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Gastrointestinal > Anaesthetics and Perioperative Care > Flashcards

Anaesthetics and Perioperative Care Flashcards

1
Q

What are the stages of wound healing?

A

Haematomesis

Inflammation

Regeneration

Remodelling

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2
Q

What are hypertrophic scars?

A

Excessive amounts of collagen within a scar

Nodules may be present histologically containing randomly arranged fibrils within and parallel fibres on the surface

The tissue itself is confined to the extent of the wound itself and is usually the result of a full thickness dermal injury

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3
Q

What is a Keloid scar?

A

Excessive amounts of collagen within a scar. Typically will pass beyond the boundaries of the original injury

They do not contain nodules and may occur following even trivial injury

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4
Q

What drugs can impair wound healing?

A

NSAIDS

Steroids

Immunosupressive agents

Anti neoplastic drugs

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5
Q

Describe ASA 1

A

A normal healthy patient

Healthy

Non-smoking

No or minimal alcohol use

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6
Q

Describe ASA 2

A

A patient with mild systemic disease

Current smoker

Social alcohol drinker

Pregnancy

Obesity (BMI 30 - 40)

Well-controlled Diabetes Mellitus/Hypertension

Mild lung disease

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7
Q

Describe ASA 3

A

A patient with severe systemic disease

Poorly controlled DM/HTN

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 of MI or cerebrovascular accidents

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8
Q

Describe ASA 4

A

A patient with severe systemic disease that is a constant threat to life

Recent Myocardial infarction

Cerebrovascular accidents

Ongoing cardiac ischaemia

Severe valve dysfunction

Severe reduction of ejection fraction

Sepsis

DIC

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9
Q

Describe ASA 5

A

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

Multiple organ/system dysfunction

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10
Q

Describe ASA 6

A

A declared brain-dead patient whose organs are being removed for donor purposes

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11
Q

Name common IV induction/sedation agents

A

Propofol

Sodium thiopentone

Ketamine

Etomidate

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12
Q

Give properties of sodium thiopentone

A

Extremely rapid onset of action making it the agent of choice for rapid sequence of induction

Marked myocardial depression

Metabolites build up quickly

Little analgesic effects

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13
Q

Give properties of propofol

A

Rapid onset of anaesthesia

Pain on IV injection

Anti emetic properties

Moderate myocardial depression

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14
Q

Give properties of etomidate

A

Has favorable cardiac safety profile with very little haemodynamic instability

No analgesic properties

Adrenal suppression

Post operative vomiting is common

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15
Q

Give properties of ketamine

A

Has moderate to strong analgesic properties

Produces little myocardial depression making it a suitable agent for anaesthesia in those who are haemodynamically unstable

May induce state of dissociative anaesthesia resulting in nightmares

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16
Q

Name an inhaled general anaesthetic

A

Halothane

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17
Q

Name an IV general anaesthetic

A

Thiopental

18
Q

Give side effects of thiopental

A

Laryngospasm

19
Q

Give side effects of Halothane

A

Hepatotoxicity

Myocardial depression

Malignant hyperthermia

20
Q

Give GA complications

A

Post op pain

Post op N&V

Post op confusion

Laryngospasm when removing the ventilation tube

Hypoxia if inability/delayed ventilation

Hypotension

Respiratory depression

21
Q

Name common local anaesthetic agents

A

Lidocaine

Cocaine

Bupivacaine

Prilocaine

22
Q

What is the most widely used local anaesthetic?

A

Lidocaine

23
Q

How is local anesthetic toxicity managed?

A

IV 20% lipid emulsion

24
Q

When should lidocaine and adrenalin preparations not be used?

A

Minor surgery involving the finger as can cause digital ischaemia

25
Q

What are the two categories of muscle relaxants used in anaesthesia?

A

Depolarising and non-depolarising

26
Q

Name common muscle relaxants

A

Suxamethonium

Atracurium

Vecuronium

Pancuronium

27
Q

Which muscle relaxant is depolarising?

A

Suxamethonium

28
Q

What is the muscle relaxant of choice for rapid sequence intubation?

A

Suxamethonium/depolarising agent

29
Q

When is suxamethonium contraindicated?

A

Patients with penetrating eye injuries or acute narrow angle glaucoma, as suxamethonium increases intra-ocular pressure

30
Q

Give complications of suxamethonium

A

Muscle fasciculations

Malignant hyperthermia

Hyperkalaemia

31
Q

What is included in the anaesthetic checklist?

A

Patient has confirmed site, identity, procedure, consent

Site is marked

Anaesthesia safety check completed

Pulse oximeter is on patient and functioning

Does the patient have a known allergy?

Is there a difficult airway/aspiration risk?

Is there a risk of > 500ml blood loss (7ml/kg in children)?

32
Q

Describe the pre-surgery work up for elective cases

A

Consider pre admission clinic to address medical issues.

Blood tests including FBC, U+E, LFTs, Clotting, Group and Save

Urine analysis

Pregnancy test

Sickle cell test

ECG/CXR

33
Q

Describe the pre-surgery workup for diabetics

A

Patients with diet or tablet controlled diabetes may be managed using a policy of omitting medication and checking blood glucose levels regularly

Diabetics who are poorly controlled or who take insulin will require variable rate intravenous insulin infusion. Potassium supplementation should also be given.

Diabetic cases should be operated on first.

34
Q

Describe the pre-surgery workup for colonoscopy

A

Laxatives day before

Patients do not eat for 24 hours

35
Q

What are the fasting rules pre surgery?

A

Patients can

Eat food up to 6 hours before

Drink clear fluids up to 2 hours before

36
Q

Why are patients nil by mouth prior to surgery?

A

Reduce the likelihood of pulmonary aspiration of gastric contents.

37
Q

What medications should patients stop pre-surgery?

A

COCP, 4 weeks prior

38
Q

What is malignant hyperthermia?

A

Condition often seen following administration of anaesthetic agents, characterised by hyperpyrexia and muscle rigidity caused by excessive release of Ca2+ from the sarcoplasmic reticulum of skeletal muscle

39
Q

What drugs can cause malignant hyperthermia?

A

Halothane

Suxamethonium

Antipsychotics (neuroleptic malignant syndrome)

40
Q

How is malignant hyperthermia managed?

A

Dantrolene

  • Prevents Ca2+ release from the sarcoplasmic reticulum
41
Q

When is DVT prophylaxis started post-surgery?

A

Ted stalkings after admission

LMWH 6-12 hours post surgery

Gastrointestinal (14 decks)

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