Anaesthetics + Perioperative Care Flashcards

1
Q

What ASA is a normal healthy patient?

A

ASA I

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2
Q

What ASA is a brain-dead patient?

A

ASA VI

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3
Q

What ASA is a patient who will likely die without surgical management?

A

ASA V

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4
Q

How does BMI differ between ASA II and III

A

II: >30
III: >40

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5
Q

A social drinker with tight diabetes control is an ASA?

A

II

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6
Q

How does MI history differ between ASA III and IV

A

>3 months = III
<3 months = IV

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7
Q

What ASA is someone with end stage renal disease?

A

Regular dialysis: III
no dialysis: IV

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8
Q

When should you avoid TED stockings

A

Peripheral artery or neuropathy
Fragile or allergy prone skin
Improper fit (deformity, oedema)

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9
Q

VTE prophylaxis in acutely ill, palliative, psychiatrically ill

A

LMWH
fondapirinux sodium if above contraindicated

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10
Q

VTE prophylaxis in renal impairment

A

LMWH or UFH
May need to reduce dose

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11
Q

VTE prophylaxis in a cancer patient

A

NOT ROUTINE IF MOBILE/RECEIVING THERAPY

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12
Q

If a myeloma patient was receiving -lidomides + steroids, what VTE prophylaxis would you give?

A

Aspirin 75 or 150mg
OR
LMWH

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13
Q

What post-op VTE regimens would you give for an elective hip?

A

10 days LMWH then aspirin 75/150mg for another 28 days
OR
LMWH 28 days + VTE stockings until discharge
OR
Rivaroxaban

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14
Q

Post-op VTE meds for elective knee

A

14 days 75/150mg aspirin
OR
14 days LMWH + VTE stockings until discharge
OR
Rivaroxaban

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15
Q

Post-op VTE meds for fractures of pelvis, hip and prox femur

A

Month long regimen of
LMWH from 6-12 hours post-op
Fondapirinux 6 hours post-op where there is low risk of bleeding

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16
Q

Which diabetic medication do you change THE DAY BEFORE surgery?

A

Once daily insulin
Reduce dose by 20%

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17
Q

On surgery day, what do you do
a) in the morning
b) in the afternoon
if the patient is on metformin?

A

For both
OD/BD: take normally
TDS: Omit lunchtime dose

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18
Q

On surgery day, what do you do
a) in the morning
b) in the afternoon
if the patient is on glicliazide

A

Morning
OD: omit
BD: omit morning dose
Afternoon
OD or BD: omit

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19
Q

On surgery day, what do you do
a) in the morning
b) in the afternoon
if the patient is on a -flozin?

A

Omit all on day of surgery

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20
Q

On surgery day, what do you do
a) in the morning
b) in the afternoon
if the patient is on lantus

A

Reduce dose by 20% for day before and of surgery

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21
Q

On surgery day, what do you do
a) in the morning
b) in the afternoon
if the patient is on novomix/humulin 3

A

Twice daily/biphasics
Half morning dose, don’t change evening dose

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22
Q

What two diabetic drugs are taken as normal the day before and of surgery?

A
  • gliptins (DPPIV inhibitors)
  • tides (GLP-1 analogues)
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23
Q

Patient gets a fever on day 1 post-op; what is the likely cause? how would you treat it?

A

Wind (1-2), water (3), wound (5), walking (5-7), wonder drug (7+)

Ateclasis

Sit upright, breathing exercises

24
Q

Patient gets a fever day 7 post-op, what is the cause?

A

Wind (1-2), water (3), wound (5), walking (5-7), wonder drug (7+)

25
Q

Patient gets a fever day 5 post-op, what is the likely cause?

A

Wind (1-2), water (3), wound (5), walking (5-7), wonder drug (7+)

26
Q

What causes a fever day 6 post op?

A

Wind (1-2), water (3), wound (5), walking (5-7), wonder drug (7+)

DVT/PE

27
Q

What causes a fever on post op day 3?

A

Wind (1-2), water (3), wound (5), walking (5-7), wonder drug (7+)

UTI

28
Q

What action should be taken pre-op if the blood loss in surgery is

Unlikely

Likely

Definite

A

U: G+S

L: Cross match 2 units

D: 4-6 units

29
Q

When should blood transfusion be given in patients normally and with ACS

A

normal: 70g/L or under

ACS: 80g/L or under

30
Q

Patient with clinically significant (not haemorrhage) bleeding with APTT >1.5, what do you give?

A

FFP

150-220ml

31
Q

Patient with clincially signficant bleeding with DIC with fibrinogen conc <1.5g/L

A

Fibrinogen <1.5g/L so cryoprecipitate

32
Q

When can cryoprecipitate be given prophylactically?

A

Surgery with significant bleeding risk

fibrinogen <1/0g/L

33
Q

What can be given to reverse severe bleeding or IC haemorrhage?

A

Prothormbin complex concentrate

34
Q

When can TXA be useful in bleeding trauma?

A

Bolus then infusion within 3hours of bleeding

35
Q

How do the IV anaesthetics work?

A

Most potentiate GABA-A inhibition

Ketamine blocks NMDA receptors

36
Q

When is propofol to be used with caution?

A

Haemodynamic instability as causes hypotension

37
Q

What side-effect of propofol can be useful post-op?

A

Anti-emesis for high risk patients

38
Q

Which anaesthetics are useful in haemodynamic instability

A

KETAMINE

Etomidate also lesser hypotension than propofol/thiopental

39
Q

Which anaesthetic agent causes adrenal suppression?

A

Etomidate

40
Q

What anaesthetic casues hallucinations?

A

Ketamine

41
Q

Which drugs can induce malignant hyperthermia?

A

Suxamethonium

Volatile anaesthetics

42
Q

How is suxamethonium different from the other muscle relaxants?

A

Depolarising NM blocker

Causes MH, hyperkalaemia and AChase insufficiency

Cannot reverse with neostigmine

43
Q

Order the following drugs’ duration time from shortest to longest

Suxamethonium

Atracurium

Vecuronium

Pancuronium

A

S

V

A

P

44
Q

What airway methods are best for shorter procedures?

A

Oropharyngeal

Laryngeal mask

45
Q

What airway method is good in reduced GCS? When can you not use it?

A

Nasopharyngeal

Basilar skull fractures

46
Q

What is the downside of laryngeal masks/

A

Poor reflux control

47
Q

What airway method is good for optimal control for long and short term ventialtion?

A

ET tube

48
Q

Regarding lidocaine, what..

Circumstances is it cautioned?

Is used to treat it?

A

Low liver function or protein

20% lipid emulsion

49
Q

Regarding surgical nutrion options, which

Have low aspiration risk?

Are useful in those who cant enterally feed?

A

Naso-gastric, Naso-jejunal and feeding jejunostomy

TPN

50
Q

Aside from diabetc drugs, what drugs do you continue on the day of surgery?

A

B-blockers

Blood pressure meds

Diuertics for heart failure

51
Q

When does the COC pill need to be stopped before surgery?

A

4-6 weeks prior

52
Q

When does St. John/s wort and epehdra need to be stopped before surgery?

A

2 weeks prior

53
Q

When does the clopidogrel need to be stopped before surgery?

A

7 days

54
Q

When do DOACs (including treatment dose rivaroxiban) need to be stopped before surgery?

A

2 days

55
Q

When does Lithium, ACEIs and rivaroxiban (non-treatment dose) need to be stopped before surgery?

A

Day before (rivaroxiban 18hrs)

56
Q

When do K+ sparing drugs, metformin and gliciazide need to be stopped?

A

Morning of surgery

57
Q

What is done for insulin dependents if they are going to miss >1 meal/eGFR <60 or use of contrast media

A

Sliding scale insulin from NBM start