Anaesthetics And General Surgery Flashcards
What is anaesthesia?
Loss of sensation
What are the three main types of anaesthesia?
- Local
- Regional
- General
What types of anaesthetics are directed to specific parts of the body?
Local and regional anaesthetic
How do drugs that cause anaesthesia work?
By blocking the signals that pass along nerves to the brain.
Define, a technique in which tthe use of a drug produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the droid of sedation.
Conscious sedation
Name a rapid onset short-acting GA drug? can be used as a sole anaesthetic in short 15 mins procedures or to supplement further anaesthetic agents.
Thiopentone
What is suxamenthonium apnoea?
This occurs when a patient has been given suxamenthonium ( a muscle relaxant) but does not have the enzymes to metabolise it so they remain paralysed for quite a few hours, and may not be able to breathe properly at the end of anaesthetic.
Define,
an inherited disorder of skeletal muscle only triggered by certain anaesthetic drugs, where abnormal accumulation of calcium in muscle cells leads to hyper metabolism, muscle rigidity and muscle breakdown.
Malignant hyperthermia
What are the key features of malignant hyperthermia?
- Unexplained increase in expired CO2 concentration
- Unexplained tachycardia
- Unexplained increase in oxygen requirement
- Temperature increase
What is the only drug effective at limiting the malignant hyperthermia process?
Dantrolene
How would you manage a patient with malignant hyperthermia?
- give dose of dantrolene every 10 minutes
- actively cool the patient
What monitoring is required whilst anaesthesia is being given?
- blood pressure cuff
- saturation probe
- ECG dots
What type of drugs are used as premedication and to reduce the amount of other agents required for anaesthesia?
Benzodiazepines
Name three common drugs used to induce anaesthesia?
- propofol
- thiopental
- etomidate
What type of drug is usually administered in a mixture of oxygen and air or nitrous oxide, and also commonly used to maintain anaesthesia for the duration of a surgery?
Inhalational drug
How many stages of anaesthesia are there?
4
Describe stage 1 of anaesthesia?
Loss of consciousness
Describe stage 2 of anaesthesia?
- Excitement or delirium
- coughing, vomiting and struggling may occur
Describe stage 3 of anaesthesia?
- laryngeal reflex is lost, pupils dilate
Describe stage 4 anaesthesia?
Cessation of respiration to death
What were the side effects of opium use for laughing gas?
- hallucinogenic
- addiction
- respiratory depression
- death
How is nitrous oxide an unpleasant drug to use?
Makes people feel sick
What substance is still used as an hallucinogenic agent and for supplemental anaesthesia?
Nitrous oxide
Why would muscle relaxants be used for anaesthesia?
Because they cause muscle paralysis and allow intubation and also surgical access to body cavities
Name a short-acting muscle relaxant?
Suxamenthonium
Name a long-acting muscle relaxant? (Lasts for over 30 mins)
Atracurium/rocuronium
What is absolutely vital to maintain in a patient during anaesthesia?
Airway patency
What device helps to lift an unconscious patients tongue away from the posterior pharyngeal wall?
Guedel airway device
What is the purpose of definitive management of airways using a loringoscope and endotracheal tube?
- Loringoscope helps to position and place endotracheal tube
- Endotracheal tube effectively isolates the lungs from any stomach continents that may be passively regurgitated into the mouth upon anaesthesia (stops aspiration)
What is elective surgery?
Surgery that is planned in advance and a date is set so patient is prepared
What it’s open surgery?
Where a surgeon uses a scalpel to make an incision and entry into abdominal cavity
What is laparoscopic surgery?
Uses small insidious, ports and use of a celery which gives into abdomen allowing us to visualise abdomen.
What are the benefits of laparoscopic surgery over open surgery for a patient?
- less trauma to abdominal wall
- shorter recovery time for patients
What does NCEPOD stand for?
National confidential enquiry into patient outcome and death
Why was NCEPOD developed?
To reduce mortality on patients requiring emergency surgery
What is NCEPOD?
A national fare work of referral for patients and allows senior staff to expedite unwell patients and communicate effectively with theatre staff regarding the urgency of surgery.
What are the four NCEPOD categories of intervention?
- Immediate
- Urgent
- Expedited
- Elective
What type of surgery is described:
Patient requiring early treatment where the condition is not an immediate threat to life, limb or organ survival. Normally within days of decision to operate.
Expedited
What system records patients vital signs and allows identification if an Ill patient.
National early warning system (NEWS)
What does SBAR stand for?
Situation
Background
Assessment
Recommendation
Define, care given prior to an operation?
Pre-operative care
Define, care given under anaesthetic whilst getting an operation?
Peri-operative care
What is patient clerking?
An overall assessment of a patients condition at the time of admission
What medications need to be stopped prior to GA?
- ACE inhibitors
- anti-hypertensives
In pre-operative care, what needs to be assessed?
1.Blood investigations
2. Assess risk of DVT
3. Assess risk of haemorrhage
4. ECG for baseline cardiac activity
If a patient is fasting , what will they require prior to surgery?
Maintenance fluids and fluid assessment
What is the best maintenance fluid therapy for fasting patients in pre-operative assessment?
0.18% saline with 4% dextrose +/_ K+ (20-40mmol/l) based on 1ml/Kg/hour
What does ABG stand for?
Arterial blood gas sample