Chapter 2: Anaesthesia Flashcards
Name the 5 drug classes used in a typical Anaesthesia regimen
Anxiolytics Antisialitics Analgesics Antiacids (if pt at risk of aspiration) Antiemetic (5HT3 antagonists)
Side effect to Atropine
Anticholinergic
thus tachycardia, urinary retention, glaucoma and sedation
Side effects of opioids
Respiratory depression, constipation, decreased cough reflex, N+V
Side effects of thiopental
laryngospasm
Side effects of Propofol
respiratory depression
cardiac depression
pain on injection
Side effects of volatile agents
N+V
cardiac depression
respiratory depression
vasodilation
Complications of Pain sensation
urinary retention
diathermy burns
pressure necrosis
local nerve injuries
Complications of consciousness
cannot communicate, when 0.15% of pts have retained consciousness
Complications of loss of muscle power
Corneal abrasion
No respiration
No coughing
Complications of malignant hyperpyrexia
rare, seen in autosomal dominant inheritance rapid rise in temperature early sign of muscle spasm hypoxemia hypercarbia hyperK metabolic acidosis arrhythmia
How is the analgesic ladder followed
- Non-opioid: aspirin, paracetamol, NSAID
- Weak opioid: codeine, dihydrocodein, tramadol
- Strong opioid: morphine, diamorphine, hydromorphine, oxycodone
Steps to control pain
Check which route is best - PO, Subcut, PR, IM, SC, inhalation or IV
how many doses needed to give - regular dosing
explain how the anaesthesia will be administered and reassure pt
Side effects of
Paracetamol
NSAIDs
Aspirin
P: liver impairment
N: Musculoskeletal pain, renal and biliary colic
- Contraindications: peptic ulcer, clotting disorder, anticoagulants
- cautions: asthma, renal/hepatic impairment, preggers, elderly
A: CI in children to Reye’s syndrome
Side effects of morphine and diamorphine
N+V, resp depression, constipation, cough suppression, urinary retention, decreased bp, sedation
Why is controlling pain important
Psychological (humanitarian)
Social reasons (surgery is less feared)
Biological reasons: if followed in this sequence
Biological reason for pain control follows a sequence, name it.
Pain - autonomic activation - increased adrenergic activity - arteriolar vasoconstriction - reduced wound perfusion - decreased tissue oxygenation - delayed wound healing - serious or mortal consequences
Name the 8 Post Op Complications
Pyrexia Confusion Dyspnoea or hypoxia Decreased BP Increased BP Decreased Urine output N+V HypoNa+
How does post op complication Pyrexia come about? What do you do?
Mild pyrexia in the first 48 hrs comes from atelactasia, tissue dmg, necrosis, or blood transfusion
send for CBC, U+E, CRP, cultures
dipstick the urine
Consider MSU, CXR and abdo US/CT
How does post op complication Confusion come about?
agitation, disorientations and attempts to leave the hospital at night
caused by hypoxia infection drugs alcohol withdrawal liver/renal failure urinary retention MI/Stroke
How does post op complication Dyspnoea come about?
What do you test for?
Any previous lung disease?
check for pneumonia, pulmonary collapse, aspiration, LVF, PE, Pneumothorax
Test of CBC, ABG, CXR, ECG
How does post op complication Decreased BP come about? What do you do?
if severe, tilt bed head down + O2 delivery
check pulse and BP
IF post op, hypervolemia results from inadequate fluid input, check fluid chart + replace losses
Monitor urine output
How does post op complication Increased BP come about? What do you do?
pain
urinary retention
idiopathic HT
inotropic drugs
How does post op complication Decreased urine output come about? What do you do?
if <30mL/hr
blocked catheter
mal-sited catheter
Flush/replace catheter
Oliguria is due to little replacement of lost fluid
How does post op complication N+V output come about? What do you do?
mechanical obstruction
ileus
emetic drugs
AXR
NGT
Antiemetic
How does post op complication decreased Na+ output come about? What do you do?
check pre-op level
SIADH can ppt due to perioperative pain, Nausea and Opioids, chest infection
Do not overadmin IV fluids
- may exacerbate
How do you talk about post-op complications to the pt?
Anaesthetic: Resp depression Surgery in general: wound infection, haemorrhage, neurovascular dmg Specific procedure Pain DVT PE Wound dehiscence Compliations in post-gastric surgery Other complications
