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finals > anaethetics > Flashcards

anaethetics Flashcards

1
Q

metformin on day of surgery

A

OD or BD = take as normal
TDS: miss lunchtime dose

assumes only one meal will be missed during surgery, eGFR> 60 and no contrast in procedure

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1
Q

reverse action of benzo eg midazolam

A

flumazenil

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2
Q

commonly used induction agents

A

propafol
sodum thiopentone
ketamine
etomidate

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2
Q

what to check before parathyroid surgery

A

methylene blue to identify gland

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2
Q

checklist before induction of anaesthesia

A

pt confirmed: site indentity, procedure, consent
site marked
anaesthesia safety check
pulse ox on pt
allergies?
difficut airway/asp risk?
risk of >500ml blood loss (kids7ml/kg)

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2
Q

3 phases of operation checklist

A

sign in - b4 anaethesia
time out - before incision
sign out - b4 pt leaves op

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3
Q

what to check before thyroid surgery

A

vocal cord check

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4
Q

sentinal node biopsy

A

radioactive marker/patent blue dye

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5
Q

surgery involving thoracic duct

A

consider administration of cream

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6
Q

pheochromocytoma surgery

A

alpha and beta blockage

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7
Q

surgery for carcinoid tumors

A

cover with octreotide

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8
Q

colorectal cases

A

bowel prep esp if left sided surgery

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9
Q

when is adrenaline with local contraindicated

A

pt taking MOAI or TCAs

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10
Q

tx for local anaesthetic toxicity

A

IV 20% lipid emulsion

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11
Q

increased risk of local anaesthetic toxicty

A

liver dysfxn
low protein state

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12
Q

how does lidocaine work

A

blocks Na channels in axon = disrupts action potential

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13
Q

paralytic ileus what is it and what can contribute

A

pseudo obstruction bc reduced bowel peristalsis post bowel surgery

deranaged electrolytes can contribute thefore check potassium mag and phos as might show this AND hypovolaemia before nausea and vom begins

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14
Q

mx of post op/paralytic ileus

A

nil by mouth initially –> small sips clear fluids
nasogastric tube if vomiting
IV fluids (correct any electrolytes also)

total parenteral nutrition for prolonged/severe cases

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15
Q

colonoscopy prep

A

laxative day before
no food 24hrs

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16
Q

sulfonyurea eg and day of surgery

A

gliclazide

omit on day of surgery

unless morning surgery in Pt who take BD = can have afternoon dose

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17
Q

hyponatraemic encephalopathy post op causes

A

hypotonic IV fluid eg 0.45% sodium chloride

also trauma and stress = SIADH

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18
Q

paeds patients fluids caution

A

dont use hypotonic (0.45%) solution in peads __> in risk of hepatic encephalopathy

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19
Q

when to not use adrenaline with local anaesthetic

A

on digits = ischaemia

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20
Q

patients with myasthenia gravis sensitive to what paralytic agents and why

A

non-depolorising agents (rocuranium)

bc they work by competitively antagonising nicotinic acetylcholine receptors in motor end plate

in MG less of these receptors bc autoimmune distruction = more sensitive to non-depolorising blockade

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21
Q

examples of non depolorising paralytics and reversal agents and SE

A

curoniums eg
rocuranium
vecuranium
tubacurarine

reverse with neostigmine (achesterase inhib) and sugammadex

hypotension

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22
Q

ASA I classification

A

normal healthy pt

healthy non smoking minimal alcohol use

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23
Q

ASA II classification

A

pt w mild systemic disease
without major functional limitations ie

current smoker, social alochol drinker, pregnancy, Obesity (BMI30-40), well controlled DM/HTN, mild lung disease

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24
Q

ASA III classification

A

pt w severe systemic disease

one or more mod to severe disease w big functional limit ie

poor control DM, HTN
COPD
morbid obese (bmi>40)
active hepitis
alcohol abuse
pacemaker
reduced ejection frac
ESRD - undergoing reg dialysis
hx >3months ago MI
CVD accidents

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25
Q

ASA IV classification

A

pr w severe systemic disease constant threat to life

<3mths MI
CVD accidents
ongoing cardiac ischaemia or severe valve dysfxn
severe red Eject frac
sepsis
DIC
ARD
ESRD not having red dialysis

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26
Q

ASA V classification

A

moribund pt not expected tto survive w/o op

ruptured AAA
massive trauma
intracran bleed w mass effect
ischaemic bowel in face of sign cardiac pathology
multiple organ system/dysfxn

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27
Q

ASA VI classification

A

pt declared brain dead whos organs being removed for donor purposes

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28
Q

depolorisng agents examples and how they work

A

succinycholine ie suxamethonum

binds to nictonic ach receptors (non compet) = persistant depolorization of motor end plate

thats why might get fasciculations

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29
Q

muscle relaxant choice for RSI

A

suxamethonium

30
Q

adverse effects of depolorising agents

A

malignant hyperthermia
hyperkalaemia (normally transient)

31
Q

suxamethonium contraindication

A

penetrating eye injuries
acute narrow angle glaucoma

bc increases intraoc pressure

Also hyperkalaemia

32
Q

signs of paralytic ileus on examination

A

abdo distension n tenderness
absolute constipation
blood tests = fluid and electrolyte loss

33
Q

Ci in basel skull fracture airway adjunct

A

nasopharyngeal airway

34
Q

neuromuscular blocker (paralytic agent) CI in burns and trauma patients

A

Depolarising eg suxameth

increse risk of hyperkalameia in Trauma and burns pts

35
Q

nitrous oxide adverse effects

A

may diffuse into gas filled body compartments –> increase Pressure

avoid in pneuomothorax ie car accident increases risk of tension pneumothorax

36
Q

most likely cause of fever day 1-2

A

‘wind’
pneumonia
aspiriation
pul.embolism

37
Q

most likely cause of fever day 3-5

A

‘water’
UTI esp if catheter

38
Q

most likely cause of fever day 5-7

A

‘wound’
infection at surgical site
or abscess formation

39
Q

most likely cause of fever day 5+

A

‘walking’
DVT or PE

40
Q

most likely cause of fever anytime

A

drugs
transfusion reactions
sepsis
line contamination

41
Q

why does would bad post op pain management predispose to pneumonia

A

insufficient analgesia = period of pain –> pt shallow breathing

lack of deep breathing risk of atelectasis and Resp tract infections

(Atectasis no fever)

42
Q

pt on long term 10mg+ pred daily what to do for surgery

A

IV hydrocortisone supplementation before op

43
Q

air leak post lung injury ie surg

A

chest drain will show bare bubbles when suction applied

44
Q

appendicitis and then subsequent abcesses lead to deranged LFTs week after post op in ITU

A

intrabdominal sepsis may lead to hypercoaguable state therefore at risk of port vein thrombosis

portal vein supplies most of liver (hepatic artery 25%) therefore deranged LFTs

45
Q

resp stridor and small haematoma in neck post total thyroidectomy mx

A

= post op haematoma!!

heamatoma ca compress trachea = resp distress and stridor

1st remove skin clips straight away on the ward to release pressure

46
Q

hoarse voice post thyroid surg ix

A

laryngoscopy to see vocal cords to show if larygngeal nerve palsy

47
Q

hypocalaemic tetany surgical cause and pt

A

damage to parathyroid glands during thyroid surg = hypocalcaemia

oculogyric crisis and diffuse muscle spams (tetany)

give iv calcium

48
Q

heamodynamically stable which canulla and only need tempIV access

A

normal pink 20G peripheral cannula

49
Q

somone peripherally shut down how to cannulate

A

intraoesseous infusion

50
Q

long term option for IV acesss ie chemodrugs etc

A

hickmann line
(tunneled line)

US used to insert into jug vein and then cuffed into skin and integrates w surrounding tissue, therefore remove surgically

51
Q

elective Hip VTE proph

A

Ted stockings and LMWH heparin (dalte) 6-12 post op
stockings till discharge and lmwh for 28 days

or
LMWH for 10days then aspirin (75/150mg) for 28 days

or rivoraxaban

52
Q

Patients with poor Bm control or taking insulin need what in surgery

When to ideally operate

A

Sliding scale

Ideally put them 1st on theatre list to prevent complications of poor bm control

53
Q

What surgeries can thoracic duct be injured

A

Thoracic surgery ie pneumonectomy
Oesphagectomy

54
Q

RUQ pain and and bilious fluid in intraabdo drain post cholecystectomy

A

Biliary leak

55
Q

How would perforation post laprosscopic cholecystectomy present

A

Peritonitis

56
Q

Structure at risk in use of verres needle to to establish pneumoperitoneum

A

Bowel perf

57
Q

At risk structure in parotidectomy

A

Facial nerve

58
Q

When might accessory nerve be injured

A

Posterior triangle lymph node biopsy

59
Q

When might long thoracic be injured and how would it present

A

Axillaire node clearance

Scapula winging bc paralysis of serratus anterior muscle

60
Q

Long term mechanical ventilation risks

A

Tracheooesphageal fistula formation

Increasing risk of ventilator associated pneumonias and aspiration pneumonias (bc stomach contents)

61
Q

short term sedation ie endoscopy

A

midazolam

62
Q

non invasive ventilaton

A

type 1 resp failure = CPAP
inadeq o2 due to alveolar collapse (pneum) or fluid in alveoli (heart failure)
maintains min airway pressure -> holds alveoli open/forces fluid out

Type 2 = BiPAP
inadeq ventilation -> limited alveolar expansion (COPD, musc dystrophy)
adds further insp pressure = increases expansion

63
Q

invasive ventilation

A

ET tube /tracheostomy
volume control and pressure control

64
Q

increasing HR

A

anticholinergic - atropine, glycopyrrolate
B-adrenoreceptor agnoist - dobutamine (used in HF)

65
Q

increasing BP

A

Alpha agonists
 Peripheral – phenylephrine, metaraminol
 Central – noradrenaline

66
Q

increasing hr and Bp

A

Combined alpha and beta agonist – ephedrine or adrenaline (very potent)

67
Q

fentanyls

A

Fentanyl
 Alfentanil – onset and offset more rapid
 Remifentanil – ultrashort acting. Infusion only.

68
Q

antiemetic 5HT3

A

Ondansetron

69
Q

anto emetic h1

A

cyclizine

70
Q

anti emetic d2

A

domperidone, metoclopramide (Parkinson, QT prolongation), prochlorperazine

71
Q

lithium before surg

A

stop 24hrs before major surg
minor = ok

72
Q

potass sparing diuretics w surg

A

withhold morning of

73
Q

acei arbs w surgery

A

sstop 24 hrs before

74
Q

fat embolism sx and presentation

A

post long bone trauma or surgery

resp
neuro
petechial rash after 1st two

also get pyrexia
retinal haemorhhages and inraarterial fat globus

75
Q

apply cricoid pressure when intubating

A

to prevent aspiration of gastric contents

76
Q
A

finals (28 decks)

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