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

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

Answer 4

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

Question 5

What’s involved in the Triple Airway Manoeuvre?

Answer 5

Head Tilt
Chin lift
Jaw Thrust

Question 6

What is a Laryngeal mask airway?

Answer 6

A cuffed tube with a mask that sits over the glottis.

It maintains but does NOT protect the airways.

Question 7

What complications could occur during induction of anesthesia?

Answer 7

Obstruction

Aspiration

Question 8

What could cause airway obstruction under anesthesia?

Answer 8

• Ineffective Triple Airway Maneouvre
• Airway device malposition/kinking
• Laryngospasm: forced reflex adduction the vocal cords.

Question 9

Why might patient’s aspirate under anesthesia?

Answer 9

• They lose protective airway reflexes like gag, swallow and cough
• Foreign material like gastric contents, blood and surgical debris

Question 10

Define airway Maintenance and airway Protection?

Answer 10

A Maintained airway is open & unobstructed

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

Question 11

What is endotracheal intubation?

Answer 11

A cuffed tube is placed in the trachea via the oral route using a laryngoscope, muscle relaxant and “sniffing the air” position
- it is possible to keep the patient awake by using local anaestesia and fibre-optic scope.

Question 12

Why do we need muscle relaxant in endotracheal intubation?

Answer 12

To abolish the laryngeal reflexes

Question 13

Why would you choose to intubate a patient?

Answer 13

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 14

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

Answer 14

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

Question 15

What common problems occur during recovery?

Answer 15

A,B & C problems
Pain
N & V

Question 16

What are the major risks to a patient during anesthesia?

Answer 16

• 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 17

What are the major types of LA blocks?

Answer 17

Spinal
Epidural
Plexus block
Nerve block

Question 18

What is the process of anaesthesia? (7 steps)

Answer 18

1. Pre-operative Assessment
2. Preparation
3. Induction
4. Maintenance e.g. with general anaesthesia
5. Emergence
6. Recovery
7. Post-operative Care and Pain Management

Question 19

what are some of the most common drugs used in IV induction?

Answer 19

Propofol- safe, predictable

Thiopentone

Question 20

what is the most common inhalation drug

Answer 20

Sevoflurane (Halothane)

Question 21

when is gas induction used commonly?

Answer 21

more common in younger children as they are more nervous/ difficult about IV infusion.

Question 22

Features of gas inhalation?

Answer 22

• SLOW: takes time for the drug to be absorbed

- more obvious planes of anaesthesia

Question 23

Oropharyngeal airway

Answer 23

• Rigid plastic
• Only tolerated by an unconscious patient
• insertion in a light patient (wakes up easily) may cause vomiting/laryngospasm

Question 24

What occurs during awakening?

Answer 24

• muscle relaxation reversed
• anaesthtic agents off
• resumption of spontaneous respiration
• return of airway reflexes
• extubation
• can be very quick or very slow

Question 25

where does recovery take place?

Answer 25

in the PACU: Post anaesthesia care unit