Anaesthetics - conduct of anaesthetics Flashcards
What roles do anaesthetists have?
Pre-op assessment and care Critical care/intensive care Pain management Anaesthesia Post-op care
What’s involved in preparation of anaesthesia?
Planning Right patient for right operation Correct side Premedication Right equipment Drugs drawn up IV access Monitoring
What is important about the environment where induction of anaesthesia is done?
Quiet - usually done in a seperate room dedicated to induction where nobody else may enter
What drugs are used for IV induction of anaesthesia?
Propofol
Thiopentone
What is the main advantage of IV induction?
Very rapid - one arm-brain circulation = around 20 seconds
What are risks of IV induction of anaesthesia?
Easy to overdose
Generally rapid loss of airway reflexes
Apoea is very common
What drugs are used of gas induction of anaesthesia?
Sevoflurane
Halothane
What are benefits of using gas induction?
There are more obvious planes of anaesthesia
What are the planes of anaesthesia?
Analgesia/sedation/sleepy
Excitation
Anaesthetised
Overdose
How is conscious level monitored?
Movement
Respiratory pattern
Processed EEG
Planes of anaesthesia
Why is airway maintenance essential in general anaesthesia?
The tongue falls back and blocks the airway
How is airway maintained in anaesthesia?
Head tilt
Chin lift
Jaw thrust
Apparatus ie face mask, oropharyngeal airway, nasopharyngeal airway
What is the name of the manoeuvre for airway maintenance in anaesthesia?
Triple airway manoeuvre
Why is oropharyngeal airway not used in conscious patients?
Insertion in a conscious patient may cause vomiting or laryngospasm
What are airway compications leading to obstruction?
Ineffective triple airway manoeuvre
Airway device malposition or kinking
Laryngospasm
What are airway complications that can lead to aspiration?
Anaesthesia causes loss of protective reflexes ie gag, swallow, cough
Foreign maerial in lower airway ie gastric contents, blood, surgical debris
What is the difference between airway maintenance and protection?
Maintained = opened and unobstructed Protected = safe from contamination
What is the purpose of endotracheal intubation?
Airway protection
What route is usually used for endotracheal intubation?
Oral
What is essential for endotracheal intubation?
Laryngeal reflexes must be abolished
What are the risks to unconscious patients?
Airway - biggest risk Temperature Loss of protective reflexes Venous thromboembolism risk Consent and identification Pressure areas
What are the main patient positions used?
Supine Lithotomy Prone Lying on side Sitting
What are the main responsibilities of the anaesthetist during anaesthesia?
Care of the patient Muscle relaxation/analgesia Monitoring and physiological support Fluid management Documentation and recording
What are risk factors for awareness during anaesthesia?
Paralysed and ventilated patient Previous episodes of awareness Chronic CNS depressant use Cardiac surgery Major trauma General anaesthetic C section
What is done in emergence from anaesthesia?
Reverse muscle relaxation Anaesthetic agents off Resumption of spontaneous respiration Return of airway reflexes Extubation
What types of local anaesthetic are there?
Spinal
Epidural
Plexus block
Nerve block
What is Laryngospasm?
Forced reflex adduction of the vocal cords
