Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YR6 Rotations > Anaesthetics + Peri-operative care > Flashcards

Anaesthetics + Peri-operative care Flashcards

1
Q

In which patients are nasopharyngeal airways ideal? In which patients are they contraindicated?

A

Ideal: Seizure

CI: Base of skull fracture- rare risk of inserting into cranial cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the pre-op fasting recommendatios?

A

Food >6h
Clear fluids >2h

Also applkies to pregnant women not in labour + diabetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What can be used for emergency surgery in a non-pregnant adult who has not fasted?

A

Rapid sequence induction to reduce risk of gastro-oesophageal reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does rapid sequence induction involve?

A

Optimal preoxygenation
Induction agent + suxamethonium
Application of cricoid force at the onset of unconsciousness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How are diabetics treated with insulin with good glycaemic control managed during minor procedures?

A

Adjustment of usual insulin regimen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How are diabetics with surgery requiring a long asting period >1 missed meal/ poorly controlled diabetics managed during surgery?

A

Variable rate IV insulin infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are most diabetics taking oral drugs managed for surgery?

A

Manipulating medication on day of surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give 3 exceptions where diabetics on oral drugs should be managed with variable rate IV insulin infusion

A

> 1 meal to be missed
Poor glycaemic control
Risk of renal injury (low eGFR, contrast use)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How shold diabetics on metformin with a morning or afternoon op be managed?

A

Day prior: normal dose
OD-BD: normal
TD: omit lunchtime dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How shold diabetics on sulfonylureas with a morning op be managed?

A

Day prior: normal dose
OD in AM: omit
BD: omit AM dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How should diabetics on DPP IV inhibitors (-gliptins) or GLP-1 analogues (-tides) be managed for surgery?

A

Day prior: normal dose
AM or PM surgery: normal dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should diabetics on SGLT-2 inhibitors (-flozins) be managed for surgery?

A

Day prior: normal dose
AM or PM surgery: omit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How should diabetics on OD insulins e.g. Lantus, Levemir be managed for surgery?

A

Dar prior: reduce dose by 20%
AM or PM surgery: reduce dose by 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should diabetics on BD biphasic or ultra-long acting insulins e.g. Novomix 30 be managed for surgery?

A

Day prior: normal dose
AM or PM surgery: halve usual AM dose, normal evening dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How shold diabetics on sulfonylureas with a afternoon op be managed?

A

Day prior: normal dose
OD in AM: omit
BD: omit both doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

4 stages of wound healing

A

Haemostasis: mins-hours
Inflammation: 1-5d
Regeneration: 1-8w
Remodeling: 6w-1y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which phase of wound healing is the longest?

A

Remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name a condition that impairs fibroblast synthetic function and immunity with detrimental effect in healing process

A

Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

3 conditions that can compromise microvascular flow and impair healing

A

Vascular disease
Shock
Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

List 4 drugs that impair wound healing

A

NSAIDs
Steroids
Immunosuppressive agents
Anti-neoplastic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is closure?

A

Delayed primary closure: anatomically precise closure that is delayed for a few days before granulation tissue becomes macroscopically evident

Secondary closure: spontaneous closure/ surgical closure after granulation tissue has formed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are hypertrophic scars?

A

Abnormal, fibroproliferative scars with excess collagen
DONT progress beyond margins of original injury.

23
Q

5 features of hypertrophic scars

A

Pink-red
Slightly raised
Uncomfortable + itchy
Occur within weeks of injury
Limited to confines of initiating wound

24
Q

What usually causes hypertrophic scars?

A

Full thickness dermal injury

25
Q

What are keloid scars?

A

Tumour-like lesions arising from connective tissue of a scar/ spontaneously
Extend beyond the margins of the original wound

26
Q

Give 3 predisposing factors for keloid scars

A

Dark skin
Young adults
Sites: sternum, shoulder, neck, face

27
Q

Management of keloid scars

A

Early: intra-lesional steroids e.g. Triamcinolone

Excision (risk further keloid scarring/ recurrence)

28
Q

Give 5 features of keloid scars

A

Purplish-red
Firm, smooth + raised
Uncomfortable + itchy
Can occur years after injury + don’t regress
Grow beyond initiating wound area

29
Q

Which abnormal form of scar contains nodules?

A

Hypertrophic scars

30
Q

Describe the MOA of Suxamdthonium

A

Non-competitive (or depolarising) muscle relaxant
Induces prolonged depolarisation of skeletal muscle membrane

31
Q

How does the use of suxamethonium manifest in a patient?

A

Fasciculations lasting a few seconds before profound paralysis

32
Q

What is suxamethonium aka?

A

Succinylcholine

33
Q

When is suxamethonium usually used/

A

Rapid sequence intubation in emergency settings due to fast onset + short duration of action

34
Q

Give 2 adverse effects of suxamethonium

A

Malignant hyperthermia
Hyperkalaemia (norm transient)

35
Q

In which patients is suxamethonium contraindicated? Why?

A

Penetrating eye injuries + acute closed angle glaucoma
It increases intra-ocular pressure

36
Q

Name 4 competitive (non-depolarising) muscle relaxants

A

Atracurium
Tubcurarine
Vecuronium
Pancuronium

37
Q

How do competitive (non depolarising) muscle relaxants work?

A

Competitive antagonism of acetylcholine at nicotinic receptors at NMJ

38
Q

Name 1 adverse effect of competitive muscle relaxants

A

Hypotension

39
Q

What drug can be used for reversal of competitive muscle relaxants?

A

Acetycholinesterase inhibitors e.g. Neostigmine

40
Q

What is the MOA of Glycopyrrolate? How does this work?

A

Competitive antagonist of ACh at peripheral muscarinic receptors
Profound anti-secretory action

41
Q

When is Glycopyrrolate used?

A

In conjunction with other anti-cholinesterases e.g. neostigmine to reverse muscle relaxation at end of surgery if required

42
Q

What is postoperative ileus aka?

A

Paralytic ileus

43
Q

What is the common cause of postoperative ileus?

A

Surgery involving the bowel
Reduced bowel peristalsis resulting in pseudo-obstruction

44
Q

Give 5 S/S of postoperative ileus

A

Abdo distension/ bloating
Abdo pain
N+V
Inability to pass flatus
Inability to tolerate oral diet

45
Q

What may contribute to development of post-operative ileus?

A

Deranged electrolytes
Check potassium, magnesium + phosphate

46
Q

Describe management of post-op ileus

A

NBM initially, may progress to small sips clear fluid
NG tube if vomiting
IV fluids to maintain normovolaemia
TPN for prolonged/ severe cases

47
Q

ASA 1

A

Normal healthy patient
Non-smoker
No/ minimal alcohol use

48
Q

ASA 2

A

Mild systemic disease
w/o substantive functional limits
e.g. current smoker, social alcohol drinker, pregnancy, obesity (BMI 30-40), well-controlled DM/ HTN, mild lung disease

49
Q

ASA 3

A

Severe systemic disease
Substantive funcitonal limitations
>,1 severe diseases

50
Q

ASA 4

A

Severe systemic disease that is a constant threat to life

51
Q

ASA 5

A

Moribund patient who is not expected to survive w/o the operation

52
Q

ASA 6

A

Declared brain-dead patient whose organs are being removed for donor purposes

53
Q

When is the gold standard for stopping the OCP prior to surgery under GA?

A

4w
Due to increased risk thromboembolism

No need to stop if LA

54
Q
A

YR6 Rotations (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions