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Phase 3B > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

What factors make a patient high-risk for surgery

A 
Age
Severity of surgical disease
Severity of proposed procedure
Medical co-morbidities
Exercise tolerance
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2
Q

Why is exercise tolerance important

A

Inflammatory stress response after surgery leads to an increased oxygen demand and therefore an increased cardiac output

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3
Q

What is a good way to assess physiological reserve

A

Can you climb a flight of stairs without getting breathless (consider alternate questions in those with joint pathology)

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4
Q

Hypertension target for surgery

A

> 180/100

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5
Q

When to do an ECG before surgery

A

> 55yrs - risk of silent MI
Anyone with cardiac signs/symptoms
Hypertension
Diabetes

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6
Q

Blood pressure medicines advice pre-operative

A

Continue all and take on day of surgery - especially beta blockers
ACE inhibitors/ARB should NOT be taken on day of surgery

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7
Q

What type of surgery should respiratory investigations be carried out

A

Upper abdominal

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8
Q

When is CXR require pre-operatively

A

Clinical indication or having thoracic surgery

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9
Q

How should hiatus hernia patients be managed for anaesthesia

A

PPI/H2 receptor antagonist and metoclopramide

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10
Q

Important LFTs pre-operatively

A

Clotting screen!

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11
Q

How should diabetic patients be managed pre-operatively

A

2-hourly blood glucose, ECG and U&Es. Scheduled at start of list (to minimize fasting)

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12
Q

How long prior to surgery can solids be taken

A

6 hours

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13
Q

How long prior to surgery can fluids be taken

A

2 hours

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14
Q

How long prior to surgery can breast milk be taken

A

4 hours

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15
Q

List medications that should be stopped prior to surgery

A 
Aspirin
Warfarin
Clopidogrel
ACEi/ARB
OCP
HRT
MAOIs
Sulfonylureas
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16
Q

Which drugs should be stopped 4 weeks prior to surgery

A

OCP

HRT

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17
Q

Which drugs should be stopped 1 week before surgery

A

Aspirin

Clopidogrel

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18
Q

Which drugs should be stopped 5 days before surgery

A

Warfarin

may required LMWH as replacement

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19
Q

Which drugs should be omitted on the day of surgery

A

ACEi
ARB
Sulfonylureas

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20
Q

How should airway be managed in suspected c-spine injury

A

Head in neutral position

Jaw thrust ONLY

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21
Q

Main causes of hypotension post-operatively

A

Residual anaesthesia
Hypovolaemia
Sepsis

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22
Q

What is the first line management of hypotension

A

Oxygen therapy and IV fluid challenge

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23
Q

Main causes of hypertension post-operatively

A 
Pain
Anxiety
CO2 retention
Pre-existing hypertension
Withdrawal from anti-hypertensives (omission for surgery)
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24
Q

What obs are measured post-operatively

A 
Resp rate
Pulse
Oxygen sats
Blood pressure
Urine output
Temperature
Mental sate
Pain
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25
Q

Causes of hypoxaemia post-operatively

A 
Airway obstruction
Respiratory depression
Respiratory faialure
Hypostatic pneumonia
Pulmonary atelectasis
Aspiration pneumonia
Pulmonary embolism
26
Q

Causes of oliguria post-operatively

A

Dehydration/hypovolaemia
AKI/acute renal failure
Urinary retention/obstruction

27
Q

Causes of confusion post-operatively

A

Hypoxaemia
Alcohol withdrawal
Opiods/sedative drugs
Sepsis/infection

28
Q

What might cause pain after surgery

A

Pressure sores

29
Q

Risk factors for post-operative nausea and vomiting

A 
Pain/anxiety
Young
Female
Breast/bowel/uterus/middle ear surgery
Use of opiods drugs
History of pprevious post-op N&V
History of motion sickness
Dehydration
30
Q

Name some groups of drugs used to treat post-operative nausea and vomiting

A

Antihistamines
5-hydroxytryptamine antagonists
Dopamine antagonist
Steroids

31
Q

Antihistamines used to treat nausea

A

Cyclizine

32
Q

5-hydroxytryptamine antagonists used to treat nausea (serotonin antagonist)

A

Ondansetron

33
Q

Dopamine antagonists used to treat nausea

A

Metoclopramide, prochlorperazine

34
Q

Steroids used to treat nausea

A

Dexamethasone (single dose only)

35
Q

Guideline for treating post-operative nausea

A
  1. Cyclizine
  2. If no response in 30 mins give 5-HT antagonist
  3. Dopamine antagonist if no response in 30 minutes
36
Q

Systemic analgesic ladder

A

Simple analgesia
NSAID
Weak opiod
Strong opiod

37
Q

How is post operative pain manaed

A

Reversed analgesic ladder as pain usually starts worse and gets better

38
Q

Give some examples of simple analgesia

A

Paracetamol

39
Q

Give examples of NSAIDs

A

ibuprofen
diclofenac
keterolac

40
Q

Give examples of weak opiods

A

dihydrocodeine

tramadol

41
Q

Give examples of strong opiods

A

Morphine
Diamorphine
Fentanyl
Oxycodone

42
Q

How does codeine work

A

Metabolised to morphine in the liver.

25% of people don’t have the enzyme to metabolise codeine and it is ineffective in this population

43
Q

What are colloids

A

Fluids containing large suspended molecules such as gelatin which do not leak out of the intravascular compartment and hence act as plasma expanders. Maintain oncotic pressure before blood can be given

44
Q

Name some crystalloids

A

Hartmanns, saline, glucose and dextrose saline

45
Q

Which blood can be given in extreme emergencies

A

O negative blood

46
Q

How much to give in resuscitation fluids

A

Bolus of 500ml crystalloid containing sodium over less than 15 minutes

47
Q

Routine maintenance fluids

A

25-30 ml/kg/day water
1 mmol/kg/day sodium, potassium,chloride
50-100g/day glucose

48
Q

When to consider nasogastric or enteral feeding when giving fluids

A

If maintenance fluids needed for more than 3 days

49
Q

What is the average fluid intake of the 70kg male

A

2-2.5 litres a day

50
Q

What signs may appear if too much fluid is given

A

Right heart failure - tachycardia, peripheral oedema, raised JVP
Left heart failure - tachycardia, breathlessness, wheeze, pulmonary oedema
Electrolyte imbalance

51
Q

What are the changes to the airway in an unconscious patient

A

Reduced/no protective reflexes
Increased airway obstruction
Absent cough reflex

52
Q

What are the changes to breathing in an unconscious patient

A

Respiratory depression

53
Q

What are the changes to circulation in an unconscious patient

A

Reduced peripheral vascular tone (BP=COxSVR)

54
Q

What are the changes to disability in an unconscious patient

A

Reduced oesophageal sphincter tone & gastric motility
Inability to swallow
Reduced pain response
Reduced corneal reflexes
Decreased ability to regulate body temperature

55
Q

What are the signs of airway obstruction

A 
Increased respiratory effort
tracheal tug
intercostal recession
cyanosis (later)
stridor
tachycardia initially leading to a terminal bradycardia
cardiac arrest
56
Q

Signs of apnoea

A

Absent chest movements
no breath sounds
no evidence of airflow

57
Q

Signs of respiratory distress

A

Increased respiratory rate
increased heart rate
signs of CO2 retention (sweating, tremor, increased BP)
abnormal respiratory pattern

58
Q

What are the basic airway manoeuvres

A

Head tilt
Chin lift
Jaw thrust

59
Q

How to manage the airway in a trauma patient

A

Risk of c-spine injury so ONLY perform jaw thrust! Keep the head and neck isolated

60
Q

What level of oxygen do patients receive during anaesthesia

A

Minimum of 30%

61
Q

Which patients may need several days of oxygen therapy post-operatively

A 
Prolonged abdo/thoracic surgery
obese patients
sepsis or hypovolaemic shock
pre-existing respiratory compromise
receiving IV opiods

Phase 3B (3 decks)

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