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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
Q

When does induction stage four occur?

A

This occurs when too much anaesthetic medication is given relative to the amount of surgical stimulation

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26
Q

What are the consequences of induction stage four?

A

Brainstem or medullary depression

This stage is lethal without sufficient support

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27
Q

Why are the stages of induction rarely visualised in adult patients?

A

This is due to the rapid state of unconsciousness produced by intravenous induction agents

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28
Q

What three main things do we monitor once induction has been achieved?

A

Airway

Breathing

Circulation

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29
Q

Why is it essential that we monitor the patient’s airways after induction?

A

This is due to the obstructive effects caused by relaxation of upper airway tissues and loss of airway reflexes

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30
Q

How do we generally open a patient’s airways?

A

We perform a triple airway manoeuvre

This is accompanied with an anaesthetic mask

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31
Q

What are the three components of the triple airway manoeuvre?

A

Head tilt

Jaw thrust

Open the patient’s mouth

32
Q

What are three forms of additional airway management?

A

Oropharyngeal Airway

Laryngeal Mask Airway (LMA)

Endotracheal Tube (ETT)

33
Q

What is another name for the oropharyngeal airway?

A

Guedel airway

34
Q

How does the oropharyngeal airway device maintain airway patency?

A

It stops the tongue from covering the epiglottis

35
Q

What are the two complications when an oropharyngeal airway is inserted into patients who are not anaesthetised?

A

Vomiting

Laryngospasm

36
Q

How does the laryngeal mask maintain airway patency?

A

It provides a tight seal over the larynx and thus directs gas flow towards the patient’s airway

37
Q

What is a ETT?

A

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
Q

What device is used to insert an ETT?

A

Laryngoscope

39
Q

What is intubation?

A

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
Q

In which five circumstances is intubation required?

A

Unfasted Aspiration Protection

Muscle Relaxant Administration

Shared Airway Case

Strict CO2 Control

Minimal Patient Access

41
Q

What is a shared airway case?

A

This is when the surgeon and anaethestitst are working on the mouth/face

42
Q

How do we confirm a successful intubation?

A

It is indicated by an end tidal CO2 trace for more than 5 breaths

43
Q

During anaesthesia, what are the three breathing mechanisms?

A

Spontaneous

Controlled

Supported

44
Q

What is spontaneous ventilation?

A

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
Q

What is controlled ventilation?

A

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
Q

What is supported ventilation?

A

It involves partial support of spontaneous ventilation by a ventilator

This decreases the imposed work of breathing for the patient

47
Q

In what two ways do we monitor breathing after administration of anaesthesia?

A

Oxygen saturations

End-tidal CO2 volume

48
Q

Why is it essential that circulation is monitored after induction?

A

This is due to the haemodynamic effects associated with anaesthesia

49
Q

In what two ways do we monitor circulation after induction?

A

ECG heart rhythm

Blood pressure

50
Q

How often do we measure blood pressure after induction?

A

Every five minutes

51
Q

What are six complications associated with anaesthesia?

A

Awareness

Eye Injury

Hypothermia

Pressure Injury

Venous Thromboembolism

Nerve Injury

52
Q

What is awareness?

A

This occurs when patients can recall their surroundings or events related to their surgery

53
Q

In what two ways do we prevent awareness during surgery?

A

The anaesthetist monitors for signs of light anaesthesia

We can use anaesthesia depth monitors to calculate the levels of anaesthesia during surgery

54
Q

What are the three signs of light anaesthesia?

A

Tachycardia

Hypertension

Sweatiness

55
Q

List two anaesthesia depth monitors

A

BIS monitors

EEG scans

56
Q

Why are eye injuries associated with anaesthesia?

A

Due to dysfunction of the blinking reflex

This can allow foreign objects to penetrate the eyes and drying of the cornea

57
Q

In what two ways do we prevent eye injuries during surgery?

A

We tape the patient’s eyes shut

We apply a lubricating ointment to the eye

58
Q

Why is hypothermia associated with anaesthesia?

A

Due to the vasodilatory effects of anaesthetic

59
Q

What are the three complications of hypothermia during surgery?

A

Surgical site infection

Post-operative pain

Haemorrhage

60
Q

In what two ways do we prevent hypothermia during surgery?

A

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
Q

Why are pressure injuries common during anaesthesia?

A

Due to the loss of pain reflex from anaesthesia

62
Q

In what two ways do we prevent pressure injuries during surgery?

A

We carefully pad the patient’s pressure areas

We increase our awareness of the tubes surrounding the patient

63
Q

In what three ways do we prevent venous thromboembolism during surgery?

A

We encourage patient movement prior to surgery

We apply TED stockings

We apply flowtron pumps

64
Q

How do we prevent venous thromboembolism in high risk patients?

A

We administer dalteparin the night before surgery

65
Q

Why are nerve injuries common during surgery?

A

Due to the loss of pain reflex from anaesthesia

66
Q

What three nerves are commonly injured during surgery?

A

Ulnar nerve

Common fibular nerve

Brachial plexus

67
Q

How do we prevent nerve injuries during surgery?

A

We appropriately position the patient

68
Q

What is the maintenance phase of anaesthesia?

A

In order to prolong unconsciousness for the duration of the surgery, anaesthesia must be maintained

69
Q

How do we maintain anaesthesia?

A

Continuous adjustments to the administration of inhaled/intravenous anaesthetic agents

70
Q

What is the most common intravenous maintenance agent?

A

Propofol

71
Q

What equipment can be used to help maintain intravenous anaesthesia?

A

A target controlled infusion (TCI) machine

72
Q

How do we awaken the patient after surgery?

A

The administration of anaesthetic agents is discontinued

73
Q

When is a conscious state achieved after discontinuation of anaesthesia?

A

When the concentration of anaesthetic in the brain drops below a certain level

This usually takes between 1 to 30 minutes

74
Q

What two drugs are given before we discontinue anaesthesia?

A

Analgesic

Anti-emetic agents

75
Q

What must occur before we discontinue anaesthesia - if a muscle relaxant was administered?

A

The neuromuscular blockade must be reversed

76
Q

What is the emergence phase of anaesthesia?

A

It is the return to baseline physiologic function of all organ systems after the cessation of general anaesthetics

77
Q

What may occur to the patient during the emergence stage?

A

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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