Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anaesthesia > Day 1: Overview > Flashcards

Day 1: Overview Flashcards

1
Q

what is an anaesthetist

A

Anaesthetists are perioperative physicians who care for patients before, during, and after their journey through surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what does peri mean

A

around

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

division of perioperative care

A

preoperative care
intraoperative care
postoperative care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

anaesthesiology

A

also extends to pain managment (both acute and chronic)
requires meticulous applied knowledge of both basic and clinical science

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

types of anaesthesia

A

general anaesthesia
regional/ local anaesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

general anaesthesia

A

-unconscious patient induced, reversible coma
-may be achieved with intravenous or inhalational drugs
-depending on the surgery and/or drugs used, patients may breathe spontaneously or be ventilated artificially
-analgesia usually need to be administered separately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

local or regional anesthesia

A
  • a part of the body is rendered insensitive to pain, sensation (and possibly movement) by blocking nerves with a local anaesthetic
  • patient is still fully conscious (although sedation may be given)
    -specific nerves may be blocked, or whole sections
    -includes the neuraxial blocks (spinal and epidural) which block the spinal cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

the triad of general anaesthesia

A

hypnosis
analgesia
immobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what does hypnosis mean

A

loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how is hypnosis achieved

A

it is achieved with general anaesthetic agents (intravenous and/or inhalations)

typically anaesthesia is induced with IV agents and maintained with inhalations

most of these agents ONLY CAUSE HYPNOSIS and are not analgesic

Anaesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what does anaesthesia mean

A

without sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

are general anesthetic agents primarily analgesic

A

Most general anaesthetic agents primarily induce hypnosis and do not provide analgesia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is anaesthesia typically induced?

A

Anaesthesia is usually induced with intravenous agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In what situations is hypnosis increasingly used in anesthesia?

A

-Siting of invasive lines, particularly central lines.
-Siting of regional nerve blocks, especially brachial plexus blocks.
-Transthoracic echocardiography (TTE) can be conducted as a side room test to evaluate cardiac function.
-Invasive transoesophageal echocardiography (TOE) can be used intraoperatively to monitor cardiac function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why is analgesia essential during general anesthesia?

A

-The body still experiences pain under general anesthesia as most agents only interrupt consciousness.
-Pain activates the sympathetic nervous system, leading to deleterious effects.
-Additional analgesic agents are administered intravenously to ensure patient comfort.
-Strong opioids such as fentanyl and morphine are typically used.
-Regional anesthesia techniques like nerve blocks may also be employed for enhanced pain relief.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is meant by “immobility” in anesthesia?

A

“Muscle relaxation” is often synonymous with “immobility.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is immobility crucial for surgical procedures?

A

Immobility ensures an optimal surgical field for surgical access.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are paralytic agents, and when are they used in anesthesia?

A

Paralytic agents, or neuromuscular blockers, are used for surgery in large body cavities like the chest and abdomen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do patients receiving paralytic agents typically manage their airways?

A

Patients receiving paralytic agents are typically intubated and require assisted ventilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In what types of surgeries might immobility be particularly important?

A

Immobility may also be necessary for delicate microsurgery, such as on the retina or brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Does deep general anesthesia alone guarantee immobility?

A

Deep general anesthesia induces muscle relaxation but may not completely halt respiration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What happens to pain perception under general anesthesia?

A

Pain perception persists under general anesthesia due to interruption of consciousness only.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why is adequate analgesia crucial during surgery?

A

Adequate analgesia is vital for patient comfort and to prevent sympathetic nervous system activation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does pain affect the sympathetic nervous system?

A

Pain activates the sympathetic nervous system, leading to detrimental effects like increased heart rate and blood pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What additional measures are taken to provide analgesia during anesthesia?

A

Additional analgesic agents, typically strong opioids such as fentanyl and morphine, are administered intravenously.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which types of analgesic agents are commonly administered intravenously?

A

Intravenous opioids, such as fentanyl and morphine, are commonly administered for systemic analgesia during anesthesia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Besides systemic analgesia, what other technique can be used to enhance pain control?

A

Regional anesthesia techniques, such as nerve blocks, can be used in addition to systemic analgesia to enhance pain control.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What does hypnosis refer to in the context of anesthesia?

A

In anesthesia, hypnosis refers to the loss of consciousness induced by anesthetic agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is loss of consciousness achieved during anesthesia?

A

Loss of consciousness is achieved with a combination of intravenous and/or inhalational anesthetic agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the typical approach to induce and maintain anesthesia?

A

Anesthesia is typically induced with intravenous agents and maintained with inhalational agents.

31
Q

Are most anesthetic agents also analgesic?

A

Most anesthetic agents primarily cause hypnosis and do not inherently provide analgesia.

32
Q

Can patients be fully awake under regional anesthesia?

A

Under pure regional anesthesia, such as spinal anesthesia, patients can be fully awake, but sedative medication may be administered if necessary.

33
Q

What does the term “anesthesia” specifically mean?

A

The term “anesthesia” specifically means “without sensation,” emphasizing the absence of awareness or perception during the procedure.

34
Q

the perioperative journey

A

induction
maintenance
emergency

35
Q

What steps are taken prior to anesthesia induction?

A

Prior to induction, the patient is assessed, consent is checked, the theatre is prepared, and equipment is checked.

36
Q

What is the standard practice regarding intravenous access in adult patients?

A

Intravenous access is always established in adult patients before anesthesia.

37
Q

Are pre-induction drugs commonly administered? If so, for what purpose?

A

Pre-induction drugs, such as sedatives, may be given to provide anxiolysis (A level of sedation in which a person is very relaxed and may be awake)

38
Q

What is the purpose of pre-oxygenation before induction?

A

Pre-oxygenation is performed to optimize oxygenation levels before induction.

39
Q

Which medication is typically administered pre-induction to establish analgesia?

A

Typically, an opioid such as fentanyl is administered pre-induction to pre-emptively establish analgesia.

40
Q

What are the methods used for anesthesia induction?

A

Anesthesia induction can proceed with intravenous or inhalational agents.

41
Q

How is the loss of consciousness confirmed during induction?

A

Loss of consciousness is confirmed.

42
Q

What responsibility does the anaesthetist take on after loss of consciousness?

A

The anaesthetist assumes responsibility for maintaining the patient’s airway.

43
Q

Describe the implementation of a definitive airway strategy during induction.

A

A definitive airway strategy, such as mask ventilation, supraglottic airway, or endotracheal tube, is implemented.

44
Q

What is the procedure if intubation is required during induction?

A

If intubation is required, a neuromuscular blocking agent is administered first, with an onset time of 1-5 minutes depending on the drug used. The airway is then secured and checked.

45
Q

What are the primary methods used for maintaining anesthesia?

A

Maintenance of anesthesia is typically achieved using inhalational agents.

46
Q

How can propofol be administered for maintenance?

A

Propofol can be administered via infusion as an alternative to inhalational agents.

47
Q

What adjustments may be made to ventilator settings during maintenance?

A

Ventilator settings may be adjusted if mechanical ventilation is used.

48
Q

What additional monitoring or techniques may be employed during maintenance?

A

Additional monitoring or techniques, such as regional anesthesia for analgesia augmentation, may be employed.

49
Q

What steps are taken before surgery proceeds during maintenance?

A

Before surgery proceeds, the surgical area is cleaned and prepared, and the WHO Surgical Safety Checklist is implemented.

50
Q

What is crucial before emergence from anesthesia?

A

Returning control of respiration to the patient is crucial before emergence.

51
Q

What steps are taken to return control of respiration to the patient?

A

Any muscle relaxant is checked for reversal, especially non-depolarizing agents.

52
Q

How are muscle relaxants handled during emergence?

A

Respiration and oxygenation are assessed for adequacy, including spontaneous, regular breathing and normal vital signs.

53
Q

How is the anaesthetic agent managed during emergence?

A

The anaesthetic agent is discontinued.

54
Q

What is the procedure for removing airway devices during emergence?

A

Airway devices, such as endotracheal tubes, are removed either deep or upon awakening.

55
Q

What are the consequences of too light a plane of anesthesia?

A

Too light anesthesia can lead to patient awareness or emergence from anesthesia.

56
Q

What problems can arise from too deep a plane of anesthesia?

A

Too deep anesthesia can exacerbate side effects of anaesthetic agents.

57
Q

How did Guedel describe the stages of general anesthesia?

A

Guedel described 4 stages of general anaesthesia:
Stage 1: “Analgesia”  from induction to loss of consciousness

Stage 2: Excitatory phase  paradoxical disinhibition (excitement, hiccupping, swallowing, writhing about)

Stage 3: Surgical anaesthesia  eyeballs become fixed, diaphragmatic respiration

Stage 4: Overdose: diaphragmatic paralysis, loss of all reflexes  death

58
Q

Are the Guedel stages commonly observed with rapid-acting intravenous agents?

A

The Guedel stages are not typically seen with rapid-acting intravenous agents.

59
Q

progressive loss of reflexes

A

These occur as anaesthesia deepens:
-Voluntary control of eye movement
-Eyelash reflex
-Lid reflex
-Swallowing, retching and vomiting
-Conjuctival reflex
-Muscular tone
-Corneal reflex
-Glottic reflexes and control of respiration
-Pupillary light reflex

60
Q

How do patients regain consciousness during recovery from anesthesia?

A

Patients regain consciousness when the anaesthetic agents are discontinued and dissociate from their binding sites in the brain.

61
Q

Is there a specific antidote for inhalational or intravenous anesthetic agents?

A

There is no specific antidote for either inhalational or intravenous anaesthetic agents.

62
Q

What should be checked if muscle relaxation is still present during recovery?

A

If muscle relaxation is still present, the patient may be fully awake but unable to move; some neuromuscular blocking agents require reversal.

63
Q

Do opioid analgesics contribute to the depth of anesthesia during recovery?

A

Opioid analgesics cause sedation and contribute to the depth of anesthesia during recovery.

64
Q

What effect do opioid analgesics have on respiration during recovery?

A

Opioid analgesics also suppress respiration during recovery.

65
Q

postoperative placement

A
  • majority: recovery area before they are transferred to the wards
    -day cases: may be discharged home
    -special care required: high care or intensive unit or if require monitoring post anaesthetic high care unit (PAHCU)
66
Q

aims of the preoperative visit

A

-To formulate an ANAESTHETIC PLAN appropriate for both the patient and the planned procedure
-To understand the patient’s BASELINE PHYSIOLOGIC STATE
-To identify any RISK FACTORS
-To identify any conditions which can be OPTIMISED prior to surgery
-To prepare the patient psychologically

67
Q

last oral intake: solids and formula milk

A

6 hours

68
Q

last oral intake: breast milk

A

4 hours

69
Q

last oral intake: clear fluid

A

2 hours

70
Q

risk factors for aspiration

A
  • full stomach
  • pregnancy
  • increased abdominal pressure
    *obesity
    *ascites
    *bowel masses
    *bowel obstruction
  • gastric pathology
    *peptic ulcer disease, GORD, hiatus hernia
    -renal failure
    -autonomic neuropathy in diabetes
71
Q

systems examined

A

respiratory
airway
cardiovascular
other relevant systems

72
Q

specials investigations

A

Should be guided by patients age, comorbidity and planned procedure

Typical examples
-FBC
-U&E (e.g. hypertension / renal disease / elderly / acutely ill)
-Group and Save / Crossmatch (e.g. major blood loss)
-ECG (e.g. elderly / cardiac pathology / hypertension / ischaemic heart disease)
-CXR (e.g. respiratory and cardiovascular disease, elderly)
-Echocardiography (e.g. valve lesions / cardiac disease_

73
Q

the ASA classification

A

I: A normal healthy patient

II: A patient with mild systemic disease and no functional limitations

III: A patient with moderate to severe systemic disease that results in some functional limitation, but not incapacitating

IV: A patient with severe systemic disease that is a constant threat to life and incapacitating

V: A moribund patient that is not expected to live for more than 24 hours with or without surgery

VI: A brain dead patient whose organs are being harvested

E: If the procedure is an EMERGENCY, the physical status is followed by an “E’

Anaesthesia (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions