capsule peri op and anaesthesia Flashcards
what to give for local procedure in digits
local anesthetic agent-ring block. rapid and effective regional anaesthesia. never use anaesthetic containing adrenaline in digits as vasoconstroctor effects can cause ischaemia
when should lidocain not be used
intra arterially as regional anaesthetic
when does lidocain become peak plasma arterial concentration
25-20 min post injection. pt need to be monitored for at least this amount of time if larger doses of lidocaine has been used
when can you use IV lidocain as initial treatment
ventricular tachy arrthythmias
how does local anaesthetic work
inhibits influx of sodium into cells, and act on small unmyelinated c fibres before (which transmit pain and temperature sensation) large A fibres (which transmit touch and power)
when does lidocaine become peak plasma arterial concentration
25-20 min post injection. pt need to be monitored for at least this amount of time if larger doses of lidocaine has been used
when does lidocaine become peak plasma arterial concentration
25-20 min post injection. pt need to be monitored for at least this amount of time if larger doses of lidocaine has been used
how would you try to make anaesthetic more affective
enabling anaesthetic to warm up, adding adrenaline (so effect can last longer because delays anaesthetic being washed out into circulation)
but never use adrenaline in digits as it can cause ischaemia
what are side effects of local anaesthetic
cardiac arrythmias, neurotoxicity, central resp depression.
allergic reaction eg urticaria or anaphylaxis
insensible loss
evaporative water loss from skin and resp tract
50ml/h in hospitalised pt, or 0.5-1ml/kg/h
how to calculate maintenance fluid
4 2 1 rule (4mls/ kg for the first 10kg, 2mls/ kg for next 10kg and 1ml/kg for the remaining weight)
Daily sodium requirements are between 1-2 mmol/kg and potassium 0.5 – 1mmol/kg.
crystalloid
inorganic ions or small molecules- glucose
gelatin
colloidal solutions with molecular weight of 30,000. no longer in regular use
dextrose 5%
will distribute throughout total body water
hartmann’s solution
balances salt solution containing lactate-metabolised by liver to bicarbonate. balanced because it has less chloride than normal saline and closer to electrolyte contents of plasma
how to dec risk of regurgitation of stomach
A rapid sequence induction is the standard technique to rapidly secure the airway with an endotracheal tube. This technique is indicated in any patient at risk of regurgitation to reduce the likelihood of aspiration of stomach contents of which he is at a high risk of due to his hiatus hernia.
administer antacid before anaesthesia
which conditions are associated with higher risk of aspiration under anaesthesia
diabetic, diagnosed with hiatus hernia, symptoms of acid reflux, BMI 45
when do you transfuse blood post op
post op pt without cardiovascular disease do not need to be transfused unless Hb less than 80
