Anaesthetics/CIA

Question 1

ASA grades

Answer 1

I: healthy
II: mild, function normal; incl. controlled DM/HTN
III: moderate, function impaired
IV: threat to life e.g. recent MI
V: moribund (dead without operation)
VI: brain-dead (organ donor)

Question 2

DM pre-op

Answer 2

T1: insulin sliding scale + monitor BM; normal insulin once E+D
T2: omit PO hypo (except MetF); insulin if poor control; resume after

put DM first on list
hyperglyc: affects CNS/GCS, infection, wound healing

Question 3

NBM pre-op

Answer 3

6h food

2h clear fluids

Question 4

Key Drugs

Answer 4

triad: narcosis/sedation, analgesia, relaxation
1) induction + maintenance: anaesthetic + hypnotic
2) muscle relaxant: non-depol (‘curium’) or depol (sexa/decamethonium)
3) opioid analgesic e.g. fetanyl

oxygen/entonox (N20 50%)
ephedrine or metaraminol (hypoTN)
BZD (sedation)

Question 5

Check list

Answer 5

sign-in
time-out
sign-out

allergies, SaO2, machine and drugs checked and prepped, ASA/intubation

Question 6

To-Do

Answer 6

Check list
induction agent detail
PONV
post-op fever (5Ws)
stopping meds (warf 5d; antt-plt 7d)

spinal/epidural: indications, SE/risks
GA: indications, SE/risks
LA: indications, max dose, SE/risks
PCA: indications, SE/risks
PAIN LADDER (incl. doses)

Key A to E (common forget)

Question 7

post-op VTE

Answer 7

LMWH start 6-12h post-op; fondaparinux 6h
dabigatran 14h, rivaroxaban 6-10h

hip: 28-35 days
knee: 10-14 days

RF: op >90m (60 if LL), acute surgical (inflamm), mobility, VTE RF