Anesthesia for emergency surgery Flashcards
what is an emergency
is where an imminent threat to life or limb exists
what is an emergency surgery
is when an operation has to be done as soon as possible in a response to a sudden condition that threatens patient’s life and its considered life – saving.
urgent cases require surgery within what
24hrs
what factors increase perioperative risk (8)
- Limited time to asses and prepare patient
- Uncertain diagnoses
- Risk of aspiration
- Body fluid, electrolyte and acid base derangements
- Anemia and coagulation abnormalities
- Coexisting diseases and poorly controlled chronic medical problems
- Pain and its physiological effects
- After hours surgery
what is the objective of a pre-op evaluation (5)
- is to ascertain:
- the indication
- urgency
- extent of the surgery
- assess the risk of anesthesia - optimize the patient
- make them relatively fit for surgery
- organize appropriate staffing and equipment in theatre
- make a provision for ICU/HDU
what things can you do to achieve pre-op preparations (6)
- Two large bore cannulas
- Oxygen should be made available
- Correction of fluid and electrolyte
- Provision of blood/blood products
- Monitoring of tissue perfusion
- Treatment of medical conditions:
what is the aim of emergency surgery
to allow correction of the surgical pathology with minimum risk to the patient
what are some orthopedic emergencies (7)
- Open fractures
- Dislocations
- Multiple long bone #s and unstable pelvic #s
- Compartment syndrome
- Wet gangrene
- Septic joint
- Osteomyelitis
what are some general surgery emergencies (7)
- Penetrating abdominal injury
- Perforated viscus
- Generalized peritonitis
- Intestinal obstruction
- Acute appendicitis
- Massive upper G.I. Bleeding
- Massive lower G.I bleeding
what is the post anesthetic care given (3)
- Extubating of the trachea should not be performed until protective airway reflexes are intact.
- ICU /HDU care depending on the condition
- Continued resuscitation and medical care.
how can you prevent aspiration
- Concept of barrier pressure
- The lower esophageal sphincter is a physiological sphincter which is normally closed with resting pressure of 15-25mmHG above gastric pressure. - Prevention of aspiration:
- NG tubes
- drugs.
what does pre-op evaluation dictate
the extent of pre operative preparation and choice of the anesthetic technique
why do you pre-oxygenate in RSI
In breathing oxygen only, the lungs de-nitrogenate rapidly and after 3 minutes contains only oxygen and carbon dioxide
why is it that patients undergoing emergency surgery have 10 fold increased risk of adverse events compared to those having planned or elective surgery
because limited time is available for preoperative preparation of the patient and optimization of associated medical conditions
for intubation during RSI what do you do (3)
- A paralyzing dose of succinylcholine is administered immediately
- As soon as the jaw begins to relax, laryngoscopy is performed and the trachea intubated.
- Cricoid pressure is maintained until the cuff of the tracheal tube is inflated and correct placement of the tube ascertained by auscultation of both lungs
what does pre-op evaluation involve (8)
- History taking; (AMPLE HISTORY)
- Indication for the surgery
- Traumatic
- Non traumatic - History of cardiopulmonary symptoms
- History of intercurrent medical illness
- Previous history of anesthesia
- Drug history
- Social history
- History of last meal
what are some obstetrics and gynecology emergencies (6)
- Obstetric hemorrhages
- Ruptured uterus
- Prolonged obstructed labor
- Ruptured ectopic pregnancy
- Twisted ovarian cyst
- Some C/S
what processes are done during GA and ETT (2)
- Preparations:
- Checking machines and monitors
- Various sizes of ETT
- Suction catheter
- Drugs drawn up in to labelled syringes
- Pre induction base line vital signs - Induction:
- RSI
when can you apply the cricoid pressure in RSI
opinions differ:
Just before induction agent vs As soon as pt lost consciousness
what does rapid sequence induction involve (3)
- pre-oxygenation
- cricoid pressure
- intubation
what intra-op management can be done after induction is performed (5)
- Maintenance of anesthesia
- Fluid therapy
- Blood transfusion
- Intra operative monitoring
- Blood pressure
- Pulse rate
- Central venous pressure monitoring
- Urine out put
- Capnograph - Reversal and emergence from anesthesia
how do you do the pre oxygenation in RSI
Breathing 100% oxygen for at least 3 minutes before induction
what complications are common in emergency surgery (2)
- hazards of emergency anesthesia
- complications of a full stomach- vomiting/ regurgitation can cause aspiration
what things do you assess during the physical exam (3)
- General examination:
- features of painful/respiratory distress
- dehydration
- pallor
- presence or absence of tubes (N.G tube, urethral catheter) - Airways
- Cardiopulmonary
what intra op anesthetic techniques are done during management (5)
- GA+ETT
- Spinal Anesthesia
- Epidural
- P.N.B
- L.A
how can you treat aspiration if it occurs (3)
- Suction
- Oxygen
- Antibiotics
if RSI fails what can you do
L.A or awake intubation under local anesthesia should be considered
when do you release the cricoid pressure (3)
- The trachea is intubated
- The cuff inflated
- The correct position of the tube is confirmed
why arent the lungs ventilated during RSI
it will further reduces barrier pressure and predisposes patient to risk of regurgitation and aspiration
