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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
examples of non depolorising paralytics and reversal agents and SE
curoniums eg rocuranium vecuranium tubacurarine reverse with neostigmine (achesterase inhib) and sugammadex hypotension
22
ASA I classification
normal healthy pt healthy non smoking minimal alcohol use
23
ASA II classification
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
24
ASA III classification
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
25
ASA IV classification
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
26
ASA V classification
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
27
ASA VI classification
pt declared brain dead whos organs being removed for donor purposes
28
depolorisng agents examples and how they work
succinycholine ie suxamethonum binds to nictonic ach receptors (non compet) = persistant depolorization of motor end plate thats why might get fasciculations
29
muscle relaxant choice for RSI
suxamethonium
30
adverse effects of depolorising agents
malignant hyperthermia hyperkalaemia (normally transient)
31
suxamethonium contraindication
penetrating eye injuries acute narrow angle glaucoma bc increases intraoc pressure Also hyperkalaemia
32
signs of paralytic ileus on examination
abdo distension n tenderness absolute constipation blood tests = fluid and electrolyte loss
33
Ci in basel skull fracture airway adjunct
nasopharyngeal airway
34
neuromuscular blocker (paralytic agent) CI in burns and trauma patients
Depolarising eg suxameth increse risk of hyperkalameia in Trauma and burns pts
35
nitrous oxide adverse effects
may diffuse into gas filled body compartments --> increase Pressure avoid in pneuomothorax ie car accident increases risk of tension pneumothorax
36
most likely cause of fever day 1-2
'wind' pneumonia aspiriation pul.embolism
37
most likely cause of fever day 3-5
'water' UTI esp if catheter
38
most likely cause of fever day 5-7
'wound' infection at surgical site or abscess formation
39
most likely cause of fever day 5+
'walking' DVT or PE
40
most likely cause of fever anytime
drugs transfusion reactions sepsis line contamination
41
why does would bad post op pain management predispose to pneumonia
insufficient analgesia = period of pain --> pt shallow breathing lack of deep breathing risk of atelectasis and Resp tract infections (Atectasis no fever)
42
pt on long term 10mg+ pred daily what to do for surgery
IV hydrocortisone supplementation before op
43
air leak post lung injury ie surg
chest drain will show bare bubbles when suction applied
44
appendicitis and then subsequent abcesses lead to deranged LFTs week after post op in ITU
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
resp stridor and small haematoma in neck post total thyroidectomy mx
= post op haematoma!! heamatoma ca compress trachea = resp distress and stridor 1st remove skin clips straight away on the ward to release pressure
46
hoarse voice post thyroid surg ix
laryngoscopy to see vocal cords to show if larygngeal nerve palsy
47
hypocalaemic tetany surgical cause and pt
damage to parathyroid glands during thyroid surg = hypocalcaemia oculogyric crisis and diffuse muscle spams (tetany) give iv calcium
48
heamodynamically stable which canulla and only need tempIV access
normal pink 20G peripheral cannula
49
somone peripherally shut down how to cannulate
intraoesseous infusion
50
long term option for IV acesss ie chemodrugs etc
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
elective Hip VTE proph
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
Patients with poor Bm control or taking insulin need what in surgery When to ideally operate
Sliding scale Ideally put them 1st on theatre list to prevent complications of poor bm control
53
What surgeries can thoracic duct be injured
Thoracic surgery ie pneumonectomy Oesphagectomy
54
RUQ pain and and bilious fluid in intraabdo drain post cholecystectomy
Biliary leak
55
How would perforation post laprosscopic cholecystectomy present
Peritonitis
56
Structure at risk in use of verres needle to to establish pneumoperitoneum
Bowel perf
57
At risk structure in parotidectomy
Facial nerve
58
When might accessory nerve be injured
Posterior triangle lymph node biopsy
59
When might long thoracic be injured and how would it present
Axillaire node clearance Scapula winging bc paralysis of serratus anterior muscle
60
Long term mechanical ventilation risks
Tracheooesphageal fistula formation Increasing risk of ventilator associated pneumonias and aspiration pneumonias (bc stomach contents)
61
short term sedation ie endoscopy
midazolam
62
non invasive ventilaton
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
invasive ventilation
ET tube /tracheostomy volume control and pressure control
64
increasing HR
anticholinergic - atropine, glycopyrrolate B-adrenoreceptor agnoist - dobutamine (used in HF)
65
increasing BP
Alpha agonists  Peripheral – phenylephrine, metaraminol  Central – noradrenaline
66
increasing hr and Bp
Combined alpha and beta agonist – ephedrine or adrenaline (very potent)
67
fentanyls
Fentanyl  Alfentanil – onset and offset more rapid  Remifentanil – ultrashort acting. Infusion only.
68
antiemetic 5HT3
Ondansetron
69
anto emetic h1
cyclizine
70
anti emetic d2
domperidone, metoclopramide (Parkinson, QT prolongation), prochlorperazine
71
lithium before surg
stop 24hrs before major surg minor = ok
72
potass sparing diuretics w surg
withhold morning of
73
acei arbs w surgery
sstop 24 hrs before
74
fat embolism sx and presentation
post long bone trauma or surgery resp neuro petechial rash after 1st two also get pyrexia retinal haemorhhages and inraarterial fat globus
75
apply cricoid pressure when intubating
to prevent aspiration of gastric contents
76

finals (28 decks)

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