Anesthetics and Pre-Op Flashcards
positional manoeuvres to do if worry about cervical spine injury
jaw thrust preferred to head tilt/chin lift
which airway adjunct is worst and best to prevent gastric contents reflux?
worst: laryngeal mask
best: endotracheal tube
what is the risk with using an endotracheal tube? what do you monitor?
oesophageal intubation
monitor end-tidal CO2 (capnography)
anesthetic agents:
- propofol: GABA receptor agonist, proven antiemetic properties, moderate myocardial depression
- sodium thiopentone: rapid onset of action, marked myocardial depression
- ketamine: NMDA receptor antagonist, good anaesthesia for those who are haemodynamically unstable as little myocardial depression
- etomidate: risk of adrenal suppression
when should inhaled NO be avoided?
pneumothorax
risk of inhaled isoflurane, suxamethonium as inhaled anaesthetic
malignant hypothermia
which airway do you insert in patients having seizures
nasopharyngheal
which anaesthetic would you use in trauma
ketamine - does not cause drop in blood pressure
which airway adjunct s contraindicated in base of skull fractures?
nasopharyngeal
when is suxamethonium (muscle relaxant) C/I?
penetrating eye injuries, glaucoma
what can cause post-op ileus?
deranged electrolytes
Mx for post-op ileus
- nil-by-mouth
- nasogastric tube if vomiting
- IV fluids
- if severe/prolonged: TPN
Pre-op advice for diabetic meds:
- metformin
- sulfonylureas
- biphasic insulin
- once daily insulin
- DPPi4 inhibiors/GLP-1 analogues
- SGLT-2 inhibitors
- metformin: usually no change
- sulfonylureas: take as per normal day before, omit the day of
- biphasic insulin: take as per normal day before, halve the morning dose on the day of and leave evening dose unchanged
- once daily insulin: reduce by 20% sday before, reduce by 20% day of
- DPPi4 inhibiors/GLP-1 analogues: no change
- SGLT-2 inhibitors: take as normal day before, omit on day of
