Anaesthetics Flashcards

1
Q

ASA score (american society of anaesthesiologists)

A
1 = normally healthy
2 = mild systemic disease, no limit to activity
3 = severe systemic disease, limitation of activity, not incapacitating
4 = incapacitating systemic disease(s) posing threat to life
5 = moribund patient (not expected to survive 24hrs)
6 = braindead patient for donor purposes
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2
Q

common causes of elective surgery cancellation

A
  • current respiratory tract infection
  • poor control of drug therapy
  • recent MI
  • poor bloodwork
  • inadequate preparation
  • untreated hypertension, uncontrolled AF
  • logistical issues
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3
Q

general anaesthesia: akinesis

A

muscle relaxants:

  • depolarising eg.suxamethonium
  • non-depolarising, eg. atracurium, rocuronium, pancuronium
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4
Q

general anaesthesia: amnesia

A
  • induction: induce loss of consciousness in 1 arm-brain circulation time (IV), 10-20 seconds
  • last 4-10 minutes
  • propofol, thiopentone, ketamine, etomidate
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5
Q

propofol

A

IV amnesia agent

  • potentiates GABA-A
  • AE = pain on injection (due to activation of the pain receptor
  • CI in egg/soya allergy
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6
Q

thiopentone

A

IV amnesia agent

  • type of barbiturate, with anticonvulsant properties
  • AE = laryngospasm
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7
Q

maintenance amnesia agents

A

inhaled:
- sevoflurane 2% = most common, sweet smell, potential for addiction
- desflurane 6% = use in obesity and long surgeries, cardiovascular depressant effects
- isoflurane 1.15% = organ transplants, respiratory irritant = laryngospasm, coughing, breath holding
IV:
- propofol

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8
Q

7 Ps of rapid sequence inducton (RSI)

A
  • Preparation = involves ensuring the environment is optimised, equipment is available and staff are ready
  • Preoxygenation = involves the administration of high flow oxygen for 5 minutes prior to the procedure
  • Pretreatment = may involve administration of opiate analgesia or a fluid bolus to counteract the hypotensive effect of anaesthesia
  • Paralysis = administration of the induction agent and paralysing agent
  • Protection and positioning = cricoid pressure should be applied to protect the airway following paralysis
  • Placement and proof = intubation via laryngoscopy, with proof obtained (direct vision, end-tidal CO2, bilateral auscultation)
  • Post-intubation management = taping or tying the endotracheal tube, initiating mechanical ventilation and sedation agents
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9
Q

post-operative management

A
  • stop anaesthetic vapours
  • give oxygen
  • throat suction
  • reverse muscle relaxation
  • once breathing: inspect mouth, remove ET tube, O2 by facemask
  • recovery
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10
Q

PATIENT risk factors for post-operative N+V

A
  • female
  • previous PONV
  • anxious
  • motion-sickness sufferer
  • non-smoker
  • obesity
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11
Q

ANAESTHESIA risk factors for post-operative N+V

A
  • opiates
  • etomidate
  • nitrous oxide
  • volatile agents
  • dehydration
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12
Q

SURGERY risk factors for post-operative N+V

A
  • laparotomy
  • gynae
  • abdominal
  • neurological
  • ENT/eye
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13
Q

management of post-op N+V

A
Intra-op antiemetics
- ondansetron 4-8mg, dexamethasone 4-8mg
Post-op antiemetics
- cyclizine 50mg TDS
Acupuncture point P6
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14
Q

dose of local anaesthetic

A

lidocaine

  • with adrenaline = 7mg/kg
  • without adrenaline = 3mg/kg

1% = 10mg/mL OR 1g/100mL

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15
Q

spinal vs epidural anaesthetic

A

SPINAL

  • smaller volume of anaesthetic directly into CSF
  • anaesthesia lasts 2-3 hrs with longer analgesic effect
  • 5-10 mins onset
  • dense block including motor
  • AEs include: total spinal block, urinary retention, permanent neurological damage (v rare)

EPIDURAL

  • larger vol into epidural space
  • catheter can be left in to provide long term anaesthesia (up to 72 hrs)
  • 15-30 minute onset
  • less dense block than spinal
  • AEs include: headache, total spinal block, epidural abscess/haematoma
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