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Y3 - anaesthetic s > conduct of GA > Flashcards

conduct of GA Flashcards

1
Q

what is a GA

A

CONTROLLED period of unconsciousness during which you will feel nothing and remember nothing

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2
Q

stages of getting an anaesthetic

A

pre-op assessment and planning
preparation
anaesthetic: induction, maintenance, emergence, recovery
post-op care

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3
Q

pre-op assessment and planning - when does it happen

A

can begin months in advance

takes into account how major the surgery is and the complexity of the patients needs

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4
Q

what happens in the pre-op assessment

A

information gathering and giving
informed consent
trust and communication

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5
Q

what happens in the preparation period

A

right people available - anaesthetist and assistant (ODP, nurse), theatre team and surgeon
right environment
right equipment - machine checks and team brief

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6
Q

what happens when the patient is checked in

A

part of WHO theatre checklist
correct patient for correct procedure
correct site and position marked
adequate consent and in time

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7
Q

what is required when monitoring a patient

A

5 minimum standards of monitoring
must be ready and working before beginning GA

ECG monitoring
oxygen saturations
non-invasive BP (NIBP)
end tidal CO2 - info about airway CO2 levels in blood and patency of airway
airway pressure monitoring - info about how we are ventilating patient and airway patency

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8
Q

what is another thing as well as the 5 monitors that the patient requires before anaesthetic

A

IV access

usually in back of hand for ease of access

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9
Q

what is pre-oxygenation

A

give patients additional oxygen to breathe through a tight fitting face mask before anaesthetic

usually 100% oxygen

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10
Q

why are patients given supplemental oxygen before GA

A

common for pts under GA to become apnoeic and stop breathing - pause between patient stopping breathing and the anaesthetist getting more oxygen into the pts lungs

reduced FRC - less oxygen available for the blood to take out, less time before patient starts to desaturate

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11
Q

when is a gaseous induction given

A

normally reserved for small children who won’t tolerate a cannula being placed

slower induction than IV

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12
Q

3 parts to induction

A

analgesic - short acting opiate (fentanyl, alfentanil)
hypnotic - propofol, sometimes thiopentone, ketamine, benzodiazepines
muscle relaxant - avoid unless necessary

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13
Q

planes of anaesthesia

A

distinct stages between consciousness and unconsciousness that can be seen as the patient goes off to sleep

  1. analgesia and amnesia (patient feels floaty and relaxed)
  2. delirium to unconsciousness (can be associated with some excitatory behaviour - small children move about and can get upset)
  3. surgical anaesthesia - patient doesnt move in response to surgical stimulus
  4. apnoea to death - AVOID
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14
Q

airway management

A

some degree required for all patients under anaesthetic - minimally invasive to invasive

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15
Q

why is airway management required in patients under anaesthetic

A

relaxed muscles of upper airway and soft tissue collapse

some degree of airway obstruction in all patients

loss of airway reflexes - no coughing or swallowing, nothing to protect from own secretions

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16
Q

what is the simplest airway management

A

triple airway manoeuvre

head tilt, jaw thrust, open mouth

accompanied with anaesthetic mask

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17
Q

what can be used for aiway management after triple airway manoeuvre and anaesthetic mask

A

oropharyngeal airway aka Guedel
splints open the upper airway
draws up the tongue which can slip backwardxs

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18
Q

what can be used for aiway management after oropharyngeal airways

A

laryngeal mask airway - LMA

sits over the larynx with a tight seal to direct gas flow towards the patients airway

doesn’t protect the airway

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19
Q

what is used if the patient needs more definitive airway management or protection

A

endotracheal tube

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20
Q

what is an endotracheal tube

A

sits within the trachea

cuffed tube with a balloon at the end which sits in the trachea and stops anything coming past the cuff - protects the airway

21
Q

how are endotracheal tubes inserted

A

with a laryngoscope

22
Q

reasons to intubate

A

protection from aspiration e.g. emergency intervention and unfasted
need for muscle relaxation - facilitate ventilatoin
shared airway - surgeon and anaesthetist are both working in the same area
need for tight CO2 control
minimal access to patient

23
Q

what are the 3 ways for how a patient breathes during an operation

A

spontaneous ventilation - patient breathes completely on their own
supported ventilation - mix of the 2
controlled ventilation - patient is paralysed and we completely take over

24
Q

monitoring circulation under anaesthesia

A

haemodynamic instability is common

measure BP at least every 5 mins

vasoactive drugs may be necessary to maintain BP

25
Q

risk of induction

A 
anaphylaxis 
regurgitation and aspiration
airway obstruction and hypoxia
laryngospasm
CV instability 
rarely cardiac arrest
26
Q

why does laryngospasm happen and what is it

A

vocal cords constrict and prevent gas from passing into the lungs

usually a result of patient not being adequately anaesthetised

27
Q

what is awareness

A

patients will recall periods of being in theatre

ranges from remembering noises and lights to recollection and painful memories

not common 1:8200 - 1:135900

increased risk w/ muscle relaxants ad type of surgery

28
Q

signs of lightness in the anaesthetic

A

tachycardia
high BP
sweaty

29
Q

how can we measure depth of anaesthesia and reduce risk of awareness

A

depth of anaesthesia monitors

limited EEG

30
Q

risk of eye injury under anaesthesia

A

1:1000

patients don’t naturally close their eyes under anaesthesia

corneas can dry out from lack of blinking

cannot protect themselves from things brushing against their eyes

31
Q

eye care under GA

A

tape eyes shut

lubricating ointment if taping isn’t possible

pad the eyes if patient is lying face down

32
Q

risk under anaesthetic

A 
awareness
eye injury 
hypothermia
pressure injuries
VTE
nerve injury
33
Q

why is hypothermia a concern in theatre

A

unpleasant for pt to wake up cold
low body temp increases risk of surgical site infection
increased post-op pain
increased risk of bleeding and risk of requiring transfusion

34
Q

risk of hypothermia

A

1:25-1:2

depends on type and length of operation - amount and duration of exposure

35
Q

why may patients become hypothermic

A

anaesthetic agents will vasodilate - natural drop in core temp

exposed for long periods of time

36
Q

how to reduce risk of hypothermia

A

check temp at least every 30 mins, can have continuous temp monitoring w/ oesophageal probe

covering as much of the pt as possible

bear huggers - forced warm air blankets

37
Q

risk of pressure injuries

A

1:5

38
Q

how to prevent pressure injuries

A

careful padding of pressure areas

care w/ placement of cables and tubes

39
Q

risk of venous thromboembolism

A

1:100-1:4

depends on type of operation and patient factors

40
Q

reducing risk of VTE

A

keep pts active as long as possible before coming to theatre

TED stockings

flowtrons - inflate and deflate to pump blood out of the venous system in the legs

chemical prophylaxis - dalteparin

41
Q

nerve injury under anaesthesia

A

1:1000

peripheral nerves can become damaged - similar to pressure injury

nerves running over bony prominences are at particular risk - ulnar, common peroneal

brachial plexus injury through poor positioning and padding

42
Q

preventing nerve injury

A

good pressure point padding

careful positioning

43
Q

how is anaesthetic maintained

A

vapour - continuous delivery

IV - continuous infusion e.g. propofol

44
Q

what decisions need to be made about analgesia

A

needs to be: long acting, multi modal, appropriate route

45
Q

anti-emesis

A

N+V common after operations and anaesthesia

multi-modal

pharmacological vs non-pharmacological

risk assessed

46
Q

what is documented during the maintenance phase of an anaesthetic

A

prescription record
observation
ventilation
fluid balance

47
Q

risks of emergence

A

same as risks when going to sleep

48
Q

steps of emergence

A

theatre sign out
reversal of neuromuscular blockade
stop anaesthetic agent

return of spontaneous breathing
return of airway reflexes
suction and removal of airway device
transfer to recovery room

49
Q

recovery after anaesthesia

A

can be delirious on emergence - emergency surgery and small children

specific area
highly trained staff 
manage ABC until awake 
manage pain and N+V
handover to ward

Y3 - anaesthetic s (5 decks)

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