anaesthetics and preoperative care Flashcards
1
Q
where dose a laryngeal mask sit
A
in pharynx and aligns to cover the airway
2
Q
is laryngeal mask suitable for high pressure ventilation
A
no
3
Q
what airway dries secretions
A
tracheostomy
4
Q
what anaesthetic classification is a brain dead patient
A
VI
5
Q
what is propofal mechanism of action
A
GABA receptor antagonist
6
Q
is propofol an anti emetic
A
yes
7
Q
onset of action of sodium thiopentone
A
rapid onset
8
Q
mechanism of action of ketamine
A
NMDA receptor antagonist
9
Q
does ketamine cause myocardial depression
A
slightly
best for those who are haemodynamically unstable
10
Q
what is done if there is blood loss and chance of infusion is unlikely
A
group and save
11
Q
examples of surgery where group and save is done
A
hysterectomy
appendectomy
thyroidectomy
c section
12
Q
what is done if blood loss and transfusion is likely
A
cross match 2 units
13
Q
blood loss if transfusion can occur
A
cross match 4-6 units
14
Q
examples of inhaled general anaesthetics
A
volatile liquid anaesthetics
- isoflurane
- desflurane
- sevoflurane
nitrous oxide
15
Q
side effects of volatile liquid anaesthetics
A
- myocardial depression
- malignant hyperthermia
- halothane is hepatotoxic
16
Q
when should nitrous oxide be avoided
A
pneumothorax
17
Q
examples of IV general anaesthetics
A
propofol
thiopental
etomidate
ketamine
18
Q
where is easiest place to insert a central line
A
femoral
19
Q
which is preferred for central line
A
internal jugular
20
Q
what is preferred route of access in paediatric
A
intraossesous access
- proximal tibia
21
Q
size of orange cannula
A
14g
270ml/min
22
Q
size of grey cannula
A
16g
180ml/min
23
Q
size of green cannula
A
18g
80ml/min
24
Q
size of pink cannula
A
20g
54ml/min
25
size of blue cannula
22g
33ml/min
26
can you give lidocaine during acidosis
no as it detaches from protein
27
drug interactions with lidocaine
beta blocker
ciprofloxacin
phenytoin
28
can cocaine cross blood brain barrier
yes
29
when is cocaine mostly used
ENT surgery
30
how does bupivacaine work
bind to intracellular sodium channels and blocks sodium influx into nerve cells
causes depolarisation
31
dosage of lignocaine
3mg/kg
32
what is maximum dose of lignocaine
200mg
33
why does adrenaline get added to local anaesthetic
to prolong duration of action at site of injection
34
when is adrenaline contraindicated
patient taking MAOIs or tricyclic antidepressants
35
what side effect can occur after administration of anaesthetic agents
malignant hyperthermia
36
characteristics of malignant hyperthermia
hyperpyrexia and muscle rigidity
37
why does malignant hyperthermia occur
excessive release of calcium form sarcoplasmic reticulum of skeletal muscle
38
investigations for malignant hyperthermia
CK raised
contracture tests with halothane and caffeine
39
management of malignant hyperthermia
dnatrolene - prevents calcium release from sarcoplasmic reticulum
40
examples of muscle relaxants
- suxamethonium
- atrcurium
- vecuronium
- pancuronium
41
when are nasopharyngeal airways contraindicated
base of skull fractures
42
complications of naso gastric feeding
aspiration of feed or misplaced tube
43
what is surgically sited feeding tube
feeding jejunostomy
44
what can be used for long term feeding
feeding jejunostomy
45
what is definitive option in patients in whom enteral feeding is contra indicated
total parenteral nutrition
46
what is long term use of total parenteral nutrition associated with
fatty liver and deranged LFTs
47
what are early causes of post-op pyrexia
- blood transfusion
- cellulitis
- urinary tract infection
- physiology systemic inflammatory reaction
- pulmonary atelectasis
48
late causes of post-op pyrexia
- venous thromboembolism
- pneumonia
- wound infection
- anastomotic leak
49
what is post op ileus
aka paralytic ileus
common complication after surgery involving the bowel results in pseudo-obstruction
50
features of postoperative ileus
abdominal distension/bloating
abdominal pain
nausea
inability to pass flatus
inability to tolerate an oral diet
51
fluids before surgery
clear fluids until 2 hours before their operation
52
when before surgery should you stop no clear fluids
6 hours before
53
if surgery is long and diabetic will miss a meal or they have poorly controlled diabetes on insulin what is the management
variable rate intravenous insulin infusion
54
metformin day prior to admission
take as normal
55
metformin day of morning surgery
take as normal if taken twice a day
if have lunchtime dose - miss this out
56
metformin day of afternoon surgery
take as normal if taken twice a day
if lunch time dose - miss it
57
day before surgery sulfonylurea
take as normal
58
sulfonylurea day of morning surgery
once daily in morning - miss dose
twice daily- omit morning dose
59
sulfonylurea day of afternoon surgery
taken once daily in morning - omit dose
taken twice daily - omit both doses
60
DPP IV inhibitor (-gliptins) day prior to surgery
take as normal
61
DPP IV inhibitor (-gliptins) day of surgery morning or afternoon
take as normal
62
GLP-1 analogues (-tides) day prior to surgery
take as normal
63
GLP-1 analogues (-tides) day of surgery morning or afternoon
take as normal
64
SGLT-2 inhibitors (-flozins) day before surgery
take as normal
65
SGLT-2 inhibitors (-flozins) day or surgery if morning or afternoon
omit on day of surgery
66
one daily insulins day prior to surgery
reduce dose by 20%
67
once daily insulins day of surgery morning or afternoon
reduce dose by 20%
68
long acting insulin day before surgery
no dose change
69
long acting insulin day of surgery
halve the usual morning dose evening dose unchanged
70
mechanism of injury accessory nerve
posterior triangle lymph node biopsy
71
sciatic nerve mechanism of injury
posterior approach to hip
72
common peroneal mechanism of injury
legs in Lloyd Davies position
73
long thoracic nerve mechanism of injury
axillary node clearance
74
arrhythmia following cardiac surgery can lead to
hypokalaemia
75
what investigation for rectal anastomotic leaks
gatrograffin enema
76
features that increase the risk of surgical site infection
- shaving the wound using a razor
- using non iodine impregnated incise drape if one necessary
- tissue hypoxia
- delayed administration of prophylactic antibiotics in tourniquet surgery
77
perioperative period refers to
temperature management of patients from 1 hour prior to their surgery until 24 hours after the surgery has been completed
78
risk factors of perioperative hypothermia
- ASA grade 2 or above
- major surgery
- low body weight
- large volumes of unarmed IV infusions
- unwarmed blood transfusion
79
complication of perioperative hypothermia
- coagulopathy
- prolonged recovery from anaesthesia
- reduced wound healing
- infection
- shivering
80
combined oral contraceptive pill prior to surgery
stop therapy 4 weeks before
81
what is a hypertrophic scar
excessive amounts of collagen within a scar
contain nodules
82
keloid scar
excessive amounts of collagen
pass beyond the boundaries or original injury
do not regress over time may recur
83
drugs that impair wound healing
- NSAIDs
- steroids
- immunosuppressive agents
- anti neoplastic drugs
84
lidocaine mechanism of action
blockage of sodium channels disrupting the action potential
85
what is good anaesthetic agent for haemodynamically unstable patients
ketamine
86
when is a nasopharyngeal airway contraindicated
base of skull fractures
