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CP3 Crit Care > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

Define general anaesthesia

A

Drug induced, controlled, reversible LOC

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2
Q

Premedication - examples used in anxious patients

A

Temazepam

Midazolam

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3
Q

Premedication - what may you give to reduce gastric activity?

A

Ranitidine

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4
Q

When is pre-oxygenation used?

A

When ventilation - difficult

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5
Q

Anaesthetics used for IV induction (2)

A

Propofol

Fentanyl

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6
Q

What is placed after IV induction?

A

LMA/ETT

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7
Q

Agents used in gas maintenance

A

Volatile agents

e.g. isoflurane/halothane

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8
Q

what is TIVA

A

Total Intra Venous anaesthesia

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9
Q

What drug is most commonly used in TIVA

A

Propofol

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10
Q

What are the 4 stages of anaesthesia

A

Anaesthesia stage
Excitement stage
Surgical anaesthesia
Emergence

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11
Q

2 groups of adjuncts used in anaesthetics

A 
Mm relaxants (NM blocking agents) 
Anti-nociception
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12
Q

E.g.s of NM blocking agents (3)

A

Atracurium
Suxamethonium
Rocuronium

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13
Q

Anti-noception Dx e.g.s

A

Opioids
Paracetamol
NSAIDS

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14
Q

How is the potency of inhalation induction quantified?

A

MAC - Minimum alveolar concentration

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15
Q

Indications inhalation inductions (2)

A

Children/needle phobias

Spontaneous resp maintained (when difficult intubation expected)

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16
Q

How are volatile agents in inhalation induction delivered?

A

Vaporizer

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17
Q

How are volatile agents in TIVA delivered?

A

Microprocessor-controlled syringe pump

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18
Q

Indications TIVA (4)

A

Preference
Rapid recovery
Decr PONV
Laryngoscopy where volatile agents may ppt airway irritation

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19
Q

What is RSI

A

Delivery of rapid acting mm relaxant immediately after induction agent

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20
Q

When is RSI used?

A

To rapidly prod optimum conditions for intubation in ER situations

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21
Q

How does LA work

A

Blocks conduction of nn impulses along axons

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22
Q

What can you use as an adjunct to LA to vasoconstrict

A

Adrenaline

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23
Q

Why use adrenaline w/ LA?

A

Increases potency and duration

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24
Q

2 types of regional anaesthesia

A

Central/neuraxial

Major nn/regional blocks

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25
Q

E.g.s of central regional anaesthesia

A

Spinal

Epidural

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26
Q

e.g.s of major nn regional anaesthesia

A

Brachial plexus
Femoral
Sciatic

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27
Q

Max safe dose in regional anaesthesia?

A

3mg/kg lignocaine

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28
Q

Where is spinal anaesthesia injected?

A

Into CSF in subarachnoid space

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29
Q

Duration spinal anaesthesia

A

1-4hrs

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30
Q

How to measure the level anaesthetised in spinal anaesthetics?

A

Ice spray

31
Q

Continuous Monitoring during spinal anaesthesia (4)

A

ECG
BP
RR
SPo2

32
Q

C/I spinal anaesthesia (5)

A 
Incr ICp 
Hypovolaemia 
Surgery above thorax
Local/systemic infection 
> 2hrs long
33
Q

How are epidurals performed

A

Epidural catheter inserted into epidural space

LA injected via pump

34
Q

In an epidural, how long does it take for anaesthesia to be achieved?

A

45 minutes

35
Q

Monitoring epidural anaesthesia (4)

A

Continuous ECG, BP, RR, SPo2

36
Q

Complications epidural anaesthesia (3)

A

Decr BP,
resp depression
CSF puncture –> headache –> total spinal affect

37
Q

Advantages of regional anaesthesia over GA (5)

A 
Decr risk infections 
Decr CV complications 
Decr PONV
Decr pain
Decr DVT risk
38
Q

Affects of GA on the CV system (4)

A

Decr myocardial comtractility hence decr CO
HOTN
Reduction in O2 delivery + demand
Arrythmias

39
Q

Affect of GA on the resp system (5)

A 
Resp depression --> reduced FRC
Worse VQ matching
Atelectasis 
Laryngospasm --> airway obstruction
Prolonged pain + inflamm
40
Q

Affect of GA on airway (2)

A

Loss of tone

Loss of reflexes

41
Q

Affect of spinal on CV system (2)

A

Vasodilatation

Decr HR

42
Q

Affect of spinal on resp system

A

Resp depression b/c intercostal mm relax

43
Q

Risks - GA - common (4)

A

PONV
Pain
Sore throat
Teeth knocked out

44
Q

Other, less common risks GA (5)

A 
Anaphylaxis 
Awareness when under GA
Aspiration 
CV issues 
Stroke
45
Q

RF Awareness when under GA (3)

A

Emergencies
Prev awareness
Use of mm relaxants

46
Q

RF spinal anaesthesia (5)

A 
Neuro disorder due to trauma 
If high spinal block - depression of BS
Urinary retention + bladder damage
CV issues 
Spinal headache
47
Q

Current health questions to ask a patient in pre-op assessment (5)

A 
Recent/current illness 
ET + what makes them stop 
Sleep apnoea 
Smoking/alcohol
Pregnant
48
Q

Relevant med/DHx to ask in anaesthetics Hx (7)

A 
DM
HTN
IDA
Asthma/COPD
CVD
IHD
Allergies
49
Q

Anaesthetics Hx to ask (2)

A

Prev anaesthetics + reactions

Any FHx

50
Q

O/E pre-op assessment (5)

A 
Neck movement 
Jaw opening 
Dentures/crowns.caps
Airway assessment 
BMI
51
Q

What classification is used in Ananaesthesia for airway

A

Mallampati

52
Q

What classification is used to determine risk?

A

ASA

53
Q

ASA grade 1

A

Normal healthy pt

54
Q

ASA grade 2

A

Mild systemic disease

e.g. smoker, pregnant, >30BMI

55
Q

ASA grade 3

A

Severe systemic disease
(Isnt incapacitating)
E.g. COPD, BMI >40, ESRD

56
Q

ASA grade 4

A

Severe systemic disease
Constant threat to life
E.g. DIC, sepsis, recent MI

57
Q

ASA grade 5

A

Moribound patient not expected to survive 24 hrs w/o op

E.g. ruptured AAA

58
Q

ASA grade 6

A

Brain dead

59
Q

Why would you take a pre-op FBC?

A

IDA - higher risk of post-op transfusion after surgery

60
Q

For which patients do you need to take a pre-op U+E?

A

Those on: digoxin, diuretics + steroids

DM, renal disease, V+D

61
Q

For what patients do you need to take LFT’s pre-op?

A

Known hepatic disease
Alcohol Hx
Metastatic disease

62
Q

Which patients do you take BM for pre-op?

A

Diabetics

LT steroid users

63
Q

Which pt do you take clotting bloods for pre-op?

A

FH/PMH bleed

Current anticoagulation

64
Q

Which patients do you take a CXR for pre-op?

A

Hx cardio/resp disease or known malignancy

Suspect chest infection

65
Q

What screening tool is used to screen OSA pre-op?

A

STOP BANG

66
Q

Why must patients be starved before surgery?

A

Due to loss of protective cough reflex during anesthesia

67
Q

How long before an op must a patient be starved of solid food?

A

6 hours

68
Q

How long before an op must a patient stop being breastfed?

A

4 hours

69
Q

How long before an op must a patient be starved of fluids?

A

2 hours

70
Q

Things that delay gastric emptying (4)

A

Pain
Illness
Obstruction
Opioids

71
Q

Patients that lose barrier pressure and hence are more at risk of aspirating? (2)

A

Hiatus hernia

Symptomatic reflux

72
Q

Pre-op things to be aware of - diabetic patient

A

Minimise fasting - 1st on list
If well controlled DM - omit meds on day of op
If poor controlled DM/ER - variable rate infusion needed

73
Q

Pre-op assessment DM patient (4)

A

BM
Urinalysis
CK
Electrolytes

74
Q

Peri-op things to be aware of - DM (3)

A

Consider RSI to reduce aspiration risk
Reg monitor BM
If gluc >10 - insulin regimen

CP3 Crit Care (9 decks)

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