Anaesthetics and critical care Flashcards
What is the criteria for ASA I?
Healthy, non-smoking, no or minimal alcohol use
What is the criteria for ASA II?
A patient with mild systemic disease without substantive functional limitations
- Current smoker
- Social alcohol drinker
- Pregnancy
- Obesity (BMI 30 - 40)
- Well-controlled DM or HTN
- Mild lung disease
What is the criteria for ASA II?
A patient with severe systemic disease with Substantive functional limitations
Poorly controlled Diabetes Mellitus/Hypertension, COPD, morbid obesity (BMI > 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, End-Stage Renal Disease (ESRD) undergoing regularly scheduled dialysis, history (>3 months) of Myocardial infarction, Cerebrovascular accidents
What is the criteria for ASA IV?
A patient with severe systemic disease that is a constant threat to life
Recent (< 3 months) of Myocardial infarction, Cerebrovascular accidents, ongoing cardiac ischaemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis
What is the criteria for ASA V?
A moribund patient who is not expected to survive without the operation
Ruptured abdominal/thoracic aneurysm, massive trauma, intra-cranial bleed with mass effect, ischaemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction
A 23-year-old male comes in after crashing his motorbike into a bus stop. pain and tenderness in the right leg, significant abdominal bruising, and tenderness diffusely over the ribcage.
HR 105, BP 105/62, RR 20, Sp02 98%
What is the most preferable as an induction agent for anaesthesia?
Ketamine doesn’t cause a drop in blood pressure so useful in trauma
It blocks NMDA receptors
What is the surgical prep required for oral fluids?
Patients having surgery may drink clear fluids until 2hrs before their operation
Drinking clear fluids before the surgery can help reduce headaches, nausea and vomiting afterwards
Clear fluids are water, fruit juice without pulp, coffee or tea without ilk and ice lollies
Patients are advised to fast from non-clear food atleast 6hrs before surgery
What is the management of DM treatment during and before surgery?
- Patients treated with insulin who have good glycaemic control (HbA1c < 69 mmol/mol) and are undergoing minor procedures, can be managed during the operative period by adjustment of their usual insulin regimen - Reduce dose by 20%
- Surgery requiring a long fasting period of more than one missed meal - or whose diabetes is poorly controlled - require variable rate intravenous insulin infusion (VRIII)
What is the main side effect of Etomidate? Also what is the main advantage of using it
Potentiates GABA
Primary adrenal suppression - secondary to reversibly inhibiting 11B-hydroxylase
- Causes less hypotension than propofol and thiopental during induction and is therefore often used in cases of haemodynamic instability
What is the action of thiopental?main side effect and main reason for its usefulness?
A type of barbiturate (potentiates GABAA)
- laryngospams
- Highly lipid-soluble so quickly affects the brain
What can cause paralytic ileus after abdominal surgery?
Paralytic ileus can also occur in association with chest infections, myocardial infarction, stroke and acute kidney injury.
Deranged electrolytes can contribute to the development of paralytic ileus, so it is important to check potassium, magnesium and phosphate. As the bowel is not functioning as normal it is better to replace electrolytes intravenously.
when should clopidogrel be stopped before surgery?
Continue taking it unless bleeding risk is very high
7 days before surgery
when is warfarin stopped before surgery?
5 days before surgery and pateints are started on LMWH
when are ACEi stopped before surgery?
ACEi should be stopped on the day of the surgery
when is COCP stopped before surgery and when is it restarted?
stopped 4-6 weeks before surgery and re-started at least 2 weeks after the surgery
