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Year Three - Specialities > Anaesthetics - Conduct of Anaesthesia > Flashcards

Anaesthetics - Conduct of Anaesthesia Flashcards

1
Q

What are the four ways in which anaesthetists prepare for surgery?

A

Pre-Operative Assessment

Monitoring Machine Preparation

Intravenous Access

Pre-Oxygenation

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2
Q

What is the purpose of the pre-operative assessment?

A

It is an opportunity to identify co-morbidities that may lead to complications during the anaesthetic, surgical or post-operative period

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3
Q

What are the five pieces of monitoring equipment that should be prepared by anaesthetists prior to surgery?

A

ECG

Oxygen saturations

Non-invasive blood pressure

End-tidal CO2

Airway pressure

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4
Q

Why do we observe ECG’s when anaesthesia is administered?

A

Arrhythmias are common

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5
Q

Why do we observe blood pressure when anaesthesia is administered?

A

Hypotension is common

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6
Q

Where is the cannula usually inserted to allow intravenous anaesthesia administration?

A

Back of the hand

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7
Q

Why is pre-oxygenation required prior to anaesthesia?

A

Due to the fact that anaesthesia reduces functional residual capacity, oxygen is administered for a few minutes to oxygen content from 21% to nearer 100%

This increases the time to desaturation, providing the anaesthetist more time to supply the patient with oxygen before apnoea occurs

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8
Q

What are the four phases of anaesthesia?

A

Induction

Maintenance

Emergences

Recovery

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9
Q

What is the induction?

A

It is the period between the administration of induction agents and loss of consciousness

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10
Q

What are the two administration methods of induction agents?

A

Intravenous

Inhalation

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11
Q

What combination of induction agents are usually administered?

A

A short acting analgesic with a hypnotic

In some cases, a muscle relaxant may also be prescribed

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12
Q

List two short-analgesic agents

A

Fentanyl

Alfentanil

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13
Q

List three hypnotic agents

A

Propofol

Thiopentone

Ketamine

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14
Q

What is the most commonly administered hypnotic agent?

A

Propofol

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15
Q

In which patients do we administer inhalation induction agents? Why?

A

Children

They won’t tolerate the placement of a canula

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16
Q

What results in a quicker state of unconsciousness - intravenous or inhalation induction?

A

Intravenous

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17
Q

What is induction stage one?

A

It defines the period between the administration of induction agents and loss of consciousness

During this stage, the patient progresses from analgesia without amnesia to analgesia with amnesia

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18
Q

What sensation do patients report during induction stage one?

A

A relaxed and floaty sensation

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19
Q

What is another term for induction stage two?

A

Excitement stage

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20
Q

What is induction stage two?

A

It defines the period following loss of consciousness and marked by excited and delirious activity

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21
Q

What are the signs of induction stage two?

A

During this stage, the patient’s respiration and heart rate may become irregular

In addition, there may be uncontrolled movements, vomiting, suspension of breathing and pupillary dilation

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22
Q

What is another term for induction stage three?

A

Surgical anaesthesia

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23
Q

What is induction stage three?

A

It defines the period in which the skeletal muscles relax, vomiting stops, respiratory depression occurs and eye movements slow and then stop

The patient is unconscious and ready for surgery

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24
Q

What is another term for induction stage four?

A

Overdose

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25
When does induction stage four occur?
This occurs when too much anaesthetic medication is given relative to the amount of surgical stimulation
26
What are the consequences of induction stage four?
Brainstem or medullary depression This stage is lethal without sufficient support
27
Why are the stages of induction rarely visualised in adult patients?
This is due to the rapid state of unconsciousness produced by intravenous induction agents
28
What three main things do we monitor once induction has been achieved?
Airway Breathing Circulation
29
Why is it essential that we monitor the patient's airways after induction?
This is due to the obstructive effects caused by relaxation of upper airway tissues and loss of airway reflexes
30
How do we generally open a patient's airways?
We perform a triple airway manoeuvre This is accompanied with an anaesthetic mask
31
What are the three components of the triple airway manoeuvre?
Head tilt Jaw thrust Open the patient’s mouth
32
What are three forms of additional airway management?
Oropharyngeal Airway Laryngeal Mask Airway (LMA) Endotracheal Tube (ETT)
33
What is another name for the oropharyngeal airway?
Guedel airway
34
How does the oropharyngeal airway device maintain airway patency?
It stops the tongue from covering the epiglottis
35
What are the two complications when an oropharyngeal airway is inserted into patients who are not anaesthetised?
Vomiting Laryngospasm
36
How does the laryngeal mask maintain airway patency?
It provides a tight seal over the larynx and thus directs gas flow towards the patient’s airway
37
What is a ETT?
It is a flexible tube that is placed through the mouth, past the vocal cords, and into the trachea This tube is then connected to a ventilator, which delivers oxygen to the lungs This process is called endotracheal intubation
38
What device is used to insert an ETT?
Laryngoscope
39
What is intubation?
It is the process of inserting a tube into the airway via the mouth/nose to help move air in and out of the lungs
40
In which five circumstances is intubation required?
Unfasted Aspiration Protection Muscle Relaxant Administration Shared Airway Case Strict CO2 Control Minimal Patient Access
41
What is a shared airway case?
This is when the surgeon and anaethestitst are working on the mouth/face
42
How do we confirm a successful intubation?
It is indicated by an end tidal CO2 trace for more than 5 breaths
43
During anaesthesia, what are the three breathing mechanisms?
Spontaneous Controlled Supported
44
What is spontaneous ventilation?
It involves the movement of gas in and out of the lungs in response to an individual’s respiratory muscles This means that breathing occurs without ventilatory support
45
What is controlled ventilation?
It involves the anaesthetist delivering a pre-set gas volume or pressure, regardless of the patient’s own inspiratory efforts This means that breathing occurs with complete ventilatory support
46
What is supported ventilation?
It involves partial support of spontaneous ventilation by a ventilator This decreases the imposed work of breathing for the patient
47
In what two ways do we monitor breathing after administration of anaesthesia?
Oxygen saturations End-tidal CO2 volume
48
Why is it essential that circulation is monitored after induction?
This is due to the haemodynamic effects associated with anaesthesia
49
In what two ways do we monitor circulation after induction?
ECG heart rhythm Blood pressure
50
How often do we measure blood pressure after induction?
Every five minutes
51
What are six complications associated with anaesthesia?
Awareness Eye Injury Hypothermia Pressure Injury Venous Thromboembolism Nerve Injury
52
What is awareness?
This occurs when patients can recall their surroundings or events related to their surgery
53
In what two ways do we prevent awareness during surgery?
The anaesthetist monitors for signs of light anaesthesia We can use anaesthesia depth monitors to calculate the levels of anaesthesia during surgery
54
What are the three signs of light anaesthesia?
Tachycardia Hypertension Sweatiness
55
List two anaesthesia depth monitors
BIS monitors EEG scans
56
Why are eye injuries associated with anaesthesia?
Due to dysfunction of the blinking reflex This can allow foreign objects to penetrate the eyes and drying of the cornea
57
In what two ways do we prevent eye injuries during surgery?
We tape the patient’s eyes shut We apply a lubricating ointment to the eye
58
Why is hypothermia associated with anaesthesia?
Due to the vasodilatory effects of anaesthetic
59
What are the three complications of hypothermia during surgery?
Surgical site infection Post-operative pain Haemorrhage
60
In what two ways do we prevent hypothermia during surgery?
We cover the patient with warm air blankets We monitor the patient’s temperature every 30 minutes. In some cases, temperature is constantly monitored through the use of an oesophageal temperature probe
61
Why are pressure injuries common during anaesthesia?
Due to the loss of pain reflex from anaesthesia
62
In what two ways do we prevent pressure injuries during surgery?
We carefully pad the patient’s pressure areas We increase our awareness of the tubes surrounding the patient
63
In what three ways do we prevent venous thromboembolism during surgery?
We encourage patient movement prior to surgery We apply TED stockings We apply flowtron pumps
64
How do we prevent venous thromboembolism in high risk patients?
We administer dalteparin the night before surgery
65
Why are nerve injuries common during surgery?
Due to the loss of pain reflex from anaesthesia
66
What three nerves are commonly injured during surgery?
Ulnar nerve Common fibular nerve Brachial plexus
67
How do we prevent nerve injuries during surgery?
We appropriately position the patient
68
What is the maintenance phase of anaesthesia?
In order to prolong unconsciousness for the duration of the surgery, anaesthesia must be maintained
69
How do we maintain anaesthesia?
Continuous adjustments to the administration of inhaled/intravenous anaesthetic agents
70
What is the most common intravenous maintenance agent?
Propofol
71
What equipment can be used to help maintain intravenous anaesthesia?
A target controlled infusion (TCI) machine
72
How do we awaken the patient after surgery?
The administration of anaesthetic agents is discontinued
73
When is a conscious state achieved after discontinuation of anaesthesia?
When the concentration of anaesthetic in the brain drops below a certain level This usually takes between 1 to 30 minutes
74
What two drugs are given before we discontinue anaesthesia?
Analgesic Anti-emetic agents
75
What must occur before we discontinue anaesthesia - if a muscle relaxant was administered?
The neuromuscular blockade must be reversed
76
What is the emergence phase of anaesthesia?
It is the return to baseline physiologic function of all organ systems after the cessation of general anaesthetics
77
What may occur to the patient during the emergence stage?
This stage may be accompanied by temporary neurologic phenoma, such as confusion, aphasia or focal impairment in sensory or motor function

Year Three - Specialities (15 decks)

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