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Surgery > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

Positional manoeuvre to open airway:

A
  • head tilt
  • chin lift
  • jaw thrust
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2
Q

What is an oropharyngeal airway used for?

A
  • easy to insert and use
  • no paralysis
  • ideal for very short procedures
  • often bridge to more definitive airway
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3
Q

What is a laryngeal mask used for?

A
  • very easy
  • sits on pharynx and aligns to cover airway
  • poor control against reflux of gastric contents
  • paralysis not required
  • especially day surgery
  • not suitable high pressure ventilation
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4
Q

What is a tracheostomy used for?

A
  • reduces work of breathing
  • useful in slow weaning
  • percutaneous in ITU
  • dries secretions, humidified air required
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5
Q

What is an endotracheal tube used for?

A
  • optimal control of airway once cuff inflated
  • short or long term
  • errors in insertion may result in oesophageal intubation
  • paralysis required
  • higher ventilation pressures used
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6
Q

ASA I:

A
  • normal healthy patient

- non-smoking, no/minimal alcohol use

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7
Q

ASA II:

A
  • mild systemic disease

- e.g. current smoker, social drinker, pregnancy, obesity, well controlled diabetes/HTN, mild lung disease

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8
Q

ASA III:

A
  • severe systemic disease
  • substantial limitations
  • poorly controlled diabetes, morbid obesity, hepatitis, alcohol abuse, pacemaker, ESRD, regular dialysis, MI, cerebrovascular
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9
Q

ASA IV:

A
  • severe systemic disease that is constant threat to life

- e.g. recent MI, cerebrovascular, ongoing ischaemia of heart, valve dysfunction, sepsis, DIC, ARD, ESRD

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10
Q

ASA V:

A
  • moribund patient not expected to survive without operation

- e.g. rupture aneurysm, massive trauma, ischaemic bowel, multiple organ dysfunction

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11
Q

ASA VI:

A
  • brain dead

- organs being removed for donor purposes

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12
Q

How is propofol used as an anaesthetic agent?

A
  • GABA receptor agonist
  • rapid onset
  • pain on IV injection
  • rapidly metabolised with little metabolite accumulation
  • anti emetic
  • moderate myocardial depression
  • maintaining sedation in ITU, total IV anaesthetic and daycare surgery
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13
Q

How is sodium thiopentone used as an anaesthetic agent?

A
  • very rapid onset
  • marked myocardial depression
  • metabolites build quickly
  • unsuitable for maintenance
  • little analgesic
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14
Q

How is ketamine used as an anaesthetic agent?

A
  • NMDA receptor antagonist
  • induction of anaesthesia
  • moderate to strong analgesic properties
  • little myocardial depression so suitable for haemodynamically unstable
  • dissociative anaesthesia resulting in nightmares
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15
Q

How is etomidate used as an anaesthetic agent?

A
  • favourable cardiac safety profile - haemodynamic instability
  • no analgesia
  • unsuitable for maintaining sedation as prolonged use can cause adrenal suppression
  • post operative vomiting is common
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16
Q

What to do if blood loss in surgery where transfusion is unlikely?

A

group and save

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17
Q

What to do if blood loss in surgery where transfusion is likely?

A

cross match 2 units

salpingectomy for ruptured ectopic pregnancy, total hip replacement

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18
Q

What to do if blood loss in surgery where transfusion is definite?

A

cross match 4-6 units

total gastrectomy, oophorectomy, oesophagectomy, elective AAA repair, cystectomy, hepatectomy

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19
Q

Inhaled anaesthetic:

A
  • halothane

- ADR: hepatotoxicity, myocardial depression, malignant hyperthermia

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20
Q

What are peripheral venous cannulas unsuitable for?

A
  • vasoactive drugs
  • e.g. inotropes and irritant drugs e.g. TPN
  • unless very short setting
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21
Q

How should central lines be inserted?

A
  • using US
  • femoral lines easier to insert but high infection rates
  • internal jugular preferred - multiple lumens
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22
Q

How should intraosseous access be inserted and what is it used for?

A
  • anteromedial aspect of proximal tibia
  • access to marrow cavity and circulatory
  • preferred in paediatric
  • may be used in adults
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23
Q

What are tunnelled lines?

A
  • Groshong and Hickman
  • popular for long term therapeutic
  • inserted using US into internal jugular vein and then tunnelled under skin
  • can be linked to injection ports under skin
  • popular in paediatric
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24
Q

What is a peripherally inserted central cannula?

A
  • picc lines popular for central venous access

- inserted peripherally so less major complications than conventional central lines

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25
Q

Orange cannula size and flow rate:

A
  • 14g

- 270ml/min

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26
Q

Grey cannula size and flow rate:

A
  • 16g

- 180ml/min

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27
Q

Green cannula size and flow rate:

A
  • 18g

- 80ml/min

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28
Q

Pink cannula size and flow rate:

A
  • 20g

- 54ml/min

29
Q

Blue cannula size and flow rate:

A
  • 22g

- 33ml/min

30
Q

What kind of drug is lidocaine?

A
  • amide
  • LA and anti arrhythmic
  • affects sodium channels
  • hepatic metabolism, protein bound, renal excreted
31
Q

Lidocaine toxicity:

A
  • due to IV or excess administration
  • increased risk in liver dysfunction or low protein
  • treat with IV 20% lipid emulsion
  • initial CNS over activity and then depression
  • blocks inhibitory pathways and then activating pathways as well
  • cardiac arrhythmias
  • increased doses combined with adrenaline
32
Q

What does lidocaine interact with?

A
  • beta blockers
  • ciprofloxacin
  • phenytoin
33
Q

What kind of drug is cocaine and what is it used for?

A
  • salt - cocaine hydrochloride
  • LA paste
  • 4 and 10% conc
  • nasal mucosa -ENT
  • vasoconstriction
  • lipophilic so readily crosses BBB
  • can cause arrhythmias and tachycardia
34
Q

What kind of drug is bupivacaine:

A
  • binds to intracellular portion of sodium channels and blocks sodium influx into nerves
  • prevents depolarisation
  • longer action than lidocaine
  • topical wound infiltration at conclusion of surgical procedures
  • cardiotoxic so contra in regional blockage
  • levopbupivicaine less cardiotoxic and causes less vasodilation
35
Q

What is prilocaine used for:

A
  • less cardiotoxic

- intravenous regional anaesthesia

36
Q

Dose of lignocaine plain and with adrenaline:

A
  • 3mg/kg

- 7mg/kg

37
Q

Dose of bupivacaine plain and with adrenaline:

A
  • 2mg/kg

- 2mg/kg

38
Q

Dose of prilocaine plain and with adrenaline:

A
  • 6mg/kg

- 9mg/kg

39
Q

Max dose lignocaine:

A

200mg

40
Q

Max dose lignocaine:

A

500mg

41
Q

Max dose bupivicaine:

A

150mg

42
Q

What is malignant hyperthermia?

A
  • often seen after anaesthetics
  • hyperpyrexia and muscle rigidity
  • excessive release of calcium from sarcoplasmic reticulum
  • associated with defect chromosome 19 encoding ryan-done receptor
  • autosomal dominant
43
Q

Causative agents malignant hyperthermia:

A
  • halothane
  • suxamethonium
  • antipsychotics (NMS)
44
Q

Investigations and management malignant hyperthermia:

A
  • CK raised
  • contracture tests with halothane and caffeine
  • manage with dantrolene - prevents calcium release from SR
45
Q

When are nasopharyngeal airways used and contraindicated?

A
  • decreased GCS
  • ideal for seizures
  • NOT in base skull fractures
46
Q

What is suxamethonium?

A
  • muscle relaxant
  • depolarising neuromuscular blocker
  • inhibits Ach at NM junction
  • fastest onset and shortest duration
  • generalised muscular contraction prior to paralysis
  • ADR: hyperkalaemia, malignant hyperthermia, lack of acetylcholinesterase
47
Q

What is atracurium?

A
  • muscle relaxant
  • non depolarising neuromuscular blocking drug
  • 20-45 minutes action
  • generalised histamine release on administration may produce facial flushing, tachycardia and hypotension
  • not excreted by liver or kidney, broken down in tissue by hydrolysis
  • reversed by neostigmine
48
Q

What is vecuronium?

A
  • muscle relaxant
  • non depolarising neuromuscular blocking drug
  • 30-40 minutes action
  • degraded by liver and kidney and effects prolonged in organ dysfunction
  • reversed by neostigmine
49
Q

What is pancuronium?

A
  • muscle relaxant
  • non depolarising neuromuscular blocekr
  • 2-3 minutes for onset
  • duration 2 hours
  • partially reversed with neostigmine
50
Q

What are the depolarising and non-depolarising neuromuscular blocking drugs?

A
  • depolarising: suxamehtonium (succinylcholine)

- non-depolairisng: tubocurarine, atracurium, veruconium, pancuronium

51
Q

How do depolarising neuromuscular blocking drugs work and ADR?

A
  • bind to nicotinic ach receptors so persistent depolarising of motor end plate
  • ADR: malignant hyperthermia, hyperkalaemia
52
Q

CONTRA of depolarising neuromuscular blocking drugs:

A

-penetrating eye injuries
-acute narrow angle glaucoma
(suxamethonium increases intra-ocular pressure)

53
Q

How do non-depolarising neuromuscular blocking drugs work and ADR?

A
  • competitive antagonist of nicotinic ach receptors

- ADR: hypotension

54
Q

How do you reverse non-depolarising neuromuscular blocking drugs?

A

acetylcholinesterase inhibitors e.g. neostigmine

55
Q

What is paralytic ileus?

A
  • common complication after bowel surgery especially
  • no peristalsis results in pseudo-obstruction
  • also in association with chest infections, myocardial infarction, stroke and AKI
  • deranged electrolytes can contribute
56
Q

Early causes of post-op pyrexia (0-5 days):

A
  • blood transfusion
  • cellulitis
  • UTI
  • physiological systemic inflammatory reaction
  • pulmonary atelectasis
57
Q

Late causes of post-op pyrexia:

A

-VTE
pneumonia
-wound infection
-anastomotic leak

58
Q

3 phases of operation on checklist:

A
  • before induction of anaesthesia
  • before incision of skin
  • before patient leaves room
59
Q

What needs to be checked before induction of anaesthesia?

A
  • patient identify confirmed
  • site marked
  • anaesthesia safety check completed
  • pulse oximeter on patient and functioning
  • allergies
  • any aspiration or airway risk
  • risk of >500ml blood loss?
60
Q

When should women stop taking the pill/hormone replacement before surgery?

A

4 weeks

61
Q

What are the stages of wound healing?

A
  • haemostasis
  • inflammation
  • regeneration
  • remodeling
62
Q

What is the haemostats stage of wound healing?

A
  • minutes to hours after

- vasospasm in adjacent vessels, platelet plug formation and generation of fibrin rich clot

63
Q

What is the inflammation stage of wound healing?

A
  • days 1-5
  • neutrophils migrate into wound
  • growth factors released (basic fibroblast growth factor and VEGF)
  • fibroblasts replicate within adjacent matrix and migrate into wound
  • macrophages and fibroblasts couple matrix regeneration and clot substitution
64
Q

What is the regeneration stage of wound healing?

A
  • days 7-56
  • platelet derived GF and transformation GF stimulate fibroblasts and epithelial cells
  • fibroblasts produce collagen network
  • angiogenesis occurs and wound resembles granulation tissue
65
Q

What is the remodelling stage of wound healing?

A
  • week 6-1 year
  • longest phase of healing process may last up to 1 year
  • fibroblasts differentiate (myofibroblasts) and these facilitate wound contraction
  • collagen fibres remodelled
  • microvessels regress leaving pale scar
66
Q

What is a hypertrophic scar?

A
  • excess collagen

- nodules with randomly arranged fibrils and parallel fibrils

67
Q

What is a keloid scar?

A
  • excess collagen in scar
  • beyond boundaries of original injury
  • no nodules
  • do not regress over time and may recur following removal
68
Q

Drugs impairing wound healing:

A
  • NSAID
  • steroid
  • immunosuppressive
  • anti-neoplastic

Surgery (10 decks)

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