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CP3 Crit Care > 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

in which patients is inhalation induction used?

A

Used in needle phobics/difficult intubation expected

Maintains spontaneous respiration

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7
Q

In which patients is TIVA used in?

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

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21
Q

What is the main complication of spinal anaesthesia?

A

Hypotension

-vasoconstrictors & fluids

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22
Q

What are the contraindications to spinal anaesthesia?

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

What is epidural anaesthesia?

A

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

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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 
6-4-2: solid food, breast feeding, clear fluids 
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

49
Q

What is the purpose of cricoid pressure

A

reduce risk of regurgitation

50
Q

What is malignant hyperthermia?

A

condition often seen following administration of anaesthetic agents

51
Q

What are the characteristics of malignant hyperthermia?

A

characterised by hyperpyrexia and muscle rigidity

52
Q

What are the causes of malignant hyperthermia?

A

halothane

suxamethonium

53
Q

What is the treatment of malignant hyperthermia?

A

Dantrolene

54
Q

What are the benefits of an oropharyngeal airway?

A

Easy to insert and use
No paralysis required
Ideal for very short procedures
Most often used as bridge to more definitive airway

55
Q

What are the benefits of a laryngeal mask airway?

A

Widely used
Very easy to insert
Device sits in pharynx and aligns to cover the airway
Paralysis not usually required
Commonly used for wide range of anaesthetic uses, especially in day surgery

56
Q

What are the drawbacks of a laryngeal mask airway?

A

Poor control against reflux of gastric contents

Not suitable for high pressure ventilation (small amount of PEEP often possible)

57
Q

What are the benefits of a tracheostomy?

A

Reduces the work of breathing (and dead space)
May be useful in slow weaning
Percutaneous tracheostomy widely used in ITU

58
Q

What are the benefits of endotracheal tube?

A

Provides optimal control of the airway once cuff inflated
May be used for long or short term ventilation

Higher ventilation pressures can be used

59
Q

What are the drawbacks of endotracheal tubes?

A

Errors in insertion may result in oesophageal intubation (therefore end tidal CO2 usually measured)
Paralysis often required

CP3 Crit Care (11 decks)

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