Anaesthetics Flashcards
What do preoperative investigations depend on
Patient medication and comorbidites
Severity of surgery
Elective or emergency
Scoring systems for health of patient pre surgery
ASA
ASA scoring
1- healthy
2- minor systemic condition that enables them to walk up 2 flights of stairs
3- major systemic disease that is a threat to life
4- major disease that is constant threat to life
5- patient wont make it oast 24 hours
Scoring system for risk to patient of surgery
POSSUM
How does possum score work
Use patient physiological and operative variables to give risk of mortality or morbidity of surgery. This then determines what sort of mid operative monitoring is done or where the patient needs to be monitrored after surgery. For example if mortality rate over 5% then would end up post operatively on ICU
What to do with diabetes perioperatively
Ensure Hba1c is well controlled
What to do pre operatively with HTN
Check most recent at GP as before surgery very high, if over 160/80 need to treat
What to do intra-operatively with HTN
Keep within 20% of their normal
What to do with IHD pre operatively
Make sure no recent deterioration and is well controlled. If has been a change then refer to cardiology or do ECG to check for anomaly
What to do with IDH intra operatively
Check for HR and BP constantly
What to do with IHD post operatively
Consider taking to HDU
What to do with asthma or COPD perioperatively
Ensure taking medication and no exacerbating symptoms or signs recently
What is INR range for surgery perioperatively
Less than 1.5
What should be considered with anticoagulants
Why are they taking it
Should they be stopped?
What needs to be done to optimise SCD patients for surgery
Haematology review
What should be done peroperatively for SCD patients
Ensure good care so warm, hydrated, analgesia and infection free
What is criteria for suitability for day stay surgery
Social- patient consent and is there suitable care situation at home
Medical- fitness and are they stable chronically
Surgical- mobile?, complication risk needs monitoring?
Why do NBM pre surgery
Reduce risk of aspiration as paralysed swallowing reflex
Usual guidance on ceasing fluid and food
Food 6 hours
Water 2 hours
What to include when recording on controlled drug register
Dose
Form of administration
Strength
Instalment prescription
Whats included on instalment prescription
Amount of medicine per instalment
Interval between instalments
What is another name for oropharangeal airways
Guedel
How to do sizing of oropharyngeal airways
Side of mouth to angle of mandible
Who do you use bag-mask-valves in
Apnoeic patients
What FiO2 can be achieved in bag mask valves
60-90
What does supraglottic device look like
A cobra
What are 3 aiway adjuncts we need to know
Endotracheal tubes
Supraglottic device
Bag mask valves
What are the 5 steps to safer surgery
Briefing Sign in Time out Sign out De brief
What is done in briefing in 5 steps to safer surgery
All the team meet to introduce themselves, discuss order and each persons role
What is done in sign in in 5 steps to safer surgery
Lead by anaesthetist to patient pre any anaesthetic
Confirm patient details, the procedure and the side
Check allergies
Prophylaxis
What is done in time out in 5 steps to safer surgery
Lead by surgeon pre incision
Check anaesthetic side all fine and details
All equipment sterile
What is done in sign out in 5 steps to safer surgery
Lead by anaesthetist where do equipment check to see if any left in body, prescriptions and any prophylaxis given
What should be considered for VTE prophylaxis
Their mobility
Risk factors such as cancer, prophylaxis
Bleeding risk
What is the WHO pain ladder
Determies level of pain relief given post operatively
3 tiers to WHO pain ladder
Step 1- non opioid
Step 2- weak opioid
Step 3- strong opioid
What enables you to move up WHO pain ladder
Increasing or persisting pain
What anti emetics are given alongside pain relief
Ondensatron Prochlorperazine Cyclizine Dexamethasone Metoclopramide
Dose and administration of ondensatron
4-8mg TDS
PO IV
Dose and administration of cyclizine
50mg TDS
PO IV
Dose and administration of dexamethasone
4-8mg
PO/slow IV/IM
Dose and administration of metoclopramide
10mg TDS
PO IV
Dose and administration of propchlorperazine
12.5mg BD
IM
SEs ondensatron
Bradychardia
Long QT
SEs cyclizine
Tachycarida
Anti-cholinergic
SEs dexamethasone
Hyperglycaemia
Perineal burning
SEs metoclopramide
Extrapyramidal SEs
SEs prochlorperazine
Extrapyramidal SEs
Long QT
Aim of temperature control in anaesthesia
36C
What is always given for heat control if surgery over 30mins
Bair hugger
Methods used to warm up patients
Bair hugger
Warming IV fluids
Heat moisturiser exchangers
Method of warmth control for very long surgeries
Warming IV fluids
What is effect anaesthesia on temp control
Makes you colder
What is management of severe bronchospasm outside of theatre
Start high flow O2 Salbutamol nebulisers Hydrocortisone Ipatropium bromdie Theophylline Magnesium
Pnemonic for control of severe bronchospasm
OSHITM
How would you treat a tension pneuomthorax
16 gauge needle decompression in 2ics MCL
Resp emergencies need to be aware of in anaesthetics
Asthma attacks
Hameo/pneumothorax
Anaphylaxis
Foreign body aspiration
Anaphylaxis triggers
Stings Nuts Foods Antibiotics Anaesthetic drugs Contrast media
Recognising anaphylaxis ABC
Airway SOB and swallowing Stridor Hoarse voice Breathing Wheeze Confusion from hypoxia SOB- tachypnoea Accessory muscle involvement Circulation shock signs Tachycardia Hyoptension Loss of conciousness Can arrest
What is main management of anaphylaxis
Adrenaline
Then supportive measures such as airway establishment, O2, hydrocortisone, IV fluid and chlorphenamine
When should you give blood transfusion
Tranfusion guideline
Post operatively what scores do you use to monitor recovery and if theyre getting worse
NEWS
Early warning signs of detioration of patient
Tachycardia
Hypotensive
HR above SBP
How to define SIRS
2 of Temp out of 36-38 HR above 90 RR above 20 or Pa CO2 below 4.3kPa WBC abnormal
What is common after surgery
SIRS
What are indications for ABG
Interpret oxygenation levels Assess resp derangements Assess metabolic derangements Acid base status Assess lactate CO poisoning
Contraindications to ABG
Local infection Distorted anatomy Presence of fistulas Peripheral vascular disease Severe coagulopathy Recent thrombolysi
What can lead to errors with ABG measurements
Presence of air in sample
Venous as opposed to arterial blood
Improper heparin amount
Delay in transportation
Complications of ABG
Haematoma Nerve damage Arteriospasm Aneurysm Syncope vasovagal
What are goals of oxygen therapy
Relieve hypoxaemia
Prevent CO2 accumulation
Reduce work of breathing such as CPAP
Ensure adequate clearance of secretions and limit effects of hypothermia
Oxygen delivery methods
Nasal cannula
Hudson facemask
Venturi
Non-rebreather
When do you nasal cannulae
Non-acute setting
Mild hypoxia
What FiO2 are nasal cannulae
24-30
Flow rate of nasal cannulae
1-4
FiO2 venturi
24-60
FiO2 hudson facemask
30-40
Flow rate hudson
5-10
Flow rate of venturi
Fixed depending on colour
What oxygen therapy preferred in COPD
Venturi
Who are non-rebreather mask used for
Apnoeic
Flow rate of non rebreather
15
FiO2 of non rebreath
60-90
What is purpose of non-rebreather
Stop breathing expired air
What are 2 non-invasive modes of ventilation
CPAP
BiPAP
Who do you use CPAP for
Type 1 RF in order to splint open airways
What is CPAP
continuous positive air pressure that occurs all the time
What is device used for CPAP
Tight fitting mask
What is BiPAP
Bilevel positive airways pressure
How does BiPAP work
High positive pressure on inspiration and lower positive pressure on expiration
Who do you use BiPAP for
T2 RF such as COPD exacerbation
Treatment for anaphylaxis
IM adrenaline
