Anaesthetics and peri-op Flashcards
where in the spine is epidural analgesia given in c-section
below L2
L3/4 or L4/5
how do you calculate fluid deficit
IV fluids given- output of urine
all of this over the same time period e.g. 24 hours
ASA grade 1
defined as normal healthy patients, who are non-smokers and with no/minimal alcohol intake.
ASA grade 2
defined as patients with mild systemic disease e.g. well controlled diabetes or hypertension, current smoker, obesity (BMI 30-40), and mild lung disease.
ASA grade 3
defined as patients with severe systemic disease e.g. poorly controlled diabetes or hypertension, COPD, morbid obesity (BMI >40), history of ACS/stroke/TIA >3 months ago.
ASA grade 4
defined as patients with severe systemic disease that is a constant threat to life e.g. MI/stroke/TIA within 3 months, severe valve dysfunction, severe reduction in ejection fraction, sepsis.
ASA grade 5
defined as moribund patients not expected to survive the operation e.g. ruptured abdominal aortic aneurysm, massive bleed, intracranial haemorrhage with mass effect.
ASA grade 6
defined as a patient declared brain-dead whose organs are being removed for donation.
what is first line for acute alcohol withdrawal
lorazepam
works quicker than chlordiazepoxide
most likely cause of post op pyrexia within 24 hours
physiological SIRS
which GA is particularly useful for patients with a high risk of post-operative vomiting
propofol
when should nitrous oxide be avoided
in pneumothorax,
increases pressure in gas filled cavities, in this case leading to tension pneumothorax
in terms of blood products, what should be done if transfusion is unlikely to be needed
just group and save
in terms of blood products, what should be done if transfusion is likely to be needed
cross match 2 units
in terms of blood products, what should be done if transfusion is definitely needed
cross match 4-6 units
which induction agents are problematic in myasthenia gravis patients?
non-depolarising agents e.g. rocuronium
work by antagonism of nicotinic acetylcholine receptors in the motor end plate, producing paralysis by their blockade.The myasthenic patient has fewer available nicotinic receptors due to autoimmune-mediated destruction, meaning that they are more sensitive to non-depolarising blockade.
benefit of nasogastric jejunal feeding
Avoids problems of feed pooling in stomach (and risk of aspiration)
Safe to use following oesophagogastric surgery
adverse effects of volatile liquid anaesthetics
(isoflurane, desflurane, sevoflurane)
- Myocardial depression
- Malignant hyperthermia
- Halothane (not commonly used now) is hepatotoxic
which IV anaesthetic causes adrenal suppression
ethomidate
which IV anaesthetic causes laryngospasm
thiopental
requirement for CT head within the hour
GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting
early causes of post-op pyrexia (0-5 days)[5]
Blood transfusion
Cellulitis
Urinary tract infection
Physiological systemic inflammatory reaction (usually within a day following the operation)
Pulmonary atelectasis - this if often listed but the evidence base to support this link is limited
late causes of post-op pyrexia (>5 days)
Venous thromboembolism
Pneumonia
Wound infection
Anastomotic leak
causes of post op fever
Day 1-2: ‘Wind’ - Pneumonia, aspiration, pulmonary embolism
Day 3-5: ‘Water’ - Urinary tract infection (especially if the patient was catheterised)
Day 5-7: ‘Wound’ - Infection at the surgical site or abscess formation
Day 5+: ‘Walking’ - Deep vein thrombosis or pulmonary embolism
surgery requiring a long fasting period of more than one missed meal or whose diabetes is poorly controlled require what
variable rate insulin infusion
example of hepatotoxic agent
halothane
anaesthetic with antiemetic properties
propofol
which anti diabetic drugs can be used on the day of the surgery [2]
gliptins and GLP analogues
signs of wound dehiscence
bowel protruding
wound rupture
urgent senior review
why should hypotonic saline be avoided in children
risk of hyponatraemic encephalopathy
how long before surgery can patients have fluids
2 hours before
drinking clear fluids before the operation can help reduce headaches, nausea and vomiting afterwards
bowel prep for colonoscopy
no food for 24 hours before exam
have laxatives day before
agent with strongest analgesic effect
ketamine
which agents can cause myocardial depression
propofol and sodium thiopentone
which agent may cause pain on IV injection
propofol
MoA of lidocaine
blockage of sodium channels
