Anaesthetics

Question 1

What is a pre-op assessment and when is this carried out?

Answer 1

It is carried out a few weeks/days prior to theatre to assess a patients fitness for surgery

Question 2

what is pre-op preparation and when is this carried out?

Answer 2

this happens on the day of the operation to ensure the patient is still fit for theatre and that there have been no major changes between pre-op assessment and theatre

Question 3

what are the 3 pillars of general anaesthesia

Answer 3

1. induction - reduce conscious level
2. analgesia
3. paralysis

Question 4

What are important things to go through at the pre-op assessment

Answer 4

co-morbidities:
MI, angina, IHD, PVD, PE, COPD, asthma, DM, BMI, CKD, reflux, liver disease
Medications and allergies:
ACEI, diuretics, aspirin, warfarin, PPI
Previous anaesthetic experience e.g. drug reactions, PONV…

Question 5

Should ACEI be stopped prior to surgery and when

Answer 5

yes, risk of hypotension and AKI

stop on the day of surgery

Question 6

Should aspirin be stopped prior to surgery and when

Answer 6

yes

7 days beforehand

Question 7

should clopidogrel be stopped prior to surgery

Answer 7

yes

Question 8

should warfarin be stopped prior to surgery and when

Answer 8

yes

5 days prior to surgery

Question 9

when can you restart warfarin after surgery

Answer 9

immediately after theatre

monitor INR

Question 10

how should diabetics manage their medications prior to surgery

Answer 10

normally until the day of surgery
monitor their glucose regularly
they should be first on the theatre list
IV insulin for complex cases

Question 11

What are the rules for fasting prior to surgery

Answer 11

food - 6 hours
milk - 4hours
clear liquid - 2 hours

Question 12

Why do patients fast before being anaesthetised for surgery

Answer 12

to prevent aspiration

Question 13

what is bridging therapy in relation to antithrombotic medications in preparation for surgery

Answer 13

patients with a high risk of DVT/PE/stroke and those with metallic heart valves –>
stop warfarin as planned 5 days before
on day 3 you give LMWH
then you stop the LMWH 24 hours before theatre

Question 14

what is the most common complaint/symptom after surgery

Answer 14

PONV

Question 15

what is involved in the post-op assessment of the patient

Answer 15

analgesia
anti-emetics
fluids
restarting of medications

Question 16

what is local anaesthesia

Answer 16

reversible numbing of a specific region of the body to prevent pain

Question 17

what is the difference between epidural and spinal anaesthesia

Answer 17

epidural = epidural space and acts on nerve roots 
spinal = into CSF and acts on spinal cord directly

Question 18

what is RSI

Answer 18

Rapid sequence induction

method of inducing anaesthesia in a patient with a high risk of aspiration

Question 19

What is day surgery

Answer 19

planned admission of surgical procedure where the patient is admitted, undergoes surgery and is discharged on the same calendar day

Question 20

what is DOSA

Answer 20

Day of surgery admission
patient comes in on the day of surgery rather than the night before
(this does not necessarily mean it will be a day surgery)

Question 21

What should be done for all females ages 12-55 before surgery

Answer 21

pregnancy test

Question 22

what is the sequence of anaesthesia for surgery

Answer 22

premedication 
induction 
maintenance 
reversal 
recovery

Question 23

what are the 3 reasons to administer drugs in anaesthetics

Answer 23

induction - reduce a patients level of consciousness
analgesia - block painful stimuli
paralysis - relax skeletal muscle

Question 24

how can GA be administered

Answer 24

IV or inhalational

Question 25

What is the most immediate effect of GA

Answer 25

loss of airway

Question 26

what is local anaesthetic

Answer 26

reversible blocking of nerve conduction

Question 27

how can LA be administered

Answer 27

topical 
infiltration 
peripheral nerve block 
epidural 
spinal

Question 28

post operatively, what derangements may be seen in the following systems:
CVS
Resp
GI 
CNS
Urinary

Answer 28

CVS - hypotension (from anaesthesia, haemorrhage or the disease itself)
Resp - hypoxaemia (from anaesthesia), resp depression (from opioids), impaired breathing (from pain)
GI - PONV, post-op ileus
CNS - delayed recovery of consciousness, pain
Urinary - post-op oliguria

Question 29

what can cause post-anaesthetic shivering/shaking

Answer 29

loss of control of your body temperature can cause this

it is not like a seizure

Question 30

what is the ASA score

Answer 30

score for assessing peri-operative status

Question 31

describe ASA 1

Answer 31

normal healthy patient

Question 32

describe ASA 2

Answer 32

patient with mild systemic disease
smoker 
pregnant 
obese 
controlled DM

Question 33

describe ASA 3

Answer 33

patient with severe systemic disease
alcohol dependence
morbid obesity 
hepatitis 
pace maker 
ESRD 
COPD
History of MI, stroke, CAD, OSA

Question 34

describe ASA 4

Answer 34

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

Question 35

describe ASA 5

Answer 35

moribund patient who is not expected to survive without the operation

Question 36

describe ASA 6

Answer 36

declared brain dead patient whose organs are being removed for donation

Question 37

what is malignant hyperthermia a serious side effect of and what is the management

Answer 37

suxamethonium

IV dantrolene therapy

Question 38

how long should a patient stop the OCP before GA

Answer 38

4 weeks