Conduct of General Anaesthesia

Question 1

What are the basic phases of anaesthesia?

from pre-op to post-op

Answer 1

Pre-operative assessment
Preparation
Induction
Maintenance
Emergence
Recovery
Post-operative care + pain management

Question 2

What are the factors to consider in preparation for anaesthesia?

Answer 2

Planning
Check it is the correct patient, operation, R/L side, correct equipment
Draw up drugs
IV access
Monitor

Question 3

What are the features of IV induction of anaesthetic?

Answer 3

It is rapid
Easy to overdose
Apnoea is very common

Question 4

What are the features of gas induction anaesthetic?

Answer 4

Common in young children
Slow
More obvious planes of anaesthesia

Question 5

What are the planes of anaesthesia?

Answer 5

4 stages:
analgesia/ sedation
excitation (onset of automatic respiration)
anaesthesia: light > deep
overdose

Question 6

How is conscious level monitored carefully?

Answer 6

loss of verbal contact
movement
respiratory pattern
ECG
stages/planes of anaesthesia

Question 7

What are the features of anaesthetic induction?

Answer 7

quietness
gas or IV agent is used
Careful monitoring of conscious level necessary
Airway maintenance

Question 8

How is airway maintained?

Answer 8

Simple manoeuvres:
head tilt
chin lift
jaw thrust

Airway maintenance is always required in general anaesthesia

Question 9

What apparatus is used for airway maintenance?

Answer 9

face mask
oropharyngeal airway (only tolerated in unconscious patient)
nasopharyngeal airway

Question 10

What are the complications from airway maintenance?

Answer 10

Ineffective triple airway manoeuvre
Airway device malposition
Laryngeal spasm
May result in airway obstruction
Aspiration can occur (e.g. gastric contents in lower airway) as anaesthesia means loss of protective airway reflexes

Question 11

How is the airway maintained and protected?

Answer 11

Maintained if airway is open and not obstructed

A cuffed tube in the trace can protect the airway from contamination

Question 12

What are the reasons for intubation?

Answer 12

Protect airway from gastric contents
Artificial ventilation (where muscle relaxants are used)
Need for tight control of blood gases
Restricted access to airway

Question 13

What are the risks to an unconscious patient?

Answer 13

Airway
Temperature
Loss of protective reflexes
VTE risk
Consent and identification
Pressure areas

Question 14

What are the factors to consider when continuing anaesthesia?

Answer 14

care of the unconscious patient
Muscle relaxation + analgesia
Monitoring
Fluid management
Documentation

Question 15

How do you monitor the unconscious patient?

Answer 15

Respiratory parameters
Agent monitoring
Temperate
Urine output
Invasive venous/ arterial monitoring
ECG

Question 16

What are the features of emergency/ awakening?

Answer 16

Muscle relaxation reversed
Anaesthetic agents off
Resume spontaneous respiration
Return of airway reflexes
Extubation
Can be very quick or slow

Question 17

What are the features of recovery + problems?

Answer 17

There is dedicated area with trained staff for recovery
Many patients have not yet regained consciousness or airway control

Problems with:
ABC
Pain control
Post-op nausea + vomiting

There is criteria before discharge back to ward