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. About 20 seconds

Question 2

What are 4 Planes (stages) of anaesthesia?

Answer 2

1) Sedation 2) Excitation 3) Anaesthesia (Light->Deep) 4) Overdose IV goes so fast you don’t notice them. Inhalational, the patient visibly passes through these planes. i.e. sleepy, excited, anaesthetised … etc.

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 7 stages for an anaesthetist during surgery?

Answer 4

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

Question 5

In order of “seriousness”, what are the 4 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 are the 3 main apparatus for airway maintenance in anaesthesia?

Answer 7

Face mask

Oropharyngeal (Guedel) Airway

Nasopharangeal Airway

Question 8

What is a Laryngeal mask airway?

Answer 8

A cuffed tube with a mask that sits over the glottis

Question 9

What complications could occur during induction of anesthesia?

Answer 9

Obstruction Aspiration

Question 10

What could cause airway obstruction under anesthesia?

Answer 10

Ineffective Triple Airway Maneouvre Airway device malposition/kinking Laryngospasm

Question 11

Why might patient’s aspirate under anesthesia?

Answer 11

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

Question 12

Define airway Maintenance and airway Protection?

Answer 12

A Maintained airway is open & unobstructed A protected airway is protected from contamination. Only endotracheal intubation will do this

Question 13

What is endotracheal intubation?

Answer 13

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

Question 14

Why do we need muscle relaxant in endotracheal intubation?

Answer 14

To abolish the laryngeal reflexes

Question 15

Why would you choose to intubate a patient?

Answer 15

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 16

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

Answer 16

Basic - SpO2, ECG, NIBP, FiO2 & ETCO2

Respiratory parameters

Agent Monitoring

Temperature

Urine Output and NMJ

Invasive venous/arterial monitoring

Processed EEG

Ventilator Disconnect

Question 17

What common problems occur during recovery?

Answer 17

A,B & C problems Pain N&V Hence it’s done in a dedicated area with trained staff

Question 18

What are the major risks to a patient during anesthesia?

Answer 18

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 19

What are the major types of LA blocks?

Answer 19

Spinal

Epidural

Plexus block

Nerve block

Question 20

What two drugs are mentioned in the lecture for IV induction?

Answer 20

Propofol Thiopentone

Question 21

What are complications that an anaesthetist must consider?

Answer 21

Airway

Breathing

Circulation

Position / Technique related

Awareness of Patient

Question 22

Why is “landing as hazardous as takeoff”?

I.e. what problems can occur in emergence?

Answer 22

Muscle relaxation is reversed

Anaesthetic agents off

Resupmtion if spontaneous respiration

Return of airway reflexes / control

Extubation

(all of the above can be very quick or very slow)