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Anaesthetics > Conduct of Anaesthesia > Flashcards

Conduct of Anaesthesia Flashcards

1
Q

What are the phases of the process of anaesthesia?

A 
Pre-operative assessment 
Preparation
Induction 
Maintenance
Emergence
Recovery 
Post-operative care and management
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2
Q

What is involved in the preparation for anaesthesia?

A 
Planning 
Right patient, right operation, right side 
Pre-medication
Right equipment and personnel
Drugs drawn up 
IV access gained
Monitoring
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3
Q

What is involved in the induction of anaesthesia?

A

Quietness
Gas or IV agent
Careful monitoring of conscious level
Airway maintenance

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4
Q

What are some of the drugs used in IV induction?

A

Propofol

Thiopentone

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5
Q

What are the features of IV induction?

A

Rapid - one arm-brain circulation around 20 seconds
No obvious planes
Easy to overdose
Generally rapid loss of airway reflexes
Apnoea common
Airway reflexes weak off quite quickly allowing quick control of airways by anaesthetists

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6
Q

What are the features of gas induction?

A

Sevoflurane (Halothane) used
Common in young children
Slow
Considerably more planes of anaesthesia

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7
Q

What are the planes of anaesthesia?

A 
Analgesia/sedation
Excitation
Anaesthesia (light-deep) 
Overdose
Sleepy/excited/anaesthetised
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8
Q

How is conscious level monitored?

A 
Loss of verbal contact
Movement 
Respiratory pattern 
Processed EEG 
Stages/planes of anaesthesia
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9
Q

When is airway maintenance required?

A

Always required in general anaesthesia

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10
Q

How is airway maintenance achieved?

A

Simple manoeuvres e.g. head tilt, chin lift, jaw thrust
Triple airway manoeuvre
Face mask
Oropharyngeal or nasopharyngeal airway

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11
Q

What are the features of the oropharyngeal airway?

A

Developed by Guedel in US
Rigid plastic
Only tolerated by unconscious patient
Insertion in a light patient may cause vomiting or laryngospasm

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12
Q

How is more advanced airway management achieved?

A

Using laryngeal mask airway - cuffed tube with mask sitting over the glottis

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13
Q

What are the possible causes of airway obstruction?

A 
Foreign body (almost always this) 
Ineffective triple airway manoeuvre 
Airway device malposition or kinking 
Laryngospasm
Forced reflex adduction of vocal cords 
Caused by airway stimulation in light planes of anaesthesia
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14
Q

Why might anaesthesia result in aspiration?

A

Anaesthesia causes loss of airway reflexes e.g. cough, gag, swallow

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15
Q

What is the difference between airway maintenance and protecting?

A

Airway is maintained if it is open and obstructed

Only a cuffed tube in the trachea protects the airway from contamination

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16
Q

What are the features of endotracheal intubation?

A

Placement of cuffed tube in trachea
Oral route most commonly used
Laryngeal reflexes must be abolished

17
Q

Why might intubation be necessary?

A

Protect airway from gastric contents
Need for muscle relaxation and artificial ventilation
Shared airway with risk of blood contamination
Need for tight control of blood gases
Restricted access to airway

18
Q

What are the risks to the unconscious patient?

A 
Airway 
Temperature 
Loss of protective reflexes e.g. corneal, joint position
Venous thromboembolism 
Consent and identification 
Pressure areas
19
Q

What are the positions which might be used for procedures requiring anaesthetic?

A 
Supine
Lithotomy 
Prone
Lying on side
Sitting
20
Q

What are the features of continuing anaesthesia?

A 
Care of unconscious patient 
Muscle relaxation, analgesia 
Monitoring and physiological support 
Fluid management 
Documentation and recording 
Induction agents wear off
Maintenance with IV, inhalation agent or both 
Self or artificial ventilation
Balanced technique 
Analgesia 
Gas supply
21
Q

What are the features of monitoring anaesthesia?

A

Basic minimum monitoring - SpO2, ECG, non-invasive BP, FiO2, ETCO2
Respiratory parameters - tidal volume, airway pressures
Agent monitoring
Temperature, urine output, NMJ
Invasive venous/arterial monitoring
Processed EEG
Ventilatory disconnect

22
Q

What are the possible anaesthetic complications?

A 
Airway 
Breathing 
Circulation
Related to techniques or position 
Awareness
23
Q

What are the risk factors for awareness?

A 
Paralysed and ventilated 
Previous episode of awareness 
Chronic CNS depressant use 
Cardiac surgery 
Major trauma 
GA C-section
24
Q

What are the features of emergence/awakening?

A 
Muscle relaxation reversed
Anaesthetic agents switched off
Resumption of spontaneous respiration 
Wait for return of airway reflexes/control
Extubation 
Can be very quick or very slow
25
Q

What are the features of recovery?

A

Dedicated area with trained staff
Many patients not yet regained consciousness or airway control
Continuing responsibility of anaesthetist
Problems with A, B, C
Pain control
Post-operative nausea and vomiting
Set criteria for discharge back to ward

Anaesthetics (5 decks)

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