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Phase 4 - Katherine > Anaesthetics COPY > Flashcards

Anaesthetics COPY Flashcards

1
Q

Name some anti emetics ?

Which is best for post op nausea / vomiting?

vertigo?

travel sickness ?

A

ondansetron
cyclizine
domperidone
metoclopramide
prochlorperazine

ondansetron
prochlorperazine
cyclizine

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2
Q

what things do you need to do pre op?

A

Optimise medical conditions
Adjust medication
Check investigations
Check weight
EXPLAIN AND CONSENT

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3
Q

parts of relevant anaesthetic Hx ?

A

previous anaesthetics, FHx
Airway problems
PONV

Malignant hyperpyrexia - this is a dangerous complication of anaesthesia due to an underlying muscular disorder.
(Inherited skeletal muscle disorder. May reverse with Dantralene. Triggered by volatiles and suxamethonium.Hyperkalaemia, hypoxia, temperature, rhabdomyolysis)

Suxamethonium apnea
(Patient does not have enzyme to break down therefore use propofol (Inherited disorder of acetylcholinesterase)

Allergies
Anaesthetic agents, analgesics, antibiotics, latex and eggs (propofol)

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4
Q

What to do for pt on warfarin for AF for operation

A

Stop and use LMWH

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5
Q

What features could make a difficult airway?

A

Anatomical
small mouth, small chin, large tounge, big neck

Lack of movement in neck / mouth

poor dentition

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6
Q

What 3 tests can be used to assess airway for intubation

A

mallampati (oropharynx) - open mouth and see differing amounts of the airway

extention of upper cervical spine
(<90 degrees)

thyromental test
(Distance from tip of thyroid to tip of mandible at gull extension Normal > 6.5cm, under 6cm = difficult laryngoscopy)

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7
Q

3 parts of anaesthetic triad

A

anaesthesia
analgesia
muscle relaxation

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8
Q

With GA what 2 options of route are there?

A

IV - propofol

Inhaled (iso/sevo/desfluorane) @young children/ needle phobics

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9
Q

During induction of GA what should you do?

A

pre oxygenate / oxygenate

secure / manage airway

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10
Q

What drug is usually given with propofol for maintenance of GA

A

Remifentanil

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11
Q

What level of GCS do you need to provide airway control

A

Under 8

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12
Q

Physical manoeuvres for airway control

A

head tilt
chin lift
jaw thrust

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13
Q

When would be cautious using a nasopharyngeal tube?

A

base of skull fracture

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14
Q

3 ways to determine correct placement of ET tube?

A

Chest movement
Misting of mask
Trace on capnography

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15
Q

2 places an ET tube can go thats wrong

A

oesophagus
1 bronchus (too far in)

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16
Q

which local anaesthetic only lasts for a short period of time?

A

lidocaine

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17
Q

which local anaesthetic can provide 2 hours anaestheia and 12 hours of analgesia

A

bupivocaine

use for regional blocks

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18
Q

advantages of regional anaestheisa over GA

A

Avoids GA
Can be awake
Avoid airway problems
Less nausea and vomiting
Better peri-operative pain control

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19
Q

Where does an epidural go? spinal ?

A

between ligaments and dura

through dura

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20
Q

3 reasons muscle relaxants are used for surgery ?

A

Relax opening to trachea (glottis)

Relax muscles for surgery

Patients do not fight ventilators

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21
Q

Egs of muscle relaxants

A

suxamethonium - used for emergencies

Atracurium, rocuronium, vecuronium

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22
Q

Reversal of muscle relaxants

A

neostigmine

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23
Q

How do NSAIDS work ?

A

Inhibit cyclo-oxygenase

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24
Q

Side effects of opiodss

A

CNS - sedation, miosis
CVS- bradycardia, hypotension
Resp - brady / apnoea
GI - N+V, constipation
Urinary - retention
Skin - itching

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25
Egs of weak opiods
codeine tramadol
26
rule of 1/3s for fluids
2/3 intracellular (28L) (Na/Cl poor, K rich) 1/3 extracellular (14L) (Na/cl rich, K poor) - 2/3 interstitial - 1/3 intravascular
27
Egs of crystaloid fluids
NaCl dextrose hartmanns
28
What is a crystaloid fluid? colloid?
Ions or small molecules dissolved in water Larger insoluble molecules retained within plasma for longer
29
Egs of synthetic colloid fluids
blood, albumin Synthetic (starch gelatin - these are never used) risk of anaphylaxis!
30
Difference between t1/2 resp failure and mx with NIV
1 Hypoxia without hypercapnia CPAP continuous 2 Hypoxia with hypercapnia NPPV (BiPAP biphasic)
31
CPAP vs NPPV
CPAP Increases intrathoracic pressure by maintaining a positive end expiratory pressure allowing the alveoli to stay open rather than collapse. improves FRC and oxygenation reverse resp acid NPPV increase tidal volume by giving the breath an extra push whilst also painting PEEP. This increased breath allows for better CO2 clearance
32
What happens in T1 resp failure - how does CPAP help
V/Q missmatch Inadequate oxygenation -Alveolar collapse (pneumonia -Fluid in alveoli (L heart failure) CPAP - maintains minimum airway pressure alveolus held open fluid forced from lung
33
Eg of 2 causes of t2 resp faulure ? How does BiPAP help
COPD, Muscular dystrophy Inadequate ventilation(effect of dead space) -> limited alveolar expansion at inspiration adds inspiratory pressure (IPAP) and EPAP at expiration (further expands lung holds open collapsing increases ventilation airway)
34
DDx for resp failure - Name a couple
Pneumonia Atelectasis (collapsed units), pneumothorax Pulmonary oedema Thromboembolic disease Bronchospasm/obstruction, pre-existing, ARDS, increased metabolic demand Central respiratory depression
35
Complications of invasive ventilation
VAP (ventilator associated pneum) VALI (lung injury) Need sedation and muscle relaxant Immobility + TED stocking Oxygen toxicity
36
What is involved in the pre-op assessment?
History of presenting compaint Surgical, anaesthetic and medical history Systems review Drug history and allergies Social history ASA SCORE
37
ASA score
1 - normal 2 - mild systemic disease with no limitation of activity 3 - severe systemic disease with limitation of activity 4 - incapacitating 5 6
38
NCEPOD - how quickly you have to do surgery
1 - minutes 2 - hours 3 - days 4 - planned
39
Pre-op drug changes
Steroids - continue Diuretics - drop say before ACEi - stop if major surgery or if blood loss anticipated BBs - always continue Diabetic meds - sliding scale over night Warfarin - stop 4 days before and monitor INR cOCP - supposed to stop 4 weeks before and re-start 2 weeks after
40
Cancelation reasons
URTI recent MI poor control of drugs poor bloodworm - electrolyte abnormalities inadequate prep - consent, fasting uncontrolled AF
41
CHECKLIST FOR SAFETY
IDENTITY PROCEDURE CONSENT EQUIPTMENT SITE MARKED ALLERGIES ASPIRATION RISK
42
Post op
stop vapours give o2 throat suction reverse muscle relaxation - neostigmine
43
Causes of post-op N&V
Patient - female, previous post-op n&v, anxious Anaesthetic - opioids, NO2, dehydration Surgery - laparotomy, gynaecology, abdo neuro, ENT, eye
44
Intra and post op antiemetics
intra - dex, ond post- cyclizine wrist thing
45
Dose of lidocaine SEs of toxicity and management
3mg/kg, 7 with adrenaline Toxicity --> numbness of tongue, lightheadedness, visual and auditory disturbances ---> go on to really bad ones Management Stop injecting LA A-E REVERSAL --> intralipid
46
Differences between spinal and epidural
Spinal - subdural space - less amount - 5-10 min onset epidural - into epidural potential space - larger volume - 15-30 min headache Contraindications: - neuro disease - hypovolaemia - anticoagulants
47
Resp acidosis cause
severe asthma, COPD, hypoventilation
48
Resp alkalosis cause
hyperventilation, panic attack
49
Met acidosis cause
DKA, lactic acidosis
50
Met alkalosis cause
loss of acid (severe vomiting), NG drain
51
RISK OF FLUIDS
pulmonary oedema
52
Sx of raised ICP
headache - worse in morning, coughing, bending down vomiting - without nausea papilloedema Cushing's triad - increased systolic BP, bradycardia, Cheyne-Stoke respiration
53
Treatment of malignant hyperthermia? How does it work?
It is treated with dantrolene. Dantrolene interrupts the muscle rigidity and hypermetabolism by interfering with the movement of calcium ions in skeletal muscle.
54
How is malignant hyperthermia inherited?
Autosomal dominant
55
What are the 2 main categories of anaesthesia?
General Regional
56
What does fasting for an operation involve?
6 hrs no food 2 hrs no clear fluids
57
Give an example of premedication before general anaesthesia- post oxygenation
Benzodiazepines e.g. midazolam - relax muscles and reduce anxiety Opiates e.g. fentanyl - reduce pain and reduce hypertensive response to laryngoscope Alpha-2-adrenergic agonists e.g. clonidine - helps sedation and pain
58
When is RSI used? (2)
Emergency - preplanning not possible and pt not fasted Pts with GORD or Pregnancy to avoid aspiration
59
Give 4 examples of IV options for general anaesthetic
Propofol (the most commonly used) Ketamine Thiopental sodium (less common) Etomidate (rarely used)
60
Give 4 examples of inhaled GA
Sevoflurane (the most commonly used) Desflurane (less favourable as bad for the environment) Isoflurane (very rarely used) Nitrous oxide (combined with other anaesthetic medications – may be used for gas induction in children)
61
What is generally used to induce GA
IV medication e.g. propofol
62
What is generally used to maintain GA
Inhaled medications as it takes longer for them to diffuse through the lungs
63
What is usually used in TIVA? What is the advantage of this?
Propofol. Nicer recovery compared to inhaled options.
64
What is the one contraindication of propafol
Shock
65
What are the 2 categories of muscle relaxation
Depolarising e.g. suxamethonium Non-depolarising e.g. rocuronium
66
What can be used to reverse muscle relaxants
Cholinesterase inhibitors e.g. neostigmine
67
How do you test the muscle relaxant has worn off before the patient becomes conscious?
Nerve stimularor at ulnar nerve, facial nerve and temple (4 times each)
68
What is malignant hyperthermia?
A rare hypermetabolic response to anaesthesia Risks include: Volatile anaesthetcs Suxamethonium
69
Symptoms of malignant hyperthermia
Increased body temperature (hyperthermia) Increased carbon dioxide production Tachycardia Muscle rigidity Acidosis Hyperkalaemia
70
What is ASA 1
A normal healthy pt
71
What is ASA II
A patient with mild systemic disease (Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (BMI 30 - 40), well-controlled Diabetes Mellitus/Hypertension, mild lung disease)
72
What is ASA III
A patient with server systemic disease (Substantive functional limitations; One or more moderate to severe diseases. Examples include (but not limited to): poorly controlled Diabetes Mellitus/Hypertension, COPD, morbid obesity (BMI > 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, End-Stage Renal Disease (ESRD) undergoing regularly scheduled dialysis, history (>3 months) of Myocardial infarction, Cerebrovascular accidents)
73
What is ASA IV
A patient with severe systemic disease that is a constant threat to life
74
What is ASA 5
A moribund patient who is not expected to survive without the operation
75
What is ASA 6
A declared brain-dead patient whose organs are being removed for donor purposes
76
How should once daily long acting insulin be taken on the day before, of and day after surgery?
20% reduction in dose
77
For elective total hip replacement surgery NICE recommend commencing a low molecular weight heparin when?
6-12 hours after surgery
78
What induction agent is useful in haemodynamically unstable pts?
Ketamine
79
What kind of airway is contraindicated in basal skull fracture
Nasopharyngeal
80
When should COCP or HRT be stopped prior to surgery
4 weeks before

Phase 4 - Katherine (26 decks)

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