Conduct of anaesthesia

Question 1

5 minimum standards of equipment

Answer 1

ECG - for arrhythmia that acan occur under GA

• oxygen saturations

Non-invasive blood pressure
- BP often drops as agents are vasodilators

End Tidal C02
- around of co2 in the gas patient blows out, can show co2 in blood and patency of patients airway

Airway Pressure Monitoring

Question 2

what is end tidal co2

Answer 2

small plastic tube attached to breathing circuit which is used to give oxygen to the patient

Question 3

almost every patient will need what before they under go GA?

Answer 3

IV access - cannula

Question 4

why do you give more oxygen?

Answer 4

100% oxygen - for a couple of minutes

• Increase time to desaturation
• Reduced Functional Residual Capacity under anaesthesia
• total volume of lungs reduces

Question 5

induction - when may you use gaseous?

Answer 5

• children

- takes longer

Question 6

with an IV induction - what drugs are given (2 classes)

Answer 6

Analgesic

Hypnotic

muscle relaxant

Question 7

examples of analgesic? (2)

Answer 7

short acting opiates
Fentanyl
Alfentanil

Question 8

examples of hypnotics (3)

Answer 8

Propofol (white substance)
Thiopentone
Ketamine

Question 9

Planes of Anaesthesia - number 1 (gaseous)

Answer 9

Analgesia and amnesia (relaxed)

Question 10

Planes of Anaesthesia - number 2

Answer 10

Delirium to unconsciousness

- wriggly in children, upset

Question 11

Planes of Anaesthesia - number 3

Answer 11

patient won’t respond to stimulus

Question 12

Planes of Anaesthesia - number 4

Answer 12

Apnoea to death

Question 13

Airway Management causes (2)

Answer 13

Loss of airway reflexes

Relaxation of soft tissues

Question 14

what is the triple airway maneuver?

Answer 14

head tilt, jaw thrust and open mouth

Question 15

Oropharyngeal airway
(guedel's) are used to?

Answer 15

splint open the upper airway and draw the tongue forward

Question 16

anatomical landmarks for guedels?

Answer 16

incisors and tragus muscle of ear

• angle of Jaw to level of incisors

Question 17

4 steps for guedels?

Answer 17

invert insert rotate and locate

Question 18

if a patient needs more definitive airway management or protection - what do you use?

Answer 18

Endotracheal Tube (ETT)

Question 19

Reasons to Intubate (5)

Answer 19

• Protection from aspiration
• Need for muscle relaxation
• Shared airway
• Need for tight C02 control
• Minimal access to patient

Question 20

how can a patient breathe under an anaesthetic? (3)

Answer 20

Spontaneous ventilation - by themselves

Controlled ventilation - patient paralysed- take over breathing

Supported ventilation

Question 21

Circulation - Control of haemodynamics - what must be done every 5 mins?

Answer 21

blood pressure

Question 22

drugs used In circulation

Answer 22

Vasoactive drugs - tighten blood vessels

Question 23

Risks of induction? (6)

Answer 23

• Anaphylaxis
• Regurgitation and aspiration (fasting)
• Airway obstruction and hypoxia
• Laryngospasm - vocal chords constricting
• Cardiovascular instability
• Rarely, cardiac arrest

Question 24

other risks of GA? (6)

Answer 24

• awareness - patients may recall periods of being in theatre
• eye injury - cornea dries out from lack of blinking
• hypothermia - increase bleeding and pain etc - will naturally drop core temperature
• pressure injuries - patients don’t move

VTE - depends on operation and patient factors - TED stockings

Nerve injury - ulnar and common perineal

Question 25

awareness may occur in patients who have had?

- what can you use?

Answer 25

muscle relaxants

• Depth of Anaesthesia Monitoring

Question 26

most common nerves injured under anaesthetic?

Answer 26

ulnar and perineal

Question 27

2 options for Maintenance phase?

Answer 27

Vapour (“gas”) - delivered continuously

Intravenous anaesthesia (TIVA)

Question 28

anti-emesis features

Answer 28

Multi-modal

Pharmacological vs non-pharmacological

Risk assessed

Question 29

Emergence is?

Answer 29

patient waking up

Question 30

Emergence steps (4)

Answer 30

• Return of spontaneous breathing
• Return of airway reflexes
• Suctioning and removal of airway device
• Transfer to recovery room