Anesthetics Conduct

Question 1

Define 1 “arm-brain” circulation?

Answer 1

The time it takes for an IV GA injected into the arm to reach the brain. ~20s

Question 2

What are “Planes” of anaesthesia?

Answer 2

1) Sedation
2) Excitation
3) Anaesthesia (Light->Deep)

IV goes so fast you don’t notice them
Inhalational, the patient passes through these planes

Question 3

What do we use to monitor a patient’s conscious level during Induction?

Answer 3

Verbal contact
Movement
Resp Pattern
EEG
"Planes"

Question 4

What are the stages for an anesthetist during surgery?

Answer 4

Pre-op assessment
Prep
Induction
Maintenance
Emergence
Recovery
Post-op care

Question 5

In order of “seriousness”, what are the types of airway maintenance?

Answer 5

1) Triple airway manoeuvre
2) Face mask
3) Oropharyngeal (Guedel) airway
4) Laryngeal mask airway

Question 6

What’s involved in the Triple Airway Manoeuvre?

Answer 6

Head Tilt
Chin lift
Jaw Thrust

Question 7

What is a Laryngeal mask airway?

Answer 7

A cuffed tube with a mask that sits over the glottis

Question 8

What complications could occur during induction of anesthesia?

Answer 8

Obstruction

Aspiration

Question 9

What could cause airway obstruction under anesthesia?

Answer 9

Ineffective Triple Airway Maneouvre
Airway device malposition/kinking
Laryngospasm

Question 10

Why might patient’s aspirate under anesthesia?

Answer 10

They lose protective airway reflexes like gag, swallow and cough
Plus lots of foreign material like gastric contents, blood and surgical debris

Question 11

Define airway Maintenance and airway Protection?

Answer 11

A Maintained airway is open & unobstructed

A protected airway is protected from contamination. Only endotracheal intubation will do this

Question 12

What is endotracheal intubation?

Answer 12

A cuffed tube is placed in the trachea via the oral route using a laryngoscope, muscle relaxant and “sniffing the air” position

Question 13

Why do we need muscle relaxant in endotracheal intubation?

Answer 13

To abolish the laryngeal reflexes

Question 14

Why would you choose to intubate a patient?

Answer 14

1) Protects from gastric contents in unfasted (emergency) patients
2) For ventilation when using muscle relaxants
3) If there’s risk of blood contamination e.g. tonsilectomy
4) When needing to tightly control blood gasses e.g. neurosurgery
5) When there will be restricted airway access e.g. Maxfax

Question 15

What parameters can we measure to monitor a patient under anaesthesia?

Answer 15

SpO2, ECG, NIBP, FiO2 & ETCO2
Resp parameters
Agent Monitoring
Temp, urine output and NMJ
Invasive venous/arterial monitoring
Processed EEG

Question 16

What common problems occur during recovery?

Answer 16

A,B & C problems
Pain
N&V

Hence it’s done in a dedicated area with trained staff

Question 17

What are the major risks to a patient during anesthesia?

Answer 17

Airway problems
Temperature (too cold or too hot)
Loss of other protective reflexes e.g. corneal can cause injury
VTE
Consent/ID
Pressure areas

Question 18

What are the major types of LA blocks?

Answer 18

Spinal
Epidural
Plexus block
Nerve block