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Gen Surg > Chapter 2: Anaesthesia > Flashcards

Chapter 2: Anaesthesia Flashcards

1
Q

Name the 5 drug classes used in a typical Anaesthesia regimen

A 
Anxiolytics
Antisialitics
Analgesics
Antiacids (if pt at risk of aspiration)
Antiemetic (5HT3 antagonists)
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2
Q

Side effect to Atropine

A

Anticholinergic

thus tachycardia, urinary retention, glaucoma and sedation

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3
Q

Side effects of opioids

A

Respiratory depression, constipation, decreased cough reflex, N+V

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4
Q

Side effects of thiopental

A

laryngospasm

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5
Q

Side effects of Propofol

A

respiratory depression
cardiac depression
pain on injection

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6
Q

Side effects of volatile agents

A

N+V
cardiac depression
respiratory depression
vasodilation

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7
Q

Complications of Pain sensation

A

urinary retention
diathermy burns
pressure necrosis
local nerve injuries

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8
Q

Complications of consciousness

A

cannot communicate, when 0.15% of pts have retained consciousness

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9
Q

Complications of loss of muscle power

A

Corneal abrasion
No respiration
No coughing

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10
Q

Complications of malignant hyperpyrexia

A 
rare, seen in autosomal dominant inheritance
rapid rise in temperature
early sign of muscle spasm
hypoxemia
hypercarbia
hyperK
metabolic acidosis
arrhythmia
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11
Q

How is the analgesic ladder followed

A
  1. Non-opioid: aspirin, paracetamol, NSAID
  2. Weak opioid: codeine, dihydrocodein, tramadol
  3. Strong opioid: morphine, diamorphine, hydromorphine, oxycodone
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12
Q

Steps to control pain

A

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

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13
Q

Side effects of
Paracetamol
NSAIDs
Aspirin

A

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

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14
Q

Side effects of morphine and diamorphine

A

N+V, resp depression, constipation, cough suppression, urinary retention, decreased bp, sedation

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15
Q

Why is controlling pain important

A

Psychological (humanitarian)
Social reasons (surgery is less feared)
Biological reasons: if followed in this sequence

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16
Q

Biological reason for pain control follows a sequence, name it.

A

Pain - autonomic activation - increased adrenergic activity - arteriolar vasoconstriction - reduced wound perfusion - decreased tissue oxygenation - delayed wound healing - serious or mortal consequences

17
Q

Name the 8 Post Op Complications

A 
Pyrexia
Confusion
Dyspnoea or hypoxia
Decreased BP
Increased BP
Decreased Urine output
N+V
HypoNa+
18
Q

How does post op complication Pyrexia come about? What do you do?

A

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

19
Q

How does post op complication Confusion come about?

A

agitation, disorientations and attempts to leave the hospital at night

caused by
hypoxia
infection
drugs
alcohol withdrawal
liver/renal failure
urinary retention
MI/Stroke
20
Q

How does post op complication Dyspnoea come about?

What do you test for?

A

Any previous lung disease?
check for pneumonia, pulmonary collapse, aspiration, LVF, PE, Pneumothorax

Test of CBC, ABG, CXR, ECG

21
Q

How does post op complication Decreased BP come about? What do you do?

A

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

22
Q

How does post op complication Increased BP come about? What do you do?

A

pain
urinary retention
idiopathic HT
inotropic drugs

23
Q

How does post op complication Decreased urine output come about? What do you do?

A

if <30mL/hr
blocked catheter
mal-sited catheter

Flush/replace catheter

Oliguria is due to little replacement of lost fluid

24
Q

How does post op complication N+V output come about? What do you do?

A

mechanical obstruction
ileus
emetic drugs

AXR
NGT
Antiemetic

25
Q

How does post op complication decreased Na+ output come about? What do you do?

A

check pre-op level
SIADH can ppt due to perioperative pain, Nausea and Opioids, chest infection

Do not overadmin IV fluids
- may exacerbate

26
Q

How do you talk about post-op complications to the pt?

A 
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

Gen Surg (6 decks)

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