Anaesthetics/Pre-Op Flashcards
What are the positional manoeuvres which can be used to open airway?
- Head tilt/chin lift
- Jaw thrust (used when any concern of C spine injury)
What is the different airway adjuncts?
- Nasopharyngeal airway (good for seizures but cannot be used if basal skull fracture suspicion)
- Oropharyngeal airway (Guedel)
- Laryngeal airway (iGel)
- Endotracheal tube
What error can happen with Endotracheal tube insertion and what should be monitored to check this?
Oesophageal intubation - monitor end-tidal CO2 (capnography)
What are 2 types of inhaled anaesthetics?
- Volatile liquids e.g. isoflurane
- Nitrous oxide
What are the side effects of inhaled anaesthetics?
- Fluranes -> Malignant hyperthermia
- NO -> Avoid in pneumothorax as can cause increase in pressure in air compartments
What are the different IV anaesthetic options?
Propofol - commonly used - has anti-emetic properties so useful for high risk N+V patients
Thiopental - can cause laryngospasm but acts quickly on the brain as is fat-soluble
Ketamine - useful in trauma as does not cause drops in BP
What are the different local anaesthetic options?
Lidocaine
- Works by blocking sodium channels
- Can be toxic (treated with IV 20% lipid emulsion)
Other options include
- Bupivacaine
- Prilocaine
- Cocaine
What is malignant hyperthermia?
- Autosomal dominant
- Hyperpyrexia and muscle rigidity following anaesthetic agents, commonly suxamethonium
- Caused by excessive release of Ca2+ from skeletal muscle
- Bloods show raised CK
- Manage with Dantrolene
What are the types of muscle relaxants?
Suxamethonium
- Depolarising neuromuscular blocker
- Fastest onset and shortest duration
Others include
- Atracurium
- Vecuronium
What are causes of post-op pyrexia?
Early
- Blood transfusion
- Cellulitis
- UTI
Late
- VTE
- Pneumonia
- Wound infection
What is postoperative ileus?
- A common complication of bowel surgery
- Reduced bowel peristalsis resulting in pseudo obstruction
- Presents like obstruction
- Check potassium, magnesium and phosphate as can be caused by deranged electrolytes
- Managed conservatively with fluids, NG feeding
What are the rules regarding food and drink with surgery?
- Clear fluids until 2 hours before
- Food stopped 6 hours before
What complications are diabetic patients at higher risk of?
- Wound and resp infections
- Post-operative AKI
- Length of hospital stay
How can patients on metformin be managed?
- If taken 1 or 2 times a day, continue as normal
- If taken 3 times a day, omit lunchtime dose if prolonged surgery
How can patients on gliclazide be managed?
Omit doses on day of surgery BEFORE/DURING the operation (i.e. for morning surgery, if taken twice a day, just omit morning dose but if afternoon surgery, omit both morning and afternoon)
How should patients on DPP/GLP be managed?
Take as normal
How should patients on SGLT-2 inhibitors be managed?
Omit on day of surgery
How should patients on insulin be managed?
Once daily regime: reduce dose by 20%
Twice daily regime: half morning dose, do not change evening dose
Basal-bolus: Omit morning and lunchtime short acting insulins, reduce long acting by 20%
What is the surgical safety checklist?
- Before induction
- Before incision
- Before patient leaves the room
What needs to be on and functioning before anaesthesia?
Pulse oximeter is on and functioning
When should COCP/HRT be stopped before surgery?
4 weeks
What is cricoid pressure used for?
Prevent gastric contents entering the pharynx
Dropping sats following intubation?
Think oesophageal intubation
How should TPN be administered?
Central line
What should not be prescribed whilst a patient is using an opioid PCA?
Oral opioids
pyrexia, tachycardia and fasciculations with FH of similar symptoms
Think malignant hyperthermia
Long term mechanical ventilation in trauma patients can lead to what?
Tracheo-oeseophageal fistula formation
Treatment of local anaesthetic toxicity?
IV 20% lipid emulsion
What approach is preferred with central line insertion?
Internal jugular to reduce risk of pneumothorax
