Anaesthetics Flashcards
What is a pre-op assessment and when is this carried out?
It is carried out a few weeks/days prior to theatre to assess a patients fitness for surgery
what is pre-op preparation and when is this carried out?
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
what are the 3 pillars of general anaesthesia
- induction - reduce conscious level
- analgesia
- paralysis
What are important things to go through at the pre-op assessment
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…
Should ACEI be stopped prior to surgery and when
yes, risk of hypotension and AKI
stop on the day of surgery
Should aspirin be stopped prior to surgery and when
yes
7 days beforehand
should clopidogrel be stopped prior to surgery
yes
should warfarin be stopped prior to surgery and when
yes
5 days prior to surgery
when can you restart warfarin after surgery
immediately after theatre
monitor INR
how should diabetics manage their medications prior to surgery
normally until the day of surgery
monitor their glucose regularly
they should be first on the theatre list
IV insulin for complex cases
What are the rules for fasting prior to surgery
food - 6 hours
milk - 4hours
clear liquid - 2 hours
Why do patients fast before being anaesthetised for surgery
to prevent aspiration
what is bridging therapy in relation to antithrombotic medications in preparation for surgery
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
what is the most common complaint/symptom after surgery
PONV
what is involved in the post-op assessment of the patient
analgesia
anti-emetics
fluids
restarting of medications
what is local anaesthesia
reversible numbing of a specific region of the body to prevent pain
what is the difference between epidural and spinal anaesthesia
epidural = epidural space and acts on nerve roots spinal = into CSF and acts on spinal cord directly
what is RSI
Rapid sequence induction
method of inducing anaesthesia in a patient with a high risk of aspiration
What is day surgery
planned admission of surgical procedure where the patient is admitted, undergoes surgery and is discharged on the same calendar day
what is DOSA
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)
What should be done for all females ages 12-55 before surgery
pregnancy test
what is the sequence of anaesthesia for surgery
premedication induction maintenance reversal recovery
what are the 3 reasons to administer drugs in anaesthetics
induction - reduce a patients level of consciousness
analgesia - block painful stimuli
paralysis - relax skeletal muscle
how can GA be administered
IV or inhalational
What is the most immediate effect of GA
loss of airway
what is local anaesthetic
reversible blocking of nerve conduction
how can LA be administered
topical infiltration peripheral nerve block epidural spinal
post operatively, what derangements may be seen in the following systems: CVS Resp GI CNS Urinary
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
what can cause post-anaesthetic shivering/shaking
loss of control of your body temperature can cause this
it is not like a seizure
what is the ASA score
score for assessing peri-operative status
describe ASA 1
normal healthy patient
describe ASA 2
patient with mild systemic disease smoker pregnant obese controlled DM
describe ASA 3
patient with severe systemic disease alcohol dependence morbid obesity hepatitis pace maker ESRD COPD History of MI, stroke, CAD, OSA
describe ASA 4
patient with severe systemic disease that is a constant threat to life
describe ASA 5
moribund patient who is not expected to survive without the operation
describe ASA 6
declared brain dead patient whose organs are being removed for donation
what is malignant hyperthermia a serious side effect of and what is the management
suxamethonium
IV dantrolene therapy
how long should a patient stop the OCP before GA
4 weeks
