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AB 4th Year Acute Care + Anaesthetics > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

when is an RSI done?

A

high aspiration risk

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2
Q

what are the three aspects of an anesthetic?

A

analgesia
hypnosis
muscle relaxant

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3
Q

what happens in an RSI?

A

5 mins of preoxygenation
pressure on cricoid cartilage (prevent aspiration)
induction + muscle relaxant
intubated

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4
Q

what are the components of an RSI?

A

analgesia - fentanyl
anaesthetic/induction - propofol
muscle relaxant - suxamethonium

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5
Q

in a GA, what is given to make sure patient can ventilate themselves?

A

volatile agents

e.g NO

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6
Q

where does the spinal cord run to?

A

L1 (adults)

L3 (kids)

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7
Q

what level is the iliac crest?

A

L4/5

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8
Q

where does epidural go?

A

to epidural space (between dura and spinal cord)

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9
Q

where does spinal go?

A

subarachnoid space (CSF flows out)

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10
Q

what does an epidural pass through?

A 
skin
subcut tissue
supraspinous lig
inerspinous lig 
lig flavum 
epidural space
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11
Q

who should be intubated?

A 
GCS <8
obese
pregnant
reflux
non fasted
length 
DM
trauma
laparoscopic surgery 
acutely unwell
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12
Q

what are the short vs long acting locals?

A 
short = lidocaine
long = bupivacaine
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13
Q

who and where should adrenaline not be given?

A

fingers/ears/toes

those on MAOis/TCAs

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14
Q

who is at higher risk of local anaesthetic toxicity? what does it cause?

A

liver problems/low protein

CNS overactivity/depression/arrythmias

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15
Q

what does propofol work on?

A

works on GABA

anaesthetic

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16
Q

side effects of propfol?

A

hurts to inject
stops upper airway reflex
myocardial depression

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17
Q

what is atracurium? do you get fasciculations?

A

long acting muscle relaxant

NO

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18
Q

what is suxamethonium? do you get fasciculations?

A

short acting muscle relaxant (depolarising agent)

YES

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19
Q

how long should warfarin be withheld for pre op?

A

5 days (check INR)

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20
Q

what is the INR aim for surgery?

A

≤1.5

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21
Q

what is the warfarin reversal agent?

A

vit K

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22
Q

when can warfarin be given post op?

A

same day

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23
Q

when should heparin be stopped pre op?

A

6 hours unfrac

24 hours LMWH

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24
Q

who should not have anticoagulants stopped?

A

VTE <3mnths
mechanical valves
AF/valve disease with Hx thrombosis

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25
Q

when should clopidogrel be stopped pre op?

A

7 days

26
Q

what cardiac drugs should be withheld on the day of surgery? why?

A

ACE

AKI and hypotension risk

27
Q

how should T1DM be managed pre op?

A

fasted and first on list
take long acting but not short

give post op once eaten

28
Q

how should T2DM be managed pre op?

A

fasted and first on list
withold oral hypo on day

give metformin after once renal function is checked

29
Q

difference between HDU and ICU?

A 
HDU = single organ failing 
ICU = multiple
30
Q

difference between CPAP and BIPAP?

A

CPAP - pressure doesn’t change

BIPAP - less pressure when breathing out/more breathing in

31
Q

where are CVC usually inserted?

A

IJV
subclavian
femoral

32
Q

what do inotropes do vs chronotrope?

A

inotropic - increase contractility

chronotrope - rate

33
Q

examples of inotropic drugs?

A

adrenaline

dobutamine

34
Q

how does adrenaline work?

A

attaches to B1 receptors

increases force and rate of contraction

35
Q

examples of vasopressors? what do these do?

A

NA
adrenaline

make blood vessels contract to try increase BP

36
Q

what is classified as chronic pain?

A

> 3 months

37
Q

pain ladder?

A

non opiod + adjuvant

opiod + non + adjuvant

opiod + non + adjuvant

38
Q

what are the mid vs stronger opiods?

A

mid = codeine, tramadol, oxy

strong = morphine, oxy, methadone, fentanyl

39
Q

what can be used as pain adjuvants? what drug class are these?

A

amitryptilline (TCA)
duloxetine (SNRI)
anticonvulsants

40
Q

what is the pain rating scale?

A 
0 = no pain at rest or movement
1 = no pain at rest, slight on movement 
2 = intermittent at rest, moderate on movement
3 = continuous at rest, severe on movement
41
Q

what is a normal paracetamol dose?

A

1g 6 hourly

42
Q

what is a fast onset opiod?

A

oxycodone

43
Q

what is a less addictive opiod?

A

tramadol

44
Q

what is a normal PCA dose?

A

morphine

1mg with 5 min lockout (12mg per hour)

45
Q

e.g of a depolarising and non depolarising muscle relaxant?

A

depolarising - suxamethonium

non depol - rocuronium

46
Q

how do histamine antagonists work?

A

block H1 receptors in the CNS
cause sedation

e.g cyclizine

47
Q

how do dopamine antagonists work?

A

binds to D2 receptors and relaxes the gut (promotility)

48
Q

how do 5HT3 antagonists work?

A

antagonise 5HT3 receptors in the CNS/GI tract

49
Q

what type of drug is hyoscine bromide?

A

anti muscarinic (anti emetic)

50
Q

how long should the COCP be stopped before surgery?

A

2 weeks

51
Q

if on warfarin pre op, what can this be changed to?

A

heparin

52
Q

if on insulin, what should be done with this pre op?

A

stop on day

give a glucose, K, and insulin infusion

53
Q

what anaesthetics are more likely to make people sick?

A

opiods
NOS
ketamine

54
Q

how to check if patient is intubated and not in oesophagus?

A

chest air entry
chest movement
capnography (flat - no CO2 detected)
no steam on mask

55
Q

what happens in local anaesthetic toxicity?

A 
peri oral tingling 
numb 
anxiety
lightheaded
collapse
56
Q

what layers does an epidural pass through?

A 
skin 
subcut tissue
supraspinous
interspinous
ligamentum flavum 
epidural space
57
Q

what layers does a spinal pass through?

A 
skin 
subcut tissue
supraspinous
interspinous
ligamentum flavum 
dura
into subarachnoid space
58
Q

layers of the spinal cord?

A

dura
arachnoid
pia

59
Q 
e.g of a 
dopamine antagonist 
5HT3 antagonist 
H1 antagonist
anti muscarinic ?
A

dopamine = metaclopramide
5HT3 = ondansetrone
H1 = cyclizine
anti muscarinic = hyoscine bromide

60
Q

e.g of drowsy and non drowsy anti histamines?

A

drowsy = chlorampenicol

non drowsy = cetirizine

AB 4th Year Acute Care + Anaesthetics (8 decks)

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