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Anaesthetics > Conduct of General Anaesthesia > Flashcards

Conduct of General Anaesthesia Flashcards

1
Q

What are some roles of the anaethetist?

A
  • Pre-operative assessment
  • Perioperative medicine
  • Pain medicine
  • Critical care/intensive care medicine
  • Anaesthesia
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2
Q

What are the 4 anaesthetic stages?

A
  1. Induction
  2. Maintenance
  3. Emergence
  4. Recovery
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3
Q

What are the stages and phases of patients journey to theatre?

A
  1. Pre-operative assessment and planning
  2. Preparation
  3. Anaesthetic stages
    1. Induction
    2. Maintenance
    3. Emergence
    4. Recovery
  4. Post-operative care
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4
Q

What does preparation for theatre involve?

A
  • Right people, skills, place and time
  • Machine checks
  • Brief
  • Check-in patient
    • Correct patient, correct procedure, correctly marked site, consent
  • Apply monitoring to patient
    • 5 minimum standards of monitoring defined by association of anaesthetists minimum standards
      • ECG
      • Oxygen saturation
      • Non-invasive blood pressure (BP normally decreases)
      • End tidal CO2 (amount of CO2 in gas patient is breathing out)
      • Airway pressure monitoring
  • IV access
  • Pre-oxygenation (patients may stop breathing under anaesthetic, muscles relax so total volume in lungs reduces so this is done to increase time to desaturation)
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5
Q

What does checking in the patient involve?

A

Correct patient, correct procedure, correctly marked site, consent

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6
Q

What are the 5 minimum standards of monitoring defined by association of anaethetists minimum standards?

A
  • ECG
  • Oxygen saturation
  • Non-invasive blood pressure (BP normally decreases)
  • End tidal CO2 (amount of CO2 in gas patient is breathing out)
  • Airway pressure monitoring
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7
Q

WHat is end tidal CO2?

A

End tidal CO2 (amount of CO2 in gas patient is breathing out)

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8
Q

What can induction of anaesthesia be performed by?

A
  • IV
    • Fast onset
    • Usual combination of drugs is analgesic (fentanyl or alfentanil) with a hypnotic (propofol, thiopentone or ketamine) and sometimes a muscle relaxant
  • Inhalation
    • Unusual in adult, normally done for children
    • Slow onset
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9
Q

What is the usual combination of drugs for IV induction of anaesthesia?

A
  • Usual combination of drugs is analgesic (fentanyl or alfentanil) with a hypnotic (propofol, thiopentone or ketamine) and sometimes a muscle relaxant
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10
Q

During induction patients move through the planes of anaesthesia, what are the 4?

A
  1. Analgesia and amnesia
  2. Delirium to unconsciousness
  3. Surgical anaesthesia
  4. Apnoea to death
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11
Q

What are some complications of induction?

A
  • Anaphylaxis
  • Regurgitation and aspiration
  • Airway obstruction and hypoxia
  • Laryngospasm
  • Cardiovascular instability
  • Cardiac arrest (rarely)
  • Awareness
    • Reduce risk by using depth of anaesthesia monitors
  • Eye injury
    • Due to cornea drying out from lack of blinking
    • Reduce risk by covering eyes or using eye lubricants
  • Hypothermia
    • Increases post-op pain, risk of infection, risk of bleeding
    • Temperature is checked every 30 minutes
    • Reduce risk by covering patient
  • Pressure injury
    • Reduce risk by not placing things in contact with patients skin
  • Venous thromboembolism
    • Reduce risk by keeping patients active before surgery, using TED stockings, chemical prophylaxis
  • Nerve injury
    • Nerves that run over bony prominence are most at risk
    • Reduce risk by pressure point padding and careful positioning
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12
Q

How can the risk of the following be reduced:

  • awareness
  • eye injury
  • hypothermia
  • pressure injury
  • venous thromboembolism
  • nerve injury
A
  • Awareness
    • Reduce risk by using depth of anaesthesia monitors
  • Eye injury
    • Due to cornea drying out from lack of blinking
    • Reduce risk by covering eyes or using eye lubricants
  • Hypothermia
    • Increases post-op pain, risk of infection, risk of bleeding
    • Temperature is checked every 30 minutes
    • Reduce risk by covering patient
  • Pressure injury
    • Reduce risk by not placing things in contact with patients skin
  • Venous thromboembolism
    • Reduce risk by keeping patients active before surgery, using TED stockings, chemical prophylaxis
  • Nerve injury
    • Nerves that run over bony prominence are most at risk
    • Reduce risk by pressure point padding and careful positioning
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13
Q

Other than the administration of drugs to begin induction, what are some other important aspects?

A
  • Airway management
    • Anaesthesia causes loss of airway reflexes and relaxation of tissues
    • Types of management includes
      • Triple airway manoeuvre
    • Anaesthetic mask
    • Oropharyngeal airway – splints open airway and pushes tongue forwards, only sometimes used
    • Laryngeal mask airway (LMA)
    • Endotracheal tube (ETT)
    • Indications for intubation
      • Protection from aspiration
      • Need for muscle relaxation for operation
      • Shared airway (surgeon and anaesthetic working in same area)
      • Need for tight CO2 control
      • Minimal access to patient
  • Breathing
    • Spontaneous ventilation
    • Controlled ventilation
    • Supported ventilation
  • Circulation
    • Control of haemodynamics
      • BP taken every 5 minutes
    • Vasoactive drugs
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14
Q

What are different types of management for the airway during induction?

A
  • Triple airway manoeuvre
  • Anaesthetic mask
  • Oropharyngeal airway – splints open airway and pushes tongue forwards, only sometimes used
  • Laryngeal mask airway (LMA)
  • Endotracheal tube (ETT)
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15
Q

What does LMA stand for?

A

Laryngeal mask airway

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16
Q

What does ETT stand for?

A

Endotracheal tube

17
Q

What is the triple airway maneuver?

A
18
Q

What are indications for intubation?

A
  • Protection from aspiration
  • Need for muscle relaxation for operation
  • Shared airway (surgeon and anaesthetic working in same area)
  • Need for tight CO2 control
  • Minimal access to patient
19
Q

How often is blood pressure taken during surgery?

A
  • BP taken every 5 minutes
20
Q

What happens during the maintanence anaesthetic phase?

A

Patient kept asleep:

  • Vapour (gas)
  • Intravenous anaesthesia (TIVA)
21
Q

What is used to keep the patient asleep?

A
  • Vapour (gas)
  • Intravenous anaesthesia (TIVA)
22
Q

What does the anaethetist do during the maintanence anaesthesia phase?

A
  • Constant adjustment of anaesthetic to keep in right plane
  • Anticipation (blood loss/fluid shift/major events)
  • Analgesia
    • Long acting, multi-modal, and can be IV/local/regional
  • Anti-emesis
    • Pharmacological or non-pharmacological
  • Documentation
    • Use of anaesthetics chart
      • Contains – prescription record, observation chart, ventilation chart and fluid chart
23
Q

Is the induction or emergence phase more risky?

A

The same

24
Q

What are the steps of emergence phase?

A
  • Theatre sign out
  • Reversal of neuromuscular blockade (if used)
  • Anaesthetic agent stopped
  • Return of spontaneous breathing, airway reflexes will return, suctioning and removal of airway device
  • Transfer of patient to recovery room
25
Q

What are the steps of the recovery phase?

A
  • Manage ABC until awake
  • Initial post-operative analgesia
  • Management of nausea
  • Handover to ward
26
Q

Whats the anaethetists involvement in post-operative care?

A

Some patients go home same day, but others require more care and management:

  • Visit patients day after, a for a few days after to check up on pain management and fluid management

Anaesthetics (6 decks)

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