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Systems: Specialities AB > Anaesthetics: Conduct of General Anaesthesia > Flashcards

Anaesthetics: Conduct of General Anaesthesia Flashcards

1
Q

What roles are anaesthetists involved in?

A
  • Pre-op Assessment & Care
  • Critical Care / Intensive Care
  • Pain Management
  • Anaesthesia
  • Post-operative care
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2
Q

What are the stages in the process of anaesthesia?

A
  • Pre-operative Assessment
  • Preparation
  • Induction
  • Maintenance
  • Emergence
  • Recovery
  • Post-operative Care and Pain Management
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3
Q

What preparation is required for anaesthesia?

A
  • Planning
  • Right patient, right operation
  • Right (or left) side…..
  • Pre-medication
  • Right equipment, right personnel
  • Drugs drawn up
  • IV access
  • Monitoring
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4
Q

How is anaesthesia induced?

A

Gas or IV agent

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5
Q

What drugs are used in IV induction?

A
  • Propofol
  • Thiopentone
  • others
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6
Q

What are the general features of IV induction?

A
  • Rapid (One “arm-brain” circulation ~ 20s)
  • No obvious planes
  • Easy to overdose
  • Generally rapid loss of airway reflexes
  • Apnoea is very common
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7
Q

What agent is used in gas induction?

A

Sevoflurane (halothane)

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8
Q

Who is gas induction commonly used in?

A

Young children

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9
Q

What are the general features of gas induction?

A
  • Slow

- Considerably more obvious ‘planes’ of anaesthesia

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10
Q

List the planes of anaesthesia.

A
  • Analgesia / Sedation
  • Excitation
  • Anaesthesia: Light —> Deep
  • Overdose
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11
Q

What are the 4 components of induction?

A
  • Quietness
  • Gas or IV Agent
  • Careful monitoring of conscious level
  • Airway maintenance
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12
Q

How is conscious level monitored?

A
  • Loss of Verbal Contact
  • Movement
  • Respiratory Pattern
  • Processed EEG
  • “Stages” or “planes” of anaesthesia
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13
Q

What happens to the airway as someone loses consciousness

A

The epiglottis falls back and obstructs the airway

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14
Q

When is airway maintenance required in GA?

A

Always

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15
Q

What is the triple airway manoeuvre?

A
  • Head tilt
  • Chin lift
  • Jaw thrust
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16
Q

What simple apparatus can be used in airway maintenance?

A
  • Face mask
  • Guedel
  • NP airway
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17
Q

What are the features of the anaesthetic face mask?

A
  • Identical to those used in Resuscitation
  • Contoured to face to allow a gas-tight seal
  • Sizes from neonatal - large adult
  • Technique involves lifting the face into
  • Standard connector
18
Q

Who tolerates placement of a Guedel?

A

Only unconscious patients

19
Q

What can insertion of a guedel into a ‘light’ patient cause/

A

Vomiting or laryngospasm

20
Q

How should a guedel be inserted?

A

Adult
-Upside down and then rotated 180 once in the mouth

Children
-Can be inserted directly

21
Q

What are the features of a LMA?

A
  • Cuffed tube with ‘mask’ sitting over glottis
  • Maintains, but DOES NOT PROTECT the airway
  • Sizes for adults and children
22
Q

How should a LMA be inserted?

A
  • Direct insertion

- Inflation of cuff

23
Q

What are the features of an I-gel?

A
  • 2nd generation” LMA
  • (Relatively) Easy insertion
  • Does NOT protect from aspiration
  • Can use suctioning when inserted
24
Q

How should an I-gel be inserted?

A
  • Direct insertion

- No cuff inflation required

25
Q

What obstructive airway complications may occur?

A
  • Ineffective Triple Airway Manoeuvre
  • Airway Device malposition or kinking
  • Laryngospasm = Laryngeal spasm
26
Q

What is laryngospasm?

A
  • Forced reflex adduction of the vocal cords
  • May result in complete airway obstruction
  • Caused by airway (or other) stimulation in light planes of anaesthesia
  • Often unrelieved by simple manoeuvres
27
Q

What aspiration airway complications may occur?

A

Loss of protective airway reflexes (gag, swallow, cough) can lead to foreign material entering the lower airway (gastric contents, blood, surgical debris)

28
Q

What is a maintained airway?

A

One which is open and unobstructed

29
Q

What is the only way to protect an airway from contamination?

A

Use of a cuffed ET tube

30
Q

How is ET intubation carried out?

A
  • Oral route most commonly used
  • Laryngeal reflexes must be abolished
  • Classic method uses laryngoscope, muscle relaxant, “sniffing the morning air” position
  • Also possible in the awake patient using local anaesthesia and fibre-optic scope
31
Q

Why do we intubate patients?

A
  • Protect airway from gastric contents
  • Need for muscle relation and therefore artificial ventilation
  • Shared airway with risk of blood contamination (tonsillectomy)
  • Need for tight control of blood gases
  • Restricted access to airway
32
Q

What are the risks to an unconscious patient?

A
  • “Airway, Airway, Airway”
  • Temperature
  • Loss of other protective reflexes eg corneal, joint position
  • Venous thromboembolism risk
  • Consent & Identification
  • Pressure areas
33
Q

How can a patient be positioned when anaesthetised?

A
  • Supine
  • Lithotomy
  • Prone
  • Lying on side
  • Sitting
34
Q

How should a patient be cared for following anaesthesia?

A
  • Care of the unconscious patient
  • Muscle relaxation, analgesia
  • Monitoring and physiological support
  • Fluid management
  • Documentation and recording
35
Q

What happens after the administration of the induction agent?

A
  • Induction agents wear
  • Maintenance: IV / Inhalational or both
  • Self- or Artificial Ventilation
  • “Balanced” (multi-modal) technique
  • Analgesia
  • Gas supply from anaesthetic “machine”
36
Q

What monitoring should be take place whilst a patient is anaesthetised?

A
  • Minimum monitoring (SpO2, ECG, NIBP,FiO2, ETCO2)
  • Respiratory parameters
  • Agent monitoring
  • Temperature, urine output, NMJ
  • Invasive venous/arterial monitoring
  • Processed EEG
  • Watch for VENTILATOR DISCONNECT
37
Q

What are the risk factors for awareness during anaesthesia?

A
  • Paralysed and ventilated
  • Previous episode of awareness
  • Chronic CNS depressant use
  • Cardiac surgery
  • Major trauma
  • GA c/section
38
Q

What happens as someone awakens from anaesthetic?

A
  • Muscle relaxation reversed
  • Anaesthetic agents off
  • Resumption of spontaneous respiration
  • Return of airway reflexes / control
  • Extubation
39
Q

How are local (regional) anaesthetics administed?

A
  • Same care as GA
  • IV access required
  • Monitoring
  • Presence of anaesthetist
  • Spinal, epidural, plexus block, nerve block
  • Each technique has its own indications, benefits, hazards and complications
40
Q

What is involved in the recovery area following anaesthetic?

A
  • A dedicated area with trained staff
  • Many patients have not yet regained consciousness or AIRWAY CONTROL
  • Continuing responsibility of anaesthetist
  • Problems with A, B, C
  • Pain control
  • Post-operative Nausea & Vomiting may occur
  • Set criteria for discharge back to ward

Systems: Specialities AB (19 decks)

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