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Surg > Anaesthetics / peri op care > Flashcards

Anaesthetics / peri op care Flashcards

1
Q

How many days before surgery should Warfarin be stopped?

5 days
7 days
14 days

A

5 days

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2
Q

How many days before surgery should Clopidogrel be stopped?

5 days
7 days
14 days

A

7 days

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3
Q

How long before surgery should oral contraceptive pills/ HRT be stopped?

7 days
14 days
4 weeks

A

4 weeks

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4
Q

How long before surgery should patients stop eating and drinking for?

A

Stop eating 6 hrs before

Stop clear fluids 2 hrs before

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5
Q

Donor blood can be issued after which blood test- group and save or crossmatch?

A

Cross match

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6
Q

Which anti-emetics are best for opiod induced nausea and vomiting?

A

Ondansetron

Cyclizine

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7
Q

Which anti-emetics are best for gastric stasis/ impaired gastric emptying?

A

Metoclopramide

Domperidone

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8
Q

Which anti-emetics are dopamine antagonists?

A

Metoclopramide

Domperidone

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9
Q

Which anti-emetics are 5-HT3 antagonists?

A

Ondansetron

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10
Q

Which anti-emetics are H1 Histamine antagonists?

A

Cyclizine

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11
Q

Name 5 or more risks associated with anaesthesia.

A
  1. Eye damage (corneal abrasion)
  2. Teeth and mouth damage
  3. Pneumonia
  4. Nausea and vomiting
  5. Post op delirium/ cognitive dysfunction
  6. Accidental awareness
  7. Sore throat
  8. Anaphylaxis
  9. Malignant hyperpyrexia
  10. Death/ brain damage
  11. Nerve damage
  12. Urinary retention
  13. Post spinal/epidural headache
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12
Q

Normal urine output is >___ml/hr.

A

> 30ml/ hour

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13
Q

What is a normal urine output in ml/kg/hr?

A

> 0.5 ml/kg/hr

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14
Q

What two groups do local anaesthetics normally have?

A 
Aromatic group (hydrophobic)
Amine group (hydrophilic)
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15
Q

Give examples of Amide local anaesthetics?

A

Lidocaine
Bupivicaine
Prilocaine

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16
Q

Give examples of Ester local anaesthetics?

A

Cocaine
Procaine
Tetracaine

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17
Q

Local anaesthetics work by inhibiting influx of which ion through voltage gated channels?

A

Sodium

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18
Q

Local and regional anaesthetics work by…

A

Blocking voltage gated Na channels

Preventing transmission of pain signals so they don’t reach the CNS

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19
Q

General anaesthetics work by…

A

Preventing pain generated peripherally from being interpretted as pain by the CNS

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20
Q

Local anaesthetics can cause side effects when injected accidentally into plasma, such as…

A
  1. Light headedness
  2. Tinnitus
  3. Tongue numbness
  4. Convulsions
  5. CNS collapse
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21
Q

What is the maximum safe dose of Lidocaine (mg/kg)?

A

3mg/kg

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22
Q

What is the maximum safe dose of Bupivicaine (mg/kg)

A

2mg/kg

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23
Q

What is the maximum safe dose of Prilocaine (mg/kg)

A

6mg/kg

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24
Q

Give 2 examples of topical local anaesthetics?

A

EMLA cream (eutectic mixture of LA)- usually lidocaine and prilocaine

Lidocaine spray

Benzocaine lozenges

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25
Q

Where is a spinal anaesthetic injected?

A

L3/4
Below end of spinal cord
Into CSF- pass needle through all dura layers

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26
Q

Where is epidural anaesthetic injected?

A

Into the epidural space
Outside of the dura, just passes through ligaments
L2-4 for lower limb surgery, but can be given higher

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27
Q

What causes the plasma concentration of an anaesthetic to drop to “wake up concentration”?

A

Redistribution of the drug into tissues- mainly into fat

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28
Q

The more potent the inhaled anaesthetic, the ________ the MAC.

A

Lower

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29
Q

Entenox is a 50:50 mix of….

A 
Nitrous oxide (N2O)
Oxygen
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30
Q

Enflurane and isoflurane both cause vaso__-

A

Vasodilation

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31
Q

Sevoflurane is a widely used inhaled anaesthetic and has a rapid induction due to its ____ solubility.

A

Low

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32
Q

_______ is an inhaled anaesthetic that has a low boiling point so must be given with a heated vaporiser.

Dantrolene
Sevoflurance
Desflurane

A

Desflurane

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33
Q

How many neurons do most pain pathways have?

A

3

1st order- receptor to spinal cord
2nd order- spinothalamic tract to thalamus
3rd order- thalamus to cortex

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34
Q

What are the 2 main pain neurons?

A

a delta- nociception and mechanoreception

C- nociception and mechanoreception

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35
Q

Which neurotransmitter is implicated in acute pain?

Glutamate
Dopamine
Substance P

A

Glutamate

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36
Q

Which neurotransmitter is implicated in chronic pain?

Glutamate
Dopamine
Substance P

A

Substance P

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37
Q

Opiods are best used as analgesia for which type of pain?

A

Visceral pain

38
Q

Give 3 examples of side effects of NSAIDs.

A

Gastric ulcers
Renal failure
Bronchospasm

39
Q

Give 3 examples of side effects of opiods.

A 
Respiratory depression
Nausea and vomitting
Constipation
Depressed cough reflex
Dysphoria
Tolerance and dependence
40
Q

A hudson face mask is typically used to deliver what percentage of O2?

A

30-40%

41
Q

With a reservoir mask (emergency non rebreath mask), oxygen flows into the bag during ________.

A

Expiration

42
Q

Venturi masks are used to provide oxygen at which concentrations?

A 
Blue- 24 %
White -28%
Yellow- 35%
Red- 40%
Green- 60%
43
Q

How is MAP (Mean arterial pressure) calculated?

A

Diastolic + 1/3 (Systolic-Diastolic)

44
Q

When the oscillations in cuff pressure are at a maximum, this represents what blood pressure?

A

MAP

45
Q

When the oscillations in cuff begin increasing, this represents what blood pressure?

A

Systolic

46
Q

Oxyhaemoglobin absorbs light of what colour?

A

Blue light (narrow wavelength)

47
Q

Deoxyhaemoglobin absorbs light of what colour?

A

Red light (wider wavelength)

48
Q

Pulse oximetry uses how many light sources?

1
2
3

A

2: red light and infrared light

49
Q

What can cause a false high reading in pulse oximetry?

A

Carbon monoxide poisoning

50
Q

Peak Inspiratory Flow Rate (PIFR) is usually between….

A

25- 30 l/ min

51
Q

Peak Expiratory Flow Rate (PEFR) is usually between….

A

300-600 l/min

52
Q

The average human has how many litres of total body water?

A

42 litres

53
Q

Two thirds of total body water is stored where?

Intracellularly
Extracellularly

A

Intracellular

54
Q

One third of total body water is stored where?

Intracellularly
Extracellularly

A

Extracellular

55
Q

The average human has approx how many litres of intravascular fluid?

A

4.7 liters

56
Q

Which ions are mainly found intracellularly?

A

Potassium
Magnesium
Phosphate
Protein

57
Q

Which ions are mainly found extracellularly?

A

Sodium
Chloride
Bicarbonate

58
Q

Osmolality is the number of osmoles per __

A

kg

59
Q

Osmolarity is the number of osmoles per __

A

litre

60
Q

The normal value of plasma osmolality is ……

A

290mosm/kg

61
Q

Give 2 examples of isotonic fluids which can be given IV.

A

0.9% saline

5% dextrose glucose

62
Q

Give 3 examples of crystalloid fluids.

A
  1. 0.9% saline
  2. 5% dextrose
  3. Hartmann’s (sodium lactate)
63
Q

Give 3 examples of colloid fluids.

A

Albumin
Starch
Dextran
Gelatin

64
Q

Which body compartment does 0.9% saline go into?

A

Remains in the ECF, does NOT enter cells

Has a short half life as will be excreted by the kidneys

65
Q

Which body compartment does 5% dextrose go into?

A

Is distributed into cells once the glucose is metabolised

66
Q

Which body compartment does Hartmann’s (sodium lactate) go into?

A

Stays in the ECF

for as long as 0.9% saline does

67
Q

Give 3 examples of problems caused by using colloids.

A

Pruritis
Renal function affected
Anaphylaxis
Anti-thrombotic

68
Q

How do hypertonic sollutions affect cells?

A

Cause them to shrink

69
Q

How do hypotonic sollutions affect cells?

A

Cause them to swell and lyse

70
Q

What happens to the U&Es when a person is dehydrated?

A

Urea increases
Urea to creatinine ratio rises
Sodium increases

71
Q

A 1000ml bag of 0.9% saline causes an increase in blood volume of _____mls.

A

333mls

72
Q

A 1000ml bag of 5% dextrose causes an increase in blood volume of _____mls.

A

100mls

73
Q

For maintenance requirements a person needs _____mls/kg/hr of fluid.

A

1.5 ml/kg/hr

74
Q

First line urgent fluid therapy should involve ________mls of 0.9% saline OR ________mls of colloid.

A

2000mls 0.9% saline

1000mls colloid

75
Q

Which blood group is the most common in the UK?

A

O positive

76
Q

Which blood type can be given as donation to anyone?

A

O negative

77
Q

Which blood type can receive any blood group as a donation?

A

AB

78
Q

What are the 3 most serious risks of blood transfusion?

A
  1. Anaphylaxis
  2. ABO incompatibility
  3. Bacterial contamination
79
Q

Should a massive transfusion be given via a central line?

A

No

Can cause overload to the heart

80
Q

How should platelets be stored?

A

22 degrees
<7 days
Agitated

81
Q

How should RBCs be stored?

A

4 degrees

<35 days

82
Q

Which local anaesthetic is cardiotoxic so can not be used in regional anaesthesia nerve blocks?

A

Bupivicaine

83
Q

Which local anaesthetic is used for regional anaethesia commonly?

A

Prilocaine

84
Q

What can be given to reverse the effects of local anaesthetic (lidocaine) overdose?

A

IV 20% lipid emulsion

85
Q

Which 2 drugs are key triggers for Malignant hyperpyrexia?

A
  1. Halothane

2. Suxamethonium

86
Q

Dantrolene is used to treat which rare dangerous condition that can occur following induction of anaesthesia?

A

Malignant hyperpyrexia

87
Q

Name 1 or more drug used for SEDATION in anaesthesia.

A
  1. Midazolam
  2. Propofol (+morhpine)
  3. Ketamine
88
Q

Which IV anaesthetic commonly has pain on injection?

Etomidate
Propofol
Ketamine
Sodium thiopentone

A

Propofol

89
Q

Which IV anaesthetic can cause adrenal suppression and post op nausea?

Etomidate
Propofol
Ketamine
Sodium thiopentone

A

Etomidate

90
Q

Which IV anaesthetic can be used for Rapid Sequence Induction and in status epilepticus?

Etomidate
Propofol
Ketamine
Sodium thiopentone

A

Sodium thiopentone

91
Q

How may you know if a patient has aspirated?

A
  1. Vomiting
  2. Coughing
  3. Laryngospasm/ bronchospasm
  4. Decreasing Oxygen sats
  5. Tachypnoea
  6. Wheeze or crepitations on auscultation
  7. Direct visualisation on laryngoscopy
92
Q

Name 3 or more factors that may increase the risk of aspiration.

A
  1. Emergency surgery
  2. Patient eaten or drank within close time of operation
  3. Pregnancy
  4. Diabetes
  5. Hiatus hernia

Surg (6 decks)

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