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ANAESTHETICS > CLINICAL > Flashcards

CLINICAL Flashcards

1
Q

TRAUMA from surgery can be from what? 4 examples

A

stress response
fluid shifts
blood loss
cardiovascular, respiratory, renal or metabolic stress

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2
Q

general Anaesthesia - is what in other terms?

A

drug induced reversible coma

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3
Q

what considerations are taken into place when administering ANA?

A

patient - co-morbidities and known pathologies

nature of surgery

post-op care

ANA techniques

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4
Q

ANA role pr-operatively? 5

A 
assess 
identify high risk - high risk of getting those complications 
minimise risk 
consent 
inform and support patients decisions
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5
Q

pre-operative assessment inckudes what?

A

history
examination
investigations

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6
Q

history pre-operative assessment includes what info? 3

A

known co-morbidities
unknown co-morbidities
ability of withstand stress - exercise tolerance etc

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6
Q

history pre-operative assessment includes what info? 3

A

known co-morbidities
unknown co-morbidities
ability of withstand stress - exercise tolerance etc

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7
Q

potential ANA problems asssociated with what areas of body? 4

A

airway - issues with intubation
spine - any deformities
reflux - not fasted?
obesity - gaining access difficult

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8
Q

what grading systems are used to see what tests needed for patient pre-operatively? 3

A

ASA GRADE

SURGERY GRADE

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9
Q

ASA GRADING? FOR?

explain the levels

A

scale to see how fit healthy patient is pre-operatively

ASA1 = otherwise healthy patient 
ASA 2 = MILD to moderate systemic disturbance 
ASA3 = severe systemic disturbance 
ASA 4 = life threatning disease 
ASA 5 = moribund patient 
ASA 6 = ORGAN RETREIVAL
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10
Q

cardiac risk index includes what? 6

A 
high risk surgery 
ischaemic heart disease 
congestive heart failure 
CVD
diabetes 
renal failure
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11
Q

excericise tolerance - METS? why? explain levels?

A

indicator how well patient goes through surgery

list of which actviities patient can do without getting breathless

2mets to 9mets (healthy person)

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12
Q

why look at lifestyle of patient before surgery?

A

look at this pre-operatively too as increase risk of surgery complications

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13
Q

what happens in pre-operative medication provided by ANA?

A

most continue as normal
esp - inhalers, anti-anginals etc

might stop others that might hinder surgeyr - anti-coags.

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14
Q

IPS?

A

MDT trained for acute pain management

ANA
NURSES
etc

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15
Q

stages of an ANA?

A

INDUCTION - making patient sleep

MAINTENANCE - keeping patient asleep

EMERGENCE - process of waking up

RECOVERY - after ANA & recovery from surgery

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16
Q

end tidal co2 is?

A

measure of co2 in gas exhaled

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17
Q

mointoring standard in ANA when giving GA? 5

A 
ECG
NIBP - 3 leads 
SATURATIONS 
ETCO2 
airway pressure
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18
Q

what is the effect of ANA on patient blood pressure?

A

vasodilation

so goes down

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19
Q

what access is needed prior to ANA?

A

need to find cannula before ANA - usually hands is where IV access is found

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20
Q

why does ANA reduce o2 saturation when given?

A

under ANA - muscles relax and lung volume decreases

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21
Q

why give pre-oxygenation?

A

to prevent reduction of gas to happen quickly - as muscles relax and lung volume decrease under ANA

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22
Q

affect of residual capacity under ANA?

A

reduced UNDER ANA

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23
Q

induction in patient given how and why?

A

gaseous - slow and in kids

IV cannula - used in fast and in adults

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24
Q

induction medications categories? 3

A

multi drugs usually used

analgesic
hynotic
muscle relaxant

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25
Q

analgesic drugs e/g 1

A

fentanyl

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26
Q

hypnotic drugs example ? 2

A

propofol

ketamine

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27
Q

planes of ANA describe?

A

not on/off = definite stages/levels of consciousness

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28
Q

planes of ANA - describe the 4 planes ?

A

1 analgyesia/ amnesia - relaxed/floaty

2 delirium to unconsciousness

3 surgical ANA ——— AIM (not move to surgical stimuli)

4 apnoea to death ——– AVOID

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29
Q

affect of ANA on airways? 2

A

loss of airway reflexes

relaxation of tissues

30
Q

breathing monitored by what 3 ?

A

saturation probe
end tidal co2
airway pressure monitoring

31
Q

3 types of breathing in ANA patient?

A

spontaneous venitlation - BREATHING on own

controlled ventilation - help on breathing

supported ventilation - can bretah but we help too

32
Q

circulation affect under ANA?

A

haemodynamic instability common under ANA

changes in BP and heart rate

33
Q

how circulation monitored under ANA? 2

A

control of haemodynamics - BP checked reguaraly

vasoactive drugs given - tighten bv to increase BP

34
Q

SIGNS OF AWARENESS in ANA? 2

A

increase bp

sweaty

35
Q

how to avoid awareness in ANA?

A

increase depth of AN monitoring

measure ANA in and out - tells how asleep patient is

36
Q

body temp affect in ANA?

A

drop in temp - vasodilation

37
Q

low temp consequences in ANA patient? 4

A

increase risk of surgical infection
increase risk of bleeding
increase pain after op

increase risk of needing transfusion

38
Q

what type of injury common in ana patient?

A

pressure injury - from cables/equipment

39
Q

VTE in ANA patients?

A

thromboembolism

keep them active in long surgeries - stockings/pumpers to pump blood in legs

40
Q

what needs to be carefully done when placing patient in ANA?

A

positioning of patient

41
Q

constant adjustment means in ANA?

A

of level of ANA given to patient throughout to keep asleep

42
Q

chronic pain is classed as ?

A

longer than 3 months

43
Q

nociceptive pain describe?

A

obvious tissue injury

inflammatory pain

protective function

44
Q

neuropathic pain?

A

nervous system damage

tissue injury not as obvious

burning, shooting, numbness

45
Q

painkillers classification? 2 and examples 2 each

A

analgesics - paracetamol, NSAIDS

opioids - morphine, codeine

46
Q

tramadol ?

A

mixed opiate

46
Q

tramadol ?

A

mixed opiate - pankiller - analgyesic

47
Q

amitriptyline?

A

TCA

painkiller

increases descedning inhibitory signals - to reduce pain

48
Q

examples of anti-convulsant drugs? 2

A

carbamazepine

sodium valproate

49
Q

pain ladder used in where?

A

in acute pain NOT NEUROPATHIC PAIN

can use for nociceptive pain

50
Q

PAIN LADDER EXPLAIN EACH STAGE

A

MILD/MODERATE PAIN = non-opioids - aspirins, NSAIDS, paracetemol

MODERATE/SEVER PAIN = mild opioids, codeine, eith/without non-opioids(nsaids)

SEVERE PAIN = strong opioids - morphine, with/without non-opioids(nsaids)

51
Q

2 types of resp failure?

A

type 1 = oxygenation failure

type 2 = oxygenation & ventilation failure

52
Q

CVS failure due to shock??

A

shock leads to inability to get o2 into bloodstream - leading to cellular hypoxia

53
Q

fluid either cooloids or crystalloids mean?

A

colloids - fluid that has large active particles in it

crystalloids - fluid with small molecules in them

54
Q

septic means?

A

unresposiveness to fluid intake

55
Q

regional ANA?

A

prodcues insensbility in are/region of body

ANA produced distal site served by that nerve

56
Q

general ana means?

A

insensibilty in whole body

57
Q

local ana means?

A

produces insensibility in only the relevant part of body

ANA prodcued at site of injection

58
Q

triad of ana?

A

analgesia

hypnosis

relaxation

59
Q

opiates give what of triad of ANA?

A

analgesia

and hypnosis

60
Q

local anaesthetics give what of triad of ANA?

A

analgesia
relaxation
no hypnosis

61
Q

general ANA agents do what in the body?

A

supress neuron activity
and interfere with neuronal ion channels

by opening channels with alter neuron - hyperpolarise them

62
Q

general ANA spare what function in the body?

A

reflexes - spinal/ autonomic

63
Q

IV ANA - onset and recovery explained?

e/g

A

onset - rapid

rapid recivery

thiopentone/ propofol

64
Q

IV ANA drugs are what type?

A

highly fat soluble drugs - high % in fat

65
Q

inhaled ANA are what type of drugs ?

and their benefit?

A

halogenated hydrocarbons via lungs

minimum alveolar conc - produce affect with any agent
and low number also gives high potency - still gives same effect

66
Q

maintenence of ANA in inhaled?

A

prologned duration - extends the time

67
Q

GA common sequence?

A

general ANA is IV induction then inhaled maintenance

68
Q

ana affect on sympathetic nerve actviity?

A

reduce it

69
Q

muscle relaxants must be gIven with what? AND WHY

A

MUST BE GIVEN WITH HYPNOSIS DRUG

as not nice being awake and cant communicate as muscles relaxed

70
Q

indication to use muscle relaxant? 2

A

ventilation/intubation

when need patient to be still

71
Q

e/g of local ANA?

A

lignocaine
bupivacaine
ropivacaine

72
Q

infusion technology for?

A

to find out right dose needed
TCI - target controlled infusion system

to achieve specific conc. of agents using pharmokinetics algorithms

ANAESTHETICS (1 decks)

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