Conduct of General Anaesthesia and Pre-operative Assessment

Question 1

What are the stages and phases of general anaesthetic?

Answer 1

Pre-operative assessment and planning
Preparation
Induction
Maintenance
Emergence
Recovery

Question 2

What monitoring is done in anaesthetics?

Answer 2

ECG, Oxygen saturation, non-invasive blood pressure, end tidal CO2 and airway pressure monitoring

Question 3

Why is supplemental oxygen given pre-operatively?

Answer 3

Increases time to desaturation
Reduced functional residual capacity under anaesthesia

Question 4

What is given for induction?

Answer 4

Analgesic - fentanyl or alfentanil
Hypnotic - propofol, thiopentone or ketamine
Possibly plus muscle relaxant

Question 5

What are the planes of anaesthesia?

Answer 5

Analgesia and amnesia
Delirium to unconsciousness
Surgical anaesthesia
Apnoea to death

Question 6

Why is airway management done in anaesthetics?

Answer 6

Loss of airway reflexes and relaxation of tissues

Question 7

What is included in airway management during anaesthesia?

Answer 7

Triple airway manoeuvre
Oropharyngeal airway
Laryngeal mask airway (LMA)
Endotracheal tube (ETT) - fully protects the airway
Laryngoscope

Question 8

How is circulation controlled during anaesthesia?

Answer 8

Control of haemodynamics - BP at least every 5 mins
Vasoactive drugs

Question 9

What are the reasons to intubate?

Answer 9

Protection from aspiration, need for muscle relaxation, shared airway, need for tight CO2 control and minimal access to patient

Question 10

What are the risks of anaesthesia?

Answer 10

Anaphylaxis, regurgitation, aspiration, airway obstruction, hypoxia, laryngospasm, cardiovascular instability and rarely cardiac arrest

Question 11

What are more common risks under anaesthesia?

Answer 11

Awareness, eye trauma, hypothermia, pressure injury, nerve injury and thromboembolism

Question 12

What is included in maintenance of the anaesthesia?

Answer 12

Vapour - ‘gas’
Intravenous anaesthesia (TIVA)

Question 13

What is involved in the emergence phase?

Answer 13

Reversal of neuromuscular blockage
Anaesthetic agent is stopped
Return of spontaneous breathing, airway reflexes, suctioning + removal of airway device and transfer to recovery room

Question 14

What is general anaesthesia?

Answer 14

Drug induced reversible coma
CNS, cardiac and resp. distress
Drug interactions

Question 15

What is regional anaesthesia?

Answer 15

Profound sympathectomy
Neurological sequelae

Question 16

What are the considerations pre-operatively?

Answer 16

Patient - co-morbidities (known and unknown)
Nature of surgery
Anaesthetic techniques
Post-op care

Question 17

What is the anaesthetist role pre-op?

Answer 17

Assess, identify high risk, optimise, minimise risk, inform + support patients decisions and consent

Question 18

What is involved in the history and examination pre-op?

Answer 18

Known and unknown co-morbidities
Ability of withstand stress - exercise tolerance and CVD
Drugs and allergies
Previous surgery and anaesthesia
Potential anaesthetic problems

Question 19

What investigations are done pre-op?

Answer 19

Detect unknown conditions, severity of known disease, establish a baseline, detect complications, assess risk, guide management and document improvement

Question 20

What are some cardio investigations are may be done pre-op?

Answer 20

ECG, exercise tolerance test, echo, myocardial perfusion scan, stress echo, cardiac catheterisation and CT coronary angiogram

Question 21

What are some resp. investigations that may be done pre-op?

Answer 21

Saturations, ABG, CXR, peak flow measurements, FVC/FEV, gas transfer and CT chest

Question 22

What is ASA grading?

Answer 22

ASA1 - otherwise healthy patient
ASA3 - severe systemic disturbance
ASA4 - life threatening disease
ASA5 - moribund patient
ASA6 - organ retrieval

Question 23

What are some risk assessment tools used?

Answer 23

GUPTA, surgical outcome, STOP-BANG, Nottingham hip fracture score, P-POSSUM, CR-POSSUM, Q-POSSUM, V-POSSUM and resp. failure calculator

Question 24

What is included in the cardiac risk index?

Answer 24

High risk surgery, ischaemic heart disease, congestive heart failure, cerebrovascular disease, diabetes and renal failure

Question 25

Describe pre-op medication

Answer 25

Most continue as normal
Esp. - inhalers, anti-anginals and anti-epileptics
Exceptions - anti-diabetic medications and anticoagulants