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CP3 @ UoN - Critical Illness > Anaesthetics - Pre-Operative Assessment > Flashcards

Anaesthetics - Pre-Operative Assessment Flashcards

1
Q

What is general anaesthesia?

A

A state of total unconsciousness resulting from the use of centrally acting anaesthetic drugs

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2
Q

What are the three main types of GA?

A

IV induction w/ gas maintenance
Inhalation induction w/ gas maintenance
Total IV anaesthesia

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3
Q

Describe IV induction w/ gas maintenance

A

Pre-oxygenation/airway management
IV induction
Volatile gas maintenance

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4
Q

What are the most common IV induction agents?

A

Propofol

Thiopental

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5
Q

What are the most common volatile gas agents?

A

Sevoflurane

Isoflurane

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6
Q

Describe inhalation induction

A

Used in needle phobics/difficult intubation expected

Maintains spontaneous respiration

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7
Q

Describe Total IV anaesthesia (TIVA)

A

Used in pts w/ PMH/FH of malignant hyperthermia

-volatile agents contraindicated

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8
Q

What are the advantages of TIVA?

A

Reduced post-op N/V
Predictability in bariatric pts
More control over depth of anaesthesia

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9
Q

What is rapid sequence induction (RSI)?

A

Delivery of rapidly acting muscle relaxant immediately after induction agent
-w/o waiting to see if resp can be assisted

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10
Q

What is the main risk of RSI?

A

Unable to intubate/ventilate unconscious pt

-difficult airway equipment should always be available

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11
Q

What is the purpose of RSI?

A

To rapidly produce optimum conditions for intubation in emergency situation

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12
Q

What is the triad of GA?

A

Narcosis (pt rendered unconscious)
Analgesia (lack of pain/suppression of phys reflexes)
Relaxation (reduction/absence of muscle tone)

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13
Q

What is the MoA of local anaesthetic?

A

Blockage of conduction of nerve impulses along nerve axons w/ lignocaine +/- adren
-adren causes vasoconstriction inc potency/duration of anaesthesia

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14
Q

How can local anaesthetic be used?

A

Topically
Local infiltration
Regional anaesthesia
Spinal anaesthesia/epidural

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15
Q

What is regional anaesthesia?

A

Local anaesthetic injected directly into minor/major nerves OR epidural space/CSF

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16
Q

What is the maximum safe dose of lignocaine?

A

3mg/kg

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17
Q

What is spinal anaesthesia?

A

Local anaesthetic solutions introduced via needle directly into CSF

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18
Q

What are the features of spinal anaesthesia?

A 
Onset = Fast
Duration = 1-4hrs
Block = Complete block in affected area (T10-toes)
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19
Q

What is complete sensory block?

A

Loss of pain
Temperature
Positional sense

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20
Q

How should a pt be monitored when receiving spinal anaesthesia?

A

ECG
BP
RR
SpO2

21
Q

What is the main complication of spinal anaesthesia?

A

Hypotension

-vasoconstrictors & fluids

22
Q

What are the contraindications to spinal anaesthesia?

A 
Raised ICP
Hypovolaemia
Surgery above thorax
Local/systemic infection
Procedures >2hrs duration
23
Q

What is epidural anaesthesia?

A

Epidural catheter inserted into epidural space & local anaesthetic +/- analgesic delivered continuously via pump

24
Q

What are the features of epidural anaesthesia?

A

Onset = 45mins
Duration = Longer, often combined w/ GA/spinal
Used as on demand pain relief

25
Q

How should a patient be monitored when receiving epidural anaesthesia?

A

ECG
BP
RR
SpO2

26
Q

What are the potential complications of epidural anaesthesia?

A 
Hypotension
Resp depression
CSF/dural puncture
   -headache
   -total spinal paralysis
27
Q

What are the general benefits of regional anaesthesia?

A

Less risk of

  • chest infections
  • cardiovascular complications
  • PONV
  • post-op pain
  • DVT
28
Q

What are the effects of GA on the cardiovascular system?

A

Decreased myocardial contractility
-decreased CO
-hypotension
Arrhythmias

29
Q

What are the effects of GA on the resp system?

A

Resp depression
Decreased ventilator response to hypoxia/hypercapnia
Laryngospasm

30
Q

What are the effects of spinal anaesthesia on the cardiovascular system?

A

Blockage of sympathetic nerves
-vasodilation
-bradycardia
Perioperative myocardial ischaemia/infarct

31
Q

What are the effects of spinal anaesthesia on the respiratory system?

A

Resp depression

-if opiates used

32
Q

What pre-op cardiovascular assessment should take place?

A

ECG +/- echo

33
Q

What pre-op respiratory assessment should take place?

A

CXR
ABG
Pulmonary function

34
Q

What are the common/major risks associated w/ GA?

A 
PONV
Anaphylaxis
Awareness under GA
Aspiration (use RSI if pt not starved)
Cardio-respiratory issues
35
Q

What are the common/major risks associated w/ spinal anaesthesia?

A 
Neurological disorder (due to trauma)
High spinal block (depression of brainstem)
Urinary retention/bladder damage
Cardio-resp issues
Spinal headaches
PONV
36
Q

Describe the ASA classification

A

ASA 1 = normal healthy pt
ASA 2 = pt w/ mild systemic disease
ASA 3 = pt w/ severe systemic disease, restricting activity but not incapacitating
ASA 4 = pt w/ severe systemic disease representing constant threat to life
ASA 5 = moribund pt not expected to survive 24hrs w/o op
ASA 6 = brain-dead pt, organs being harvested

37
Q

How can operative urgency be classified?

A

Immediate
Urgent
Expedited
Elective

38
Q

Describe immediate operative urgency

A

To save life/limb/organ

  • resus & surgery simultaneous
  • pt in theatres w/i minutes
39
Q

Describe urgent operative urgency

A

Acute onset/deterioration of condition threatening life/limb/organ

  • surgery when resus complete
  • w/i 6/24hrs
40
Q

Describe expedited operative urgency

A

Stable pt requiring early intervention

-w/i days of decision to operate

41
Q

Describe elective operative urgency

A

Surgery planned/booked in advance of admission

42
Q

What investigations may be appropriate in pre-op assessment?

A 
FBC, U&Es, LFTs, BM, clotting
ECG, ECHO
CXR
Resp function tests
C-spine XR
43
Q

What is the purpose of pre-op starvation?

A

Minimise volume of gastric contents

-lowers risk of regurgitation & aspiration

44
Q

What are the pre-op starvation times for food/clear fluids?

A 
Solid food (inc milk) = 6hrs
Breast fed infants = 4hrs
Formula fed infants = 2hrs
Clear fluids (inc black tea/coffee) = 2hrs
45
Q

What are the risks of increased pre-op starvation?

A

Dehydration
PONV
Anxiety
Discomfort

46
Q

What are the principles of pre-op management of DM?

A 
Minimise pre-op fasting times
Comprehensive pre-op assessment
Omit medication on day of surgery
  -if well controlled
Sliding scale insulin infusion
  -if poorly controlled
47
Q

What are the principles of peri-op management of DM?

A

Consider RSI (DM pts prone to aspiration)
Regular BM monitoring
-if >10mmol/L consider insulin/glucose

48
Q

What are the principles of post-op management of DM?

A

Regular monitoring of BM & vital signs

CP3 @ UoN - Critical Illness (8 decks)

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