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NMF: acute care > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

What is a day surgery case?

A

planned admission where someone undergoes theatre and goes home the same day

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2
Q

What is a day of surgery admission (DOSA)?

A

when a patient attends hospital to be admitted on the day of their surgery rather than staying the night before

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3
Q

What are the advantages of DOSA?

A 
better sleep
less anxious
reduced infection risk
reduced falls and delirium risk in elderly
more cost effective
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4
Q

What are the disadvantages of DOSA?

A

shorter time for consent
patient may be late
incorrect fasting
incorrect medication taken the day of

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5
Q

How long must a patient fast

a) food?
b) milk?
c) clear liquid?

A

a) 6 hours
b) 4 hours
c) 2 hours

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6
Q

When are patients ideally seen at the pre admission clinic?

A

6-8 weeks

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7
Q

What is the purpose of the PAC?

A

patient told about side effects of anaethesia and fasting requirements

determine if any other important issues ie
airway difficulties, drug reactions, post-operative nausea risk

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8
Q

what should be screened for patients ASA grade 3 or patients having major surgery?

A

anaemia screen
Haemostasis (coagulation and LFTs)
Kidney function (or if at risk of AKI
ECG

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9
Q

What puts patients at risk for an AKI?

A 
intraperitoneal surgery
CKD (eGFR<60)
Diabetes
Heart failure
Age 65 or over
Liver disease
Nephrotoxic drugs (ACEi, NSAIDs)
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10
Q

Which factors need to be considered before discharge?

A 
pain controlled
no N+V
no complications
accceptable SEWS
passed urine
someone at home for 24hrs
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11
Q

Which drugs should be omitted day of surgery?

A 
ACE inhibitors
Angiotensin 2 antagonists (ARBs)
Diuretics unless for heart failure 
Aspirin, clopidogrel, dipyridamole, warfarin.
Lithium
NSAIDs
non-essential eg. vitamins, HRT, laxatives..
oral contraceptives
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12
Q

How does reflux affect anaesthetics?

A

may decide to intubate

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13
Q

What are the characteristics of acute pain?

A

sudden onset
known cause
controlled by normal analgesics

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14
Q

What are the 3 pillars of general anaesthesia?

A
  1. not being aware
  2. analgesia
  3. paralysis
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15
Q

What proportion of patients who present to a surgeon are surgically managed?

A

1 in 3

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16
Q

What proportion of patients go home on the day of their surgery?

A

70%

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17
Q

If a patient stops breathing, what keeps them alive?

A

functional residual capacity of the lungs

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18
Q

How can functional residual capacity be increased? what does this achieve?

A

give patient 100% oxygen to replace air in the FRC will give the patient longer to stay alive

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19
Q

What is the risk of continuing cardiovascular medications during surgery?

A

hypotension

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20
Q

Which drug must be stopped before surgery because it causes prolonged hypotension?

A

ACE-i

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21
Q

What is the difference between aspirin and other NSAIDs?

A

aspirin irreversibly blocks platelets

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22
Q

How long before surgery is aspirin stopped? Why?

A

7 days
risk of bleeding
wait this long for half life of platelets not half life of aspirin

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23
Q

How many half lives would reduce a drug’s plasma concentration to an acceptable level?

A

5

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24
Q

Why are diabetic patients undergoing surgery at risk of

a) hypoglycaemia?
b) hyperglycaemia?

A

a) fasted means they cannot take medication

b) stress

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25
Q

What is an LMA?

A

a laryngeal mask airway: supraglottic airway device

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26
Q

What is the difference between an LMA and intubation?

A

LMA sits above the glottis in the oesophagus

whereas intubation involves inserting an endotracheal tube past the glottis

27
Q

What is the glottis?

A

middle part of larynx where vocal cords are

28
Q

What is the tidal volume?

A

amount of air inspired/expired with each breath during normal breathing

29
Q

What is the vital capacity?

A

max amount of air expired after max inspiration

30
Q

What is the inspiratory reserve volume?

A

maximum volume of gas inspired after normal expiration
so it is on top of the tidal volume

ie. inspiratory capacity - tidal volume

31
Q

What is the expiratory reserve volume?

A

maximum volume of gas expired on top of tidal volume

ie. expiratory capacity - tidal volume

32
Q

What is the residual volume?

A

the volume of gas that remains in the lungs after max exhalation

ie. keeps lungs open to stop resistance

33
Q

What is the functional residual capacity?

A

the amount of air in the lungs after normal breathing

ie. their residual volume + the expiratory reserve volume

34
Q

What proportion of lung volume is the FRC?

A

40%

35
Q

Which nerves stimulate B2 adrenoreceptors in the smooth muscle of the lung? what does this do?

A

sympathetic stimulation increases diameter of airways –> bronchodilation

36
Q

Which receptors are stimulated by parasympathetic nerves in the lung’s smooth muscle?

A

muscarinic receptors which decrease diameter of airways –> bronchoconstriction

37
Q

Where are alpha1 receptors found? what do they do?

A

vascular smooth muscle

increase contraction

38
Q

Where are alpha2 receptors found? what do they do?

A

CNS

dec sympathetic outflow (inhibit noradrenaline release)

39
Q

Where are beta 1 receptors found? what do they do?

A

cardiac cells

inc heart rate, inc contractility, inc renin release

40
Q

Where are beta 2 receptors found? what do they do?

A

vascular and bronchodilator smooth muscle

vasodilation + bronchodilation

41
Q

What kind of neurotransmitter is GABA?

A

inhibitory: when it interacts with receptors of a neurone it makes it less likely to fire an action potential or release neurotransmitters

42
Q

What is a GABA A receptor?

A

ionotropic: opens channel allowing negative Cl ion to flow into the cell, hyperpolarising it and making it less likely to fire an action potential

43
Q

What are GABA B receptors?

A

g-protein coupled receptors that allow positive K+ to flow out of the neurone to hyperpolarise it and make it less likely to fire an action potential

44
Q

What is atelectasis?

A

alveoli collapse or do not expand properly

45
Q

What affect does smoking have on post-operative nausea and vomiting?

A

it decreases it

46
Q

Why is it important to minimise gastric acid before surgery?

A

to prevent pulmonary acid aspiration which can cause a type of pneumonia called Mendelson syndrome

47
Q

Should medication be given to a patient who is fasted for theatre?

A

yes

can be given with a sip of water

48
Q

Should aspirin be stopped before surgery?

A

can be given if needed to reduce risk of post-op MI

49
Q

How long before surgery should clopidogrel be stopped?

A

7 days

50
Q

What warfarin patients are high risk?

A
  • AF or valve disease w past arterial thrombosis
  • VTE in last 3 months
  • mechanical non-bio prosthetic valve
  • multiple prosthetic heart valves
51
Q

How should a patient usually on warfarin be managed post-op if there is no excess bleeding?

A

restart warfarin day of procedure and give prophylactic heparin

52
Q

Why is it important that a diabetic patient isnt
a) hypo
b) hyper
peri-operatively?

A

a) can cause irreversible brain damage

b) wound infection + cardiac complications

53
Q

How should glycaemic control of a diabetic patient be assessed before surgery?

A

HbA1c

  • if >75mmol/mol its poor
  • if >108mmol/mol needs control before proceed
54
Q

What is important when considering PaO2?

A

inspired O2

55
Q

Is pH a linear scale?

A

no it is logarithmic

56
Q

How should naloxone be given?

A

dose = 400mcg

give in 40mcg boluses

57
Q

Do anaphylaxis and sepsis cause vasodilation or vasoconstriction?

A

vasodilation

58
Q

What is cardiac output equal to?

A

HR x SV

59
Q

What is mean arterial blood pressure equal to?

A

CO x SVR

60
Q

What is the dose and route of administration of adrenaline during

a) cardiac arrest?
b) anaphylaxis?

A

a) 1mg IV

b) 0.5mg IM

61
Q

The ABGs of a patient in sudden cardiac arrest having had no bystander CPR and with no preceding ABG abnormality will likely demonstrate?

A

mixed respiratory and metabolic acidosis due to ischaemia and apnoea

62
Q

How long before surgery should COCP be stopped?

A

4 Weeks

63
Q

How long before surgery should clopidogrel be stopped?

A

7 days

64
Q

How long before surgery should warfarin be stopped?

A

5 days

NMF: acute care (6 decks)

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