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CP3 Crit Care > Anaesthetics - Peri-Operative Care > Flashcards

Anaesthetics - Peri-Operative Care Flashcards

1
Q

How common is post-op nausea/vomiting (PONV)?

A

25% surgical pts

-delayed discharge & recovery

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2
Q

What is the pathophysiology underlying PONV?

A

Input to vomiting centre from

  • higher cortical centres (memory/fear)
  • stomach/SI (direct surgical effects)
  • chemoreceptor trigger zone (anaesthetic drugs/opioids)
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3
Q

What are the risk factors for PONV?

A 
Pt = F>M, obesity, non-smoker, prev hx of PONV
Procedure = abdo, gynae, ENT
Anaesthetic = long duration, GA, inhalation agents
Post-op = pain, opioid analgesia, dehydration, hypotension
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4
Q

What are the common treatments for PONV?

A

Cyclizine (50mg/8h IV/IM/PO)
Prochlorperazine (12.5mg/6h IM)
Ondansetron (4mg/8h IV/PO)

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5
Q

When is Dexamethasone added to manage PONV?

A

At any stage if nausea not controlled

-often added w/ Cyclizine

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6
Q

What is Cyclizine?

A

Anti-histamine useful in middle ear surgery/motion sickness

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7
Q

When is Cyclizine contraindicated?

A

Heart failure
BPH
Hepatic/renal disease

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8
Q

What is Prochlorperazine?

A

Dopamine antagonist stabilizing the CTZ & having prokinetic effects
-also Metoclopramide/Domperidone

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9
Q

When is Metoclopramide ineffective?

A

PONV

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10
Q

When is Prochlorperazine contraindicated?

A

Parkinson’s

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11
Q

What is Ondansetron?

A

5-HT3 antagonist that blocks vagal afferents from gut/CTZ

  • most effective agent
  • can be given prophylactically
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12
Q

When is use of Ondansetron cautioned?

A

Hepatic impairment
QT prolongation
Pregnancy/breast feeding

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13
Q

What is Dexamethasone?

A

Glucocorticoid w/ unknown MoA augmenting other medications

-used early on

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14
Q

How long should supplementary O2 be given for post-op?

A

At least 72hrs

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15
Q

Why should supplementary O2 be given post-op?

A

Dose-dependant depression on sensitivity of central chemoreceptors to stimulatory effect on CO2

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16
Q

What are the methods of O2 delivery used post-op?

A

Nasal cannulae
Simple (Hudson) facemask
Venturi masks

17
Q

How much O2 do nasal cannulae deliver?

A

2-4 L/min + plus room air

18
Q

How much O2 do simple (Hudson) facemasks deliver?

A

5-10 L/min

19
Q

How much O2 do venture masks deliver?

A 
Blue = 24% inspired O2, 2-4 L/min
White = 28% inspired O2, 4-6 L/min
Yellow = 35% inspired, 8-10 L/min
Red = 40% inspired, 10-12 L/min
Green = 60% inspired, 12-15 L/min
20
Q

What are the limitations of pulse oximetry?

A

Cannot distinguish b/w CO & O
-inaccurate after smoke inhalation, CO poisoning, smokers
Does not reflect O2 carrying capacity
Hypovolaemia makes getting a reading difficult
Venous pulsations can produce a venous reading
Nail polish affects SpO2

21
Q

How should Warfarin be managed pre- & post-op?

A

Stop 10 days before surgery
-if INR <1.5 surgery can go ahead
Generally substituted w/ LMWH
-withheld evening before surgery

22
Q

How should Clopidogrel be managed pre-op?

A

Stop 7 days before surgery

23
Q

How should COCP be managed pre- & post-op?

A

Stop 4wks before major ops
-switching to POP acceptable
Restart at first menses
->2 wks after mobilisation

24
Q

What are the stages of wound healing?

A

haemostasis
inflammation
regeneration
remodelling

25
Q

What is the cause of a hypertrophic scar?

A

Excessive amounts of collagen within a scar

26
Q

What is the cause of a keloid scar?

A

Excessive amounts of collagen within a scar. Typically a keloid scar will pass beyond the boundaries of the original injury. They do not contain nodules and may occur following even trivial injury.

shiny dark scar bigger than the wound injury

27
Q

What are the early causes of post-op pyrexia (0-5 days)?

A 
Blood transfusion
Cellulitis 
Urinary tract infection 
physiological systemic inflammatory reaction 
Pulmonary atelectasis

Day 1-2: ‘Wind’ - Pneumonia, aspiration, pulmonary embolism
Day 3-5: ‘Water’ - Urinary tract infection (especially if the patient was catheterised)
Day 5-7: ‘Wound’ - Infection at the surgical site or abscess formation

28
Q

What are the late causes of post-operative pyrexia? >5 days

A

VTE
pneumonia
wound infection
anastomotic leak

Day 5+: ‘Walking’ - Deep vein thrombosis or pulmonary embolism
Any time: Drugs, transfusion reactions, sepsis, line contamination

29
Q

What is the management of post-operative ileus?

A

NBM + NG tube insertion

30
Q

What drug should patients taking prednisolone be prescribed before surgery?

A

Hydrocortisone

31
Q

When is thromboprophylaxis given post-surgery?

A

6 hours post surgery

CP3 Crit Care (11 decks)

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