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4th Year Exam > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

Name the 4 key features of an anaesthetic

A
  1. Lack of awareness
  2. Analgesia
  3. Optimise surgical conditions
  4. Patient safety
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2
Q

Name 3 considerations for the airway section of A-E assessment in surgery

A
  1. Intubation?
  2. Face mask with spontaneous breathing?
  3. NP airway?
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3
Q

Name 2 considerations for the breathing section of A-E assessment in surgery

A
  1. Spontaneous?

2. Baseline O2 saturations and any changes to this

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4
Q

Name 2 considerations for the circulation section of A-E assessment in surgery

A
  1. Normal BP

2. Target BP for operation

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5
Q

Name 1 consideration for the disability section of A-E assessment in surgery

A

Are any nerves under pressure (e.g. is pt. lying in difficult position)

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6
Q

Name 1 consideration for the exposure section of A-E assessment in surgery

A

Is pt. at risk of pressure ulcers (are they lying on something they shouldn’t be)

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7
Q

Name 3 respiratory conditions to be considered in a pre-operative assessment

A
  1. COPD/asthma
  2. Obstructive sleep apnoea
  3. Recent LRTI
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8
Q

Name 3 cardiovascular conditions to be considered in a pre-operative assessment

A
  1. Ischaemic heart disease (MI in last 3 months)
  2. Valvular disease
  3. Pacemaker
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9
Q

Name 3 GI conditions to be considered in a pre-operative assessment

A
  1. Aspiration pneumonitis
  2. GORD
  3. Hiatus hernia
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10
Q

Name 3 general aspects to be considered in a pre-operative assessment

A
  1. PMH/PSH
  2. Social history
  3. Height and weight
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11
Q

Name 4 drugs to be specifically considered during a pre-operative assessment (e.g. is patient regularly taking any of these)

A
  1. Anticoagulants
  2. Anti-hypertensives
  3. Steroids
  4. Normal analgesia/opiate
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12
Q

Name 5 key aspects of an airway assessment pre-operatively

A
  1. Mouth opening
  2. Teeth (e.g. crowded teeth)
  3. Jaw protrusion
  4. Neck protrusion
  5. Obesity and neck shape
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13
Q

What does the Mallampati score predict?

A

A predictor of obstructive sleep apnoea

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14
Q

What is the ASA grading?

A

A measure of pre-operative health

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15
Q

Give an example of an IV induction agent

A

Propofol

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16
Q

What is the broad mechanism by which general anaesthetic works?

A

Balance of excitatory and inhibitory effects to put pt. to sleep

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17
Q

How do inhaled anaesthetics generally work?

A

Work on GABA receptor to increase inhibitory effects

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18
Q

What is thought to be the MOA of ketamine?

A

Inhibit excitatory effects by inhibiting NMDA receptors

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19
Q

Name three main IV anaesthetic agents

A
  1. Propofol
  2. Thiopentone
  3. Ketamine
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20
Q

Name one inhaled anaesthetic

A

Sevoflurane

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21
Q

Name one depolarising neuromuscular blocker

A

Suxamethonium

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22
Q

Name one non-depolarising neuromuscular blocker

A

Rocuronium

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23
Q

Give an example of a drug used to reverse a neuromuscular blocker

A

Sugamadex (mops up NM blocker)

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24
Q

Name the two major classes of emergency drugs used in anaesthetics

A
  1. Vasopressors

2. Vagolytics

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25
Q

Give the MOA of vasopressors

A

Increase BP by:

  1. Act on Alpha 1 to vasoconstrict vessel
  2. Act on beta 1 to increase HR and myocardial activity
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26
Q

Give the MOA of vagolytics

A

Increase HR by:

  • Inhibit effects of vagus nerve to increase SNS and decrease PNS
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27
Q

Name 4 modifiable risk factors considered at pre-operative assessment

A

Alcohol
Smoking
Diet
Activity

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28
Q

What peri-operative risk scoring system is most commonly used but cannot be used for risk prediction due to variables like blood loss?

A

POSSUM

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29
Q

What is SORT and what is it used for?

A

Data entry of 6 pre-operative variables to give % mortality risk estimate for patients (non-cardiac, non-neurological surgery)

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30
Q

Name 3 components of assessment of functional capacity

A

6 min walk test
Timed up and go test
Frailty scoring

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31
Q

Name 3 components of pre-optimisation of chronic illnesses

A

Prehabilitation
Pulmonary rehab for COPD
Diabetes control

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32
Q

What is the main reason for fasting surgical patients?

A

To prevent pulmonary aspiration under anaesthesia

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33
Q

Name 3 normal anatomical and physiological barriers to aspiration in a conscious patient

A
  • Gastro-oesophageal junction (at T10)
  • Upper oesophageal sphincter
  • Protective laryngeal reflexes
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34
Q

Name 3 risks of aspiration under anaesthesia

A

Full stomach
Delayed gastric emptying
Incompetent LOS

35
Q

What are the fasting guidelines for food and clear fluid?

A

Food = 6 hours

Clear Fluid = 2 hours

36
Q

Name 3 ways to protect an unfasted patient under anaesthesia

A

Reduce gastric volume (NG aspiration)

Avoid GA (regional anaesthesia)

Increase pH of gastric contents (antacids)

37
Q

Name the 3 sections of the WHO surgical checklist

A
  1. Before induction of anaesthesia
  2. Before skin incision
  3. Before pt. leaves operating room
38
Q

What is the greatest risk involved in peri-operative blood transfusion?

A

Human error

39
Q

Name 3 situations when blood should be given

A
  1. Cardiovascular instability
  2. Poor end organ perfusion
  3. Estimated blood loss
40
Q

What is defined as major haemorrhage?

A

Rate of loss >150ml/min

41
Q

Name 3 things that should be ensured after activating a major haemorrhage protocol

A
  1. Good IV access (2 wide bore)
  2. 100% oxygen
  3. Warmed clear IV fluids
42
Q

Name 3 complications of massive transfusion

A
  1. Impaired O2 delivery to tissues
  2. Coagulopathy
  3. Fluid overload
43
Q

What is the definition of a surgical site infection?

A

Infection near or in the incisional site within 30 days (90 if prosthesis involved)

44
Q

What type of wound is uninfected?

A

Clean wound

45
Q

What is a clean-contaminated wound?

A

Operation has involved a viscus but no unusual contamination has occurred

46
Q

What type of wound is an old traumatic one with retained devitalized tissue or foreign body?

A

Dirty wound

47
Q

Define a contaminated wound

A

An open accidental wound with breaks in sterile technique

48
Q

Give 2 patient and surgical risk factors for surgical site infection

A

Patient: Immunocompromised and age

Surgical: Haematoma formation and increased length of procedure

49
Q

How does giving peri-operative prophylactic antibiotics benefit the patient?

A

Reduces the chance of surgical site infection by reducing burden of micro-organisms at the site

50
Q

Name 3 risks of peri-operative prophylactic ABX

A
  1. Adverse effects
  2. Drug resistance
  3. C. Diff
51
Q

How and when are prophylactic antibiotics used?

A

Single IV dose in:

  • Clean surgery (with prosthesis)
  • Clean-contaminated
  • Contaminated
52
Q

Within what time period does post-operative nausea and vomiting usually occur?

53
Q

Name three general categories of trigger for N&V

A
  1. Pain
  2. Motion
  3. Endogenous toxins
54
Q

Name 4 neurotransmitters involved in N&V

A
  1. 5HT
  2. Dopamine
  3. Histamine
  4. Acetylcholine
55
Q

What type of drug is ondansetron?

A

Antiemetic - 5HT antagonist

56
Q

What type of drug is droperidol?

A

Antiemetic - dopamine antagonist

57
Q

Define acute pain

A

Nociceptive or neuropathic pain lasting up to three months

58
Q

Define chronic pain

A

Neuropathic pain lasting over 3 months due to changes in pain signalling

59
Q

In the assessment of pain, what are the grades used to define functional pain?

A

A - no limitation
B - mild limitation
C - significant limitation

60
Q

What is the 1st step on the WHO pain ladder?

A

Non-opioid +/- adjuvant

61
Q

What is the 2nd step on the WHO pain ladder?

A

Weak opioid or multimodal +/- non-opioid +/- adjuvant

62
Q

What is the 3rd step on the WHO pain ladder?

A

Strong opioid +/- non-opioid +/- adjuvant

63
Q

What is the 4th step on the WHO pain ladder?

A

Interventional treatment +/- non-opioid +/- adjuvant

64
Q

Name 3 possible causes of airway compromise

A
  1. Inhaled foreign object
  2. Laryngospasm
  3. Secretions
65
Q

Name 3 management options for airway compromise

A
  1. Head tilt, chin lift
  2. Jaw thrust
  3. Airway adjuncts
66
Q

Below what GCS score is airway compromise a significant risk?

67
Q

What management should be immediately implemented if ACS is suspected?

A

MONA

Morphine and antiemetic
Oxygen
Nitrites
Aspirin

68
Q

What management should be implemented if a pt. has suspected fluid overload?

A

Diuretics and call a senior

69
Q

What is the normal range for blood glucose?

A

4-11mmol/L

70
Q

Which drug can be given to counteract opioid toxicity?

71
Q

Name 4 things to be inspected at in E of A-E assessment?

A

Rashes
Abnormal bruising
Calves
Surgical wounds

72
Q

Name 2 variable oxygen delivery devices

A

Nasal oxygen

Hudson Mask

73
Q

Name 3 fixed oxygen delivery devices

A

Venturi mask
Trauma mask
High flow nasal O2

74
Q

How does NIV work?

A

High flow device creates positive pressure to ventilate pt. via tight fitting mask instead of invasive ventilation

75
Q

How does CPAP work?

A

Keeps small airways open to decrease work of breathing

76
Q

Name 2 ways standard post-operative O2 may be delivered

A

4-6L via Hudson

35-50% via Venturi

77
Q

Give 2 examples of crystalloid fluids

A

Hartmann’s solution

4% dextrose 0.18% saline

78
Q

Name 3 main reasons for fluid prescription in adults

A

Resuscitation
Maintenance
Replacement

79
Q

What is the process of fluid administration in resuscitation?

A

500ml boluses of crystalloids for 2L, looking for response after each bag

If nothing, call senior

80
Q

What is the maximum fluid dose in maintenance?

A

Never more than 100ml/hr

81
Q

Which type of fluids are typically used in replacement of losses?

A

Crystalloids

e.g. Hartmann’s or 0.9% saline

82
Q

Name 3 risks of ventilation

A
  1. Lung injury
  2. Intubation associated pneumonia
  3. Cardiovascular effects
83
Q

What does each letter of the SPIKES model for breaking bad news stand for?

A 
Setting up
Perception
Invitation
Knowledge 
Empathy 
Summarise

4th Year Exam (20 decks)

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