Anaesthetics - Conduct of general anaesthesia

Question 1

what is the process of anaesthesia?

Answer 1

pro-op assessment > preparation > induction > maintenance > emergance > recovery > post-op care and pain management

Question 2

what is involved in preparation?

Answer 2

plan, right patient, right or left side, pre-medication, equiptment, drugs drawn up, monitoring, fluid management.

Question 3

Give 2 examples of iv induced drugs. And the a-d time.

Answer 3

Propofol, Thiopentone. Rapid, 1a-b circulation is roughly 20seconds.

Question 4

what sense is the last to be lost when anaesthesia is induced?

Answer 4

hearing

Question 5

what are the difficulties associated with iv induction?

Answer 5

easy to overdose, rapid loss of airway reflexes, apnoea is very common, no obvious planes

Question 6

give an example of a gas induces anaesthetic

Answer 6

Sevoflurane (halothane), commonly used in young children, slow, more obvious planes of anaesthesia.

Question 7

what are the planes of anaesthesia?

Answer 7

analgesia/sedation > excitation > anaesthesia > overdose

Question 8

how is conciousness monitored?

Answer 8

loss of verbal contact, movement, respiratory patter, EEG, observe te planes of anaesthesia.

Question 9

what are you aiming for with airways?

Answer 9

the reflexes to be supressed - thus the airway needs to be maintained

Question 10

where does the tounge rest due to loss of muscle tone?

Answer 10

posterior pharyngeal wall

Question 11

how is the airway maintained

Answer 11

head tilt, chin lift, jaw thrust (triple airway manoevre), then use a face mask, oropharyngeal airway “guedel airway” (or nasopharyngeal airway)

Question 12

what does a laryngeal mask do? What doesn’t it do?

Answer 12

maintains the airway BUT doesn’t protect the airway from aspiration. (good choice in a cardiac arrest)

Question 13

the airway obstruction complicaiton…

Answer 13

due to innefective triple airway manoeuvre, airway device malposition, causing laryngospasm (forced reflex adduction of the vocal cords).

Question 14

the airway aspiration complication…

Answer 14

due to loss of protective aurway reflexes (gag, swallow, cough) foreign material may become present in the lower airway (gastric contents, blood)

Question 15

whhat protects the airway from contamination?

Answer 15

cuffed tube in the trachea.

Question 16

what is endotracheal intubation?

Answer 16

placement of a cuffed tube in the trachea, first the laryngeal reflexes must be abolished. Classic method uses a laryngoscope and muscle relaxant. Then get a grade 1 veiw where you can see the true vocal cords.

Question 17

why is intubation needed?

Answer 17

protect from gastric contents, need for muscle relaxantion (during a laparotomy), need for tight control of gasses (i.e. o2 levels in neurosurgery), if there is restricted access to airway (i.e.maxfax surgery)

Question 18

what are the risks to an unconcious patient?

Answer 18

airways! Temperature, loss of other protective reflexes (blinking/corneal absarion, joint positions), venous thromboembolism, consent and identificaiton, pressure areas (patient position).

Question 19

what are thhe minimum monitoring standards for the patient?

Answer 19

spo2, ecg, nibp, etco2. ALSO temp, urine output, invasive venous/arterial monitoring, ecg, ventilator disconnect.

Question 20

complications of anaesthetics

Answer 20

airway, breathing, circulation, position, techniques, awareness.

Question 21

emergence/ awakening

Answer 21

muscle relaxation reversed, anaestetic agents off, resumption of spontaneous respiration, return of airway reflexes/control, extubation. This can be very quick of very, very slow.

Question 22

conduct of local anaesthesia

Answer 22

iv access, mointoring, spinal, epidural, plexus block, nerve block.

Question 23

how is recovery conducted?

Answer 23

ABC, pain control, mx of nausea and vomiting post-op, set criteria for discharge back to the ward.