Anaesthetics - conduct of anaesthetics

Question 1

What roles do anaesthetists have?

Answer 1

Pre-op assessment and care
Critical care/intensive care
Pain management
Anaesthesia
Post-op care

Question 2

What’s involved in preparation of anaesthesia?

Answer 2

Planning
Right patient for right operation
Correct side
Premedication
Right equipment
Drugs drawn up
IV access
Monitoring

Question 3

What is important about the environment where induction of anaesthesia is done?

Answer 3

Quiet - usually done in a seperate room dedicated to induction where nobody else may enter

Question 4

What drugs are used for IV induction of anaesthesia?

Answer 4

Propofol

Thiopentone

Question 5

What is the main advantage of IV induction?

Answer 5

Very rapid - one arm-brain circulation = around 20 seconds

Question 6

What are risks of IV induction of anaesthesia?

Answer 6

Easy to overdose
Generally rapid loss of airway reflexes
Apoea is very common

Question 7

What drugs are used of gas induction of anaesthesia?

Answer 7

Sevoflurane

Halothane

Question 8

What are benefits of using gas induction?

Answer 8

There are more obvious planes of anaesthesia

Question 9

What are the planes of anaesthesia?

Answer 9

Analgesia/sedation/sleepy
Excitation
Anaesthetised
Overdose

Question 10

How is conscious level monitored?

Answer 10

Movement
Respiratory pattern
Processed EEG
Planes of anaesthesia

Question 11

Why is airway maintenance essential in general anaesthesia?

Answer 11

The tongue falls back and blocks the airway

Question 12

How is airway maintained in anaesthesia?

Answer 12

Head tilt
Chin lift
Jaw thrust
Apparatus ie face mask, oropharyngeal airway, nasopharyngeal airway

Question 13

What is the name of the manoeuvre for airway maintenance in anaesthesia?

Answer 13

Triple airway manoeuvre

Question 14

Why is oropharyngeal airway not used in conscious patients?

Answer 14

Insertion in a conscious patient may cause vomiting or laryngospasm

Question 15

What are airway compications leading to obstruction?

Answer 15

Ineffective triple airway manoeuvre
Airway device malposition or kinking
Laryngospasm

Question 16

What are airway complications that can lead to aspiration?

Answer 16

Anaesthesia causes loss of protective reflexes ie gag, swallow, cough
Foreign maerial in lower airway ie gastric contents, blood, surgical debris

Question 17

What is the difference between airway maintenance and protection?

Answer 17

Maintained = opened and unobstructed
Protected = safe from contamination

Question 18

What is the purpose of endotracheal intubation?

Answer 18

Airway protection

Question 19

What route is usually used for endotracheal intubation?

Answer 19

Oral

Question 20

What is essential for endotracheal intubation?

Answer 20

Laryngeal reflexes must be abolished

Question 21

What are the risks to unconscious patients?

Answer 21

Airway - biggest risk
Temperature
Loss of protective reflexes
Venous thromboembolism risk
Consent and identification
Pressure areas

Question 22

What are the main patient positions used?

Answer 22

Supine
Lithotomy
Prone
Lying on side
Sitting

Question 23

What are the main responsibilities of the anaesthetist during anaesthesia?

Answer 23

Care of the patient
Muscle relaxation/analgesia
Monitoring and physiological support
Fluid management
Documentation and recording

Question 24

What are risk factors for awareness during anaesthesia?

Answer 24

Paralysed and ventilated patient
Previous episodes of awareness
Chronic CNS depressant use
Cardiac surgery 
Major trauma
General anaesthetic C section

Question 25

What is done in emergence from anaesthesia?

Answer 25

Reverse muscle relaxation
Anaesthetic agents off
Resumption of spontaneous respiration
Return of airway reflexes
Extubation

Question 26

What types of local anaesthetic are there?

Answer 26

Spinal
Epidural
Plexus block
Nerve block

Question 27

What is Laryngospasm?

Answer 27

Forced reflex adduction of the vocal cords