Anesthesia for Emergency Surgery Flashcards
What is an Emergency?
This is where there is an imminent threat to life or limb exists
What is an emergency surgery?
This 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
When should an urgent surgery be done?
Within 24hrs
What is the aim of emergency surgery?
The aim of emergency surgery is to allow correction of the surgical pathology with minimum risk to the patient
List 7 orthopedic emergencies?
Open fractures
Dislocations
Multiple long bone #s and Unstable pelvic #s
Compartment syndrome
Wet gangrene
Septic joint
Osteomyelitis
List 7 general surgery emergencies?
Penetrating abdominal injury
Perforated viscus
Generalized peritonitis
Intestinal obstruction
Acute appendicitis
Massive upper G.I. Bleeding
Massive lower G.I bleeding
List 6 obstetric Emergencies?
Obstetric hemorrhages
Ruptured uterus
Prolonged obstructed labor
Ruptured ectopic pregnancy
Twisted ovarian cyst
Some C/S
What is the difference between an elective surgery and emergency surgery in terms of risks?
Patients undergoing emergency surgery have 10 fold increased risk of adverse events compared to those having planned or elective surgery
List 8 factors that increase perioperative risk?
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 ands its physiological effects
After hours surgery
what is the approach to an emergency patient?
1.Pre-OP assessment
2.Preop preparations
3.Intraop management
4.Post Anesthetic Care
What are the parameters of Pre-op assessment?
History taking
Physical Exam
Lab investigations
What is the objective of preop assessment?
objective is to ascertain the indication, urgency, extent of the surgery and assess the risk of anesthesia which may dictate extent of pre operative preparation and choice of the anesthetic technique.
What does the pre-op History taking component involve?
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 does the physical exam aspect of preop assessment in Emergency cases invovle?
Depending upon the urgency of surgery, physical examination may be selective to identify significant cardiopulmonary dysfunction or any abnormalities that might lead to technical difficulties during anesthesia .
1.General examination:
features of painful/respiratory distress, dehydration, pallor,
presence or absence of tubes (N.G tube, urethral catheter)
2.Airways
3.Cardiopulmonary
What investigations are done in Preop assessment?
1.FBC - Hb
2.U&Es
3.Clotting profile
4.Chest x-ray and cardiac echo
What is the objective of pre-op preparations?
The objectives is to optimize the patient, make him relatively fit for surgery, organize appropriate staffing and equipment in the theatre and make a provision for an ICU/HDU.
what are the parameters for Pre-Op preparations?
1.Two large bore cannulas
2.Oxygen should be made available
3.Correction of fluid and electrolyte
4.Provision of blood/blood products
5.Monitoring of tissue perfusion
6Treatment of medical conditions:
What is the most common and devastating complication in emergency anesthesia?
Full stomach which are vomiting/regurgitation followed by aspiration.
What are the anesthetic techniques considered Intra-OP?
GA+ETT
Spinal Anesthesia
Epidural
P.N.B
L.A
For GA and ETT what preparations are done intra-op and what form of induction is used?
Preparations:
1. Checking machines and monitors
2. Various sizes of ETT
3. Suction catheter
4. Drugs drawn up in to labelled syringes
5.Pre induction base line vital signs
Induction:
RSI
What does rapid Sequence Induction invovle?
1.Preoxygenation
2. Cricoid Pressure
3.Intubation
For how long do we pre-oxygenate and what is the purpose? How much oxygen do we give?
1.Breathing 100% oxygen for at least 3 minutes before induction
2. In breathing oxygen only, the lungs de-nitrogenate rapidly and after 3 minutes contains only oxygen and carbon dioxide
What is the point of cricoid pressure and when is it done?
To obstruct the esophagus preventing from regurgitation
Opinions differs on when to apply the pressure
Just before induction agent vs As soon as pt lost consciousness
What drug is used to intubate?
Succinylcholine
