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Exam M - Anaesthetics (Megan and Rachel) > Conduct of anaesthesia > Flashcards

Conduct of anaesthesia Flashcards

1
Q

What is a general anaesthetic?

A

A period of controlled unconsciousness during which you will feel nothing and after which you will remember nothing.

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2
Q

What are the 4 phases of anaesethetic?

A
  1. Induction (when the patient goes to sleep)
  2. Maintenance (keeping the patient asleep)
  3. Emergence (waking up)
  4. Recovery (when the patient still hasn’t fully recovered yet)

I’M in the ER.

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3
Q

Who is the anaesthetic assistant?

A

Usually a specially trained nursed or operating department practitioner.

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4
Q

When is the anaesthetic machine checked?

A

At least 1x daily.

Some parts are checked between each case.

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5
Q

What is the check-in (WHO theatre safety list)?

A 
team brief 
sign in
time out
sign out
team debrief
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6
Q

What is part of the time out (checking the patient in)?

A

Ensuring correct patient
Correct procedure
Correct site (and marked)
Consent

Consent can expire if it was obtained a long time before the surgery

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7
Q

What are the essential things which should be monitored?

A
  1. ECG
  2. Oxygen saturations
  3. Blood pressure (NIBP)
  4. End tidal CO2
  5. Airway pressure.
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8
Q

How often should temperature be measured?

A

Before anaesthetic is administered, then every 30 minutes until the end of surgery.

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9
Q

What happens to the blood pressure when under anaesthetic?

A

the blood pressure will usually drop because the drugs used for anaesethetic are usually VASODILATORS.

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10
Q

Which heart symptom is very common under anaesthetic?

A

Heart arrhythmias.

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11
Q

What type of ECG monitoring is used during anaesthetics?

A

3 lead ECG, one on the left and right sholder, and one on the left side of the chest.

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12
Q

What is NIPB?

A

Non-invasive blood pressure monitoring.

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13
Q

Where does the oxygen saturation monitor go during surgery?

A

Adult - finger or ear.

Baby - the toe.

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14
Q

What does the breathing circuit allow during surgery?

A

Delivery of oxygen.
Sampling of gas (determines CO2 concentration).
Can deliver inhalational anaesthetic.

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15
Q

What is ETCO2?

A

End tidal CO2 levels, this is the amount of carbon dioxide in the air breathed OUT from the patient.

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16
Q

What is pre-oxygenation?

A

When oxygen is delivered through a tightly fitting facemask BEFORE general anaesthetic is delivered.

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17
Q

How long/percentage is oxygen given for during pre-oxygenation?

A

100% oxygen for a few minutes before GA is administered.

18
Q

Why is pre-oxygenation done?

A

Because patients become apnoeic (stop breathing) when they are put to sleep - until the anaesthetist intubates them they are not breathing - need a reserve of oxygen.

It is to fill your functional residual capacity with more oxygen, so it takes longer for the patient to desaturate.

19
Q

What is Functional Residual Capacity?

A

this is the amount of air left in the lungs after a breath - its what we use to get oxygen from and give carbon dioxide to when we arent breathing (swallowing, talking etc).

20
Q

What happens to the functional residual capacity when under general anaesthetic?

A

It reduces by about 20%, more in obese/COPD patients.

This is likely due to loss of muscle tone which help inspiration.

21
Q

What is rapid sequence induction?

A

When you coordinate putting the patient to sleep with rapid intubation of the airway.

22
Q

What are the steps for rapid sequence induction?

A

7 P’s.

Preparation.
Pre-oxygenation (high flow O2 for 5 mins).
Pre-treatment - opiates or fluid bolus.
Paralysis - Induction agent + paralysing agent.
Protection and positioning - cricoid pressure.
Placement and proof - intubation via laryngoscopy (+ proof by CO2, visual or bilateral auscultation).
Post-intubation management - taping tube, sedation agents and initiating mechanical breathing.

23
Q

Is gaseous induction or IV induction faster?

A

IV induction is much faster at putting the patient to sleep, gaseous induction is usually only done in children.

24
Q

Which 2 analgesic drugs are used?

A

Fentanyl
Alfentanil
(^these are short acting opioids)

25
Q

Which hypnotic drugs are used?

A

Propofol (most common)
Thiopentone
Ketamine
Benzodiazepines

26
Q

When is a muscle relaxant used during anaesthesia?

A

If needed but is avoided when unnecessary.

27
Q

Which type of drugs are given for anaesthetics?

A

Analgesic + hypnotic (+sometimes a muscle relaxant)

28
Q

What are the gavel planes of anaesthesia?

A
  1. Analgesia and amnesia (floaty and relaxed)
  2. Delirium to unconsciousness (can get wriggly and upset)
  3. Surgical anaesthesia (the patient won’t move in response to a surgical stimulus)
  4. Apnoea to death
29
Q

Which patients require airway management?

A

All patients require some form of airway management. The tissues relax and there is some obstruction of the airway.

30
Q

What is the first step in airway management?

A

Head tilt
jaw thrust
open mouth

31
Q

What type of equipment is used for airway management?

A

Plastic mask
Oropharyngeal airway
Laryngeal mask airway
Endotracheal tube (inserted using a laryngoscope + blown up)

32
Q

What reasons are there to intubate a patient?

A 
protect from aspiration.
Muscle relaxation
Shared airway 
Need for tight CO2 control
Minimal access to patient
33
Q

How often is blood pressure checked?

A

Every 5 minutes

34
Q

What are the main risks of anaesthetics?

A 
Anaphylaxis 
regurgitation + aspiration
laryngospasm 
cardiovascular instability
cardiac arrest
35
Q

When is laryngospasm most common in anaesthesia?

A

In ligher planes of anaesthesia

36
Q

What are the signs that someone might have awareness during surgery?

A

High BP
Tachycardia
Sweaty
Movement (might just suggest they don’t have a high enough dose of medication)

37
Q

What operation has one of the highest risks of awareness? 1 in 250?

A

Cesarean section

38
Q

How often is temperature measured?

A

Every 30 mins, anaesthetic drugs often vasodilator the vessels, causing a drop in temperature.

39
Q

What is a medical prophylaxis for venous thromboembolism?

A

Delta parin.

40
Q

Which nerves are most commonly injured during surgery?

A

Ulnar and perineal nerves (because they run over a bone).

41
Q

What is maintenance?

A

When more gas or IV medication is given throughout the operation to keep the patient asleep.

42
Q

How is emergence (waking up) of the patient done?

A

There is no drug to reverse the anaesthetic so you just have to stop it and wait till it works its way out of the system.

Exam M - Anaesthetics (Megan and Rachel) (5 decks)

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