation:
When to treat (BP>160/80)

Peri-operative control:
Maintain 20% of normal BP

102
Q

What optimisation and perioperative control is needed for:

IHD

A

Optimisation:
Symptomatic (for major procedure) OR if they have ECG abnormality

Peri-operative control:
BP & HR control. Consider post operative HDU

103
Q

What optimisation and perioperative control is needed for:

asthma

A

Optimisation:
symptomatic?signs?

Peri-operative control:
Medications according to BTS guidelines

104
Q

What optimisation and perioperative control is needed for:

COPD

A

Optimisation:
symptomatic?signs?

Peri-operative control:
Medications according to BTS guidelines

105
Q

What optimisation and perioperative control is needed for:

anticoagulatns

A

Optimisation:
why? stop or not?

Peri-operative control:
INR?APTR <1.5
Antiplatelets/LMWH resumption

106
Q

What optimisation and perioperative control is needed for:

sickle cell

A

Optimisation:
haem review

Peri-operative control:
good care: warm, hydrated, analgesia, infection free

107
Q

When would someone need to go on insulin sliding scale

A

Most type 2 diabetics can just be on metformin

If it’s a type 1 diabetic or someone who is nil by mouth for ages, then you might need it

108
Q

What patients usually go first in the list

A

Diabetics

109
Q

What FEV1 predicts need for postoperative ventilation

A

FEV<40% indicartes need for postoperative ventilation so they would need to go for ITU

110
Q 
When should you do: 
-ECG
-Echo 
-Stress echo 
pre-operatively
A
  • ECG: ischaemia, arrhythmias, baseline
  • Echo: LV function and valves
  • Stress echo- low/int/high risk of ischaemia
111
Q

What can you use for exercise tolerance if they can’t really move much

A

You can stress the heart by using dobutamine to see how well it can cope

112
Q

What is class 1, 2, 3 and 4 in the Mallampati score

A

1: complete visualisation of soft palate
2: complete visualisation of the uvula
3: visualisation of only the base of the uvula
4: soft palate not visible at all

113
Q

What is the point of nil by mouth

A

Reduce aspiratiojn risk

114
Q

What is theusual guidance for nil by mouth

A

Food: 6hr
Water: 2hr

115
Q

What is the caveat for nil by mouth

A

Reflux, obesity, slow gastric transit e.g. trauma

Then you may have food in the stomach still

116
Q

What might increase gastric time

A

Peritonitis might cause an ileus

Trauma and opioids

117
Q

When might IV fluids be needed

A

Intravenous (IV) fluids should only be prescribed for patients whose needs cannot be met by oral or enteral routes.

  • Patient NBM for medical or surgical reason (bowel obstruction, ileus, pre-operatively)
  • Patient is vomiting or has severe diarrhoea
  • Patient hypovolaemia due to blood loss (blood products likely required in addition to IV fluid)
118
Q

What are the 2 types of IV fluids

A

1) Crystalloids- solutions of small molecules in water (e.g. sodium chloride, hartmann’s, dextrode)
2) Colloids- solutions of larger organic molecules (ambulin, gelofusine)

119
Q

Why are colloids used less than crystalloids

A

they carry a risk of anaphylaxis and research has shown that crystalloids are superior in initial fluid resuscitation

120
Q

What is the difference between sodium chlorine 0.9% (normal saline) and sodium chloride 0.18%/glucose 4%

A

Sodium chlorine 0.9% (normal saline) is ISOTONIC and used for resuscitation or maintenance. Na concentration is 154, Cl is 154.

Sodium chloride 0.18% / Glucose 4% is HYPOTONIC and used for maintenance only. Na is 30, Cl is 30 and glucose is 40

121
Q

What is hartmanns solution used for

A

Isotonic

Used for resuscitation/maintenance

Na 131, K 5, Cl 111, glucose 29

122
Q

What is anaphylaxis

A

Acute life-threatening multisystem syndrome caused by sudden release of mast cell- and basophil-derived mediators into the circulation

123
Q

Differentiate the types of anaphylaxis

A

Immunology:
IgE mediated or immune complex/complement mediated

Non-immunologic:
mast cell or basophil degranulation without the involvement of antibodies (e.g. reactions caused by vancomycin, codeine, ACE inhibitors).

124
Q

When might anaphylaxis occur with blood products

A

Anaphylaxis may occur following repeated administration of blood products in patients with selective IgA deficiency (as a result of formation of anti-IgA antibodies)

125
Q

What investigations should be done after an anaphylaxis

A

Allergen skin testing: identify allergen

IgE immunoassays: RASTs to identidy food specific IgE in the serum

126
Q

Management of anaphylaxis

A

ABC approach

Secure airway- give 100% o2. Inform anaesthetist

Adrenaline IM (0.5mL of 1:1,000), can be repeated every 10 minutes

Antihistamine IV (10mg chlorpheniramine)

Steroids IV (100mh hydrocortisone)

IV crystalloid or colloid (probably not, they carry risk of anaphylaxis to stick with crystalloid!) to maintain blood pressure. If hypotensive, lie patient flat with head tilted down (lift legs)

Treat bronchospasm with salbulatol +/- ipratropium inhaler. Aminophylline IV may be necessary

127
Q

What is a side effect of using barbiturates in surgery

A 
Barbiturates
 such as 
thiopental
 can be used for 
anesthetic
 inductions. These medications lower 
blood pressure
 by depressing the medullary vasomotor center, causing global vasodilation and peripheral pooling of blood.
128
Q

What is the normal physiological response to barbiturates

A 
Physiologically
, the 
baroreceptor
 response to barbiturate induced
hypotension
 elicits a 
reflex tachycardia
 that maintains normal 
cardiac output
. In addition, the central vagolytic effect of 
barbiturates
 is a minor factor in this 
compensatory
 response.
129
Q

Which drugs can blunt the physiological response to barbiturates

A 
If the 
baroreceptor
 response is blunted, a profound decrease in 
cardiac output
 can occur with 
barbiturate
 administration, as the patient's systemic 
hypotension
 is not compensated by 
increased heart rate
. In particular, 
congestive heart failure
 and β-adrenergic blockers such as 
metoprolol
 can interfere with the 
physiologic
 compensation. Due to lack of a 
compensatory
 response, these patients can suffer a severe drop in 
cardiac output
 when given 
barbiturates
.
130
Q

When do you transfuse somebody who doesn’t have sepsis, acute coronary syndrome or neurological injury

A

Only when their Hb falls below 70.

You then aim to get them in the range 70-90 with transfusion.

Be less confident of using Hb trigger of 70 if the patient is elderly, has significant cardiorespiratory co-morbidities or inadequate tissue oxygenation

131
Q

When do you transfuse somebody with severe sepsis

A

If early (<6hr from onset), transfuse to the target of Hb 90-100

If late (>6hr from onset), transfuse to the target of Hb>70

132
Q

When do you transfuse for someone :

TBI
SAH

A

If they have TBI and delayed cerebral ischaemia, transfuse to Hb 90

If they’ve had SAH, transfuse to target of 80-100

133
Q

When should you transfuse someone with ACS

A

With ACS:
Target Hb >80-100

With stable angina:
Target Hb >70

134
Q

What is the use of a bag mask valve?

A

It’s got a valve because it’s only meant to be used on patients that aren’t breathing themselves (apnoeic)

You rig it up to the oxygen output on the wall, and you compress the bag to deliver oxygen, whilst maintaining a seal with the mask around the patient’s mouth

It can delivery 90-100% oxygen

It’s not a definitive airway because it doesn’t go into the trachea, it’s just a mask sitting over their mouth

135
Q

What is the use of a nasopharyngeal/oropharyngeal airway

A

Read the bag mask valve first.

Now these devices are for use in addition to a bag mask valve, when the airway is obstructed e.g. if they have a big tongue, you can put an OPA in. If they are seizing, you can put an NPA in.

It’s not a definitive airway because it doesn’t go into the trachea, it’s just a mask sitting over their mouth

136
Q

What is a supraglottic device? Is it a definitive airway

A

It is not a definitive airway

It sits above the level of the vocal cords.

It seals off the epiglottis and can be used to deliver o2

It’s not a definitive airway because it doesn’t go into the trachea, it’s just a mask sitting over their mouth

137
Q

What is an endotracheal tube

A

This is a definitive airway.

It is passed through the vocal cords into the trachea, and a cuff is then inflated when it is in the trachea, to fix it in place.

Intubation is required to fit the tube

138
Q

Outline the WHO pain ladder

A

Step 1: Non opioid- paracetemol/NSAID

Step 2: Weak opioid (codeine)

Step 3: Strong opioid (morphine)

139
Q

What is the mechanism of action of ondansetron

A

Antiemetic

5HT3R antagonist

4-8mg

140
Q

Side effects of ondansetron

A

Bradycardia

Long QT

141
Q

MOA of clyclizine

A

Antiemetic

H1-R antagonist

142
Q

Side effects of clyclizine

A

Tachycardia and anti-cholingeric (dry mouth, increased heart rate, urinary retention, blurred vision)

143
Q

MOA of dexamethasone

A

Corticosteroid

144
Q

Side effects of dexamethason

A

Hyperglycaemia

Perineal burning

145
Q

Mechanism of action of metachlopramisde

A

Central DA2 R antagonist

146
Q

Side effects of metaclopramide

A

Extrapyramindal symptoms

147
Q

Mechanism of action of prochlorperazine

A

DA antagonist

148
Q

Side effects of prochlorperazine

A

Extrapyramindal symptoms

Long QT syndrome

149
Q

What is necessary for warming in surgery

A

You need to keep temp >36.

If procedure is longer than 30 mins use a bair hugger

If it’s a longer procedure still, consider fluid warming

Year 3 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions