Anaesthetics & ICU Flashcards
Describe ASA I
Normal healthy patient, non-smokers and no/minimal alcohol intake.
Describe ASA II
Mild systemic disease:
- well controlled diabetes or HTN
- pregnant
- obesity (BMI 30-40)
- mild lung disease
- current smoker
Describe ASA III
Severe systemic disease:
- poorly controlled diabetes or HTN
- COPD
- BMI >40
- ACS/stroke/TIA >3 months ago
Describe ASA IV
Severe systemic disease that is a constant threat to life:
- ACS/stroke/TIA <3 months ago
- sepsis
- severe valve dysfunction
- severe reduction in ejection fraction
Describe ASA V
Moribund patients not expected to survive the operation e.g. ruptured AAA, massive bleed, intracranial haemorrhage with mass effect.
Describe ASA VI
A patient declared brain-dead whose organs are being removed for donation.
Can malignant hyperthermia present with a normal temp?
Yes ! Still given IV dantrolene
Hyperthermia is a late sign
How can hyperventilation reduce ICP?
Hyperventilation reduces pCO2 –> vasoconstriction of cerebral arteries –> rapid reduction in ICP.
Perioperative mx of patients on steroids?
Switch oral steroids to 50-100mg IV hydrocortisone.
If there is associated hypotension then fludrocortisone can be added.
For minor operations oral prednisolone can be restarted immediately post-operatively. If the surgery is major then they may require IV hydrocortisone for up to 72 hours post-op.
Where is an epidural placed?
Below L2 to avoid injury of spinal cord
Normally L3/L4 or L4/L5
Which anti-emetic needs to be avoided in post-GI surgery?
metoclopramide
A 45-year-old male undergoes a hemicolectomy for severe ulcerative colitis. Post-operatively, he develops extreme nausea.
Which antiemetic needs to be avoided?
It is likely that this N&V is due to GI obstruction following GI surgery.
Metoclopramide needs to be avoided.
What analgesia may be useful in rib fractures
Thoracic epidural
Mx of spasmodic pain in palliative care?
Diazepam
Baclofen
When should cyclizine be avoided?
Severe HF
