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Anaesthesia > Day 10: Complications of Anaesthesia > Flashcards

Day 10: Complications of Anaesthesia Flashcards

1
Q

what is critical care

A
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2
Q

who is critical care for

A

For patients with potentially recoverable conditions who can benefit from more detailed observation and treatment

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3
Q

nurse patient ratio in critical care

A

1:1

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4
Q

FASTHUG: F

A

:Feeding (enteral, parenteral)

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5
Q

FASTHUG: A

A

analgesia

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6
Q

FASTHUG: S

A

Sedation

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7
Q

FASTHUG: T

A

thrombo-prophylaxis

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8
Q

FASTHUG: H

A

Head up

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9
Q

FASTHUG: U

A

ulcer prophylaxis

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10
Q

FASTHUG: G

A

glucose control

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11
Q

Pharmacogenetic disorders of relevance

A

malignant hyperthermia
scoline apnoea
porphyria
halothane hepatitis

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12
Q

What is Malignant Hyperthermia?

A

Malignant Hyperthermia is an inherited disorder characterized by a hypermetabolic state in response to certain anesthesia agents.

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13
Q

What is the underlying cause of Malignant Hyperthermia?

A

The underlying cause of Malignant Hyperthermia is a genetic mutation affecting the calcium receptor on the sarcoplasmic reticulum in skeletal muscle cells.

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14
Q

What are the triggers for Malignant Hyperthermia?

A

Triggers for Malignant Hyperthermia include all volatile anesthetic agents, with suxamethonium being the most potent trigger.

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15
Q

What are the early and later presentations of Malignant Hyperthermia?

A

In the early stages, Malignant Hyperthermia may present with hypercapnia, increased oxygen extraction, and tachypnea. Later manifestations include cyanosis, muscle rigidity, and hyperthermia (which is a late sign).

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16
Q

What are the potential consequences of Malignant Hyperthermia?

A

renal failure
liver failure
coagulopathy
cerebral oedema
death

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17
Q

early detection of MH

A

it is vital if not it is fatal

If recognized early it is fully treatable with a good outcome

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18
Q

management of MH

A
  • discontinue trigger
    -call for help
    -hyperventilate 100% O2
    -DANTROLENE
    Specific antidote! 2.5mg/kg initial bolus
    -Cool patient and supportive management
    -ICU
    Dantrolene infusion
    Dialysis
    Supportive management
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19
Q

what is scoline apnoea

A

Abnormal or absent pseudocholinesterase enzyme

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20
Q

effects of scoline apnoea

A

Prolonged paralysis after one dose

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21
Q

management of scoline apnoea

A

Ventilate
Sedate
FFPs
Medic Alert Bracelet in future

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22
Q

what is porphyria

A

Defect in synthesis of haem

-Porphyrin accumulation
-Common in SA in those of Afrikaner descent

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23
Q

acute precipitants of porphyria

A

-Barbiturates (THIOPENTONE!)
-Pain
-Infection
-Starvation
-dehydration

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24
Q

clinical presentation of porphyria

A

-Abdominal pain & vomiting
-motor/ sensory neuropathy
-Autonomic dysfunction
-Seizures, coma and death

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25
Q

partial list of known safe drugs in porphyria

A

-Propofol for induction
-Nitrous oxide
-Isoflurane
-Most volatiles probably safe
-Suxamethonium
-Atracurium
-Morphine
-Fentayl probably safe

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26
Q

What is Halothane Hepatitis?

A

Halothane Hepatitis refers to liver inflammation and injury caused by exposure to the volatile anesthetic halothane.

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27
Q

What is the incidence of Halothane Hepatitis?

A

The incidence of Halothane Hepatitis is approximately 1 in 35,000 cases.

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28
Q

What factors may increase the risk of developing Halothane Hepatitis?

A

Halothane Hepatitis is more common after repeated exposure to halothane, which may increase the risk of developing the condition.

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29
Q

What type of immune reaction is associated with Halothane Hepatitis?

A

Halothane Hepatitis is believed to be an immune-mediated Type II hypersensitivity reaction.

30
Q

What are the potential outcomes of Halothane Hepatitis?

A

The spectrum of Halothane Hepatitis includes fatal fulminant hepatic failure, which can result in severe morbidity and mortality.

31
Q

minor complications of anesthesia

A

-sore throat
-damage to teeth
-corneal damage
-muscular pain (sux)
-PONV

32
Q

risk factors of PONV

A

-patient young, female, history of PONV or motion sickness
-anaesthetic: opioids, etomidate, N2O
-surgical: strabismus, laparoscopy, ear, orchidopexy, gynae
-Postop: pain, opiates, hypotension, forced early feeding

33
Q

prophylaxis of PONV

A

-Avoid risk factors
-pharmacological- ondansetron, droperiodol, dexamethosone
-non pharmacological- good hydration, acupressure

34
Q

major complications of anaesthesia

A

-Nerve damage
-Central venous line complications
-Hypothermia

35
Q

What are some factors that can contribute to nerve damage during anesthesia?

A

Factors contributing to nerve damage during anesthesia include patient positioning, neuraxial and regional blockade, and hypoperfusion of the spinal cord.

36
Q

Which body positions during surgery may increase the risk of nerve damage?

A

Non-supine positions and improper positioning of the arms during surgery can increase the risk of nerve damage due to compression or stretching of nerves.

37
Q

What types of anesthesia techniques can potentially lead to nerve damage?

A

Neuraxial and regional blockade techniques, such as epidurals and nerve blocks, have the potential to cause nerve damage if performed incorrectly or if complications arise.

38
Q

What is the difference between neuropraxias and long-term neurological damage?

A

Neuropraxias refer to temporary nerve injuries that typically resolve on their own, while long-term neurological damage may result in persistent sensory or motor deficits.

39
Q

How does hypoperfusion of the spinal cord contribute to nerve damage?

A

Hypoperfusion of the spinal cord, particularly during major vascular surgery or aortic cross-clamping, can lead to ischemic damage to the nerves of the spinal cord, resulting in neurological deficits.

40
Q

early central venous lines consequences

A

Pneumothorax
Haemothorax
Nerve damage
Arrhythmia
Air embolism

41
Q

late central venous lines complications

A

Sepsis
Endocarditis
Thrombosis
Tamponade

42
Q

what is hypothermia

A

Definition: core temperature < 35ºC

43
Q

precipitating factors of hypothermia

A

Cold…. Environment, IV fluids, gases

Vasodilatation due to anaesthetic agents

44
Q

prevention of hypothermia

A
  • warm theatre environment
    -passive warming of patient
    -warm IV fluids, blood, gases (HMEF)
    -active warming
45
Q

What are the underlying physiological mechanisms of hypothermia during anesthesia?

A

Hypothermia during anesthesia disrupts normal thermoregulatory mechanisms, leading to a decrease in core body temperature.

46
Q

How does hypothermia affect platelet function and bleeding risk?

A

Hypothermia impairs platelet function, increasing the risk of bleeding due to altered platelet aggregation and clot formation.

47
Q

What are the consequences of delayed metabolism of drugs due to hypothermia?

A

Delayed metabolism of drugs occurs in hypothermic patients, leading to prolonged drug effects and potential toxicity.

48
Q

How does hypothermia contribute to delayed emergence from anesthesia?

A

Hypothermia prolongs the recovery time from anesthesia as metabolic processes are slowed, leading to delayed emergence from anesthesia.

49
Q

What cardiac complications are associated with hypothermia?

A

Hypothermia can induce arrhythmias, including bradycardia and ventricular fibrillation, due to alterations in cardiac electrical activity.

50
Q

What is the common postoperative manifestation of hypothermia, and how does it occur?

A

: Postoperative shivering is a common manifestation of hypothermia, resulting from the body’s attempt to generate heat through involuntary muscle contractions

51
Q

What effect does hypothermia have on oxygen consumption?

A

Hypothermia increases oxygen consumption as the body attempts to maintain normal body temperature through metabolic processes such as shivering and increased cardiac output.

52
Q

major complication of anaesthesia

A

-death
-airway complications
-cardiac complication
-equipment failure
-awareness
-drug related

53
Q

airway complications

A

-failed intubation
-aspiration

54
Q

drug related complications

A

-anaphylaxis
-pharmacogenetic
-drug errors

55
Q

risk factors for complications: patient

A

Comorbidities
ASA status
Surgical condition
Age

56
Q

risk factors for complications: anesthetic

A

Intubation
Equipment failure
Aspiration risk
Anaphylaxis
Drug choices
Pharmacogenetic disease
Respiratory depression
Awareness

57
Q

risk factors for complications: surgical

A

-Type and extent of surgery
-Emergency or elective
-Skill and knowledge surgeon
-Mishaps

58
Q

rising airway pressures

A

-obstructed ETT
-kinked ETT
-circuit blockage
-bronchospasm
-mucus plug in airway
pneumothorax

59
Q

sudden leak in circuit

A

-dislodged ETT
-disconnection at nay point in circuit
-vaporizers, soda lime not connected properly
-warning signs
*ventilator alarms
*ventilator bellows keeps collapsing/ can’t fill

60
Q

equipment failure

A

machine failure
hypoxic gas mixture
ventilator disconnection

61
Q

drug errors

A

-important to label drugs
-use color coding system of labels
-dilute drugs appropriately

62
Q

risk factors for MI: patient

A

IHD
CCF
valvular disease
arrhythmia,
Peripheral Vascular Disease
hypovolaemia

63
Q

risk factors for MI/ arrest: anaesthetic factors

A

hypo/hypertension
tachycardia
hypoxia

64
Q

risk factors for MI/ arrest: surgical procedures

A

Major intrathoracic
Major abdominal
Major vascular
Emergency surgery

65
Q

common causes of anaphylaxis

A

-antibiotics
-muscle relaxants
-latex

66
Q

classic triad of symptoms for anaphylaxis

A

-CVS collapse
-bronchospasm
-skin changes

67
Q

management of anaphylaxis

A

-ABCs
-Adrenaline (0.5mg IM)
-Additional measures
*hydrocortisone
*antihistamine

68
Q

post operative respiratory failure: underlying disease

A

Pulmonary disease
Myasthenia gravis
Neurological
Muscular
Morbid obesity

69
Q

post operative respiratory failure: metabolic

A

Hypokalaemia
Hypoglycaemia

70
Q

post operative respiratory failure: complications

A

Aspiration
Pulmonary embolism

71
Q

post operative respiratory failure: drugs

A

Opioids
Muscle relaxants
Magnesium

72
Q

high risk groups in anesthesia

A

Obstetric GA
Trauma
Previous awareness

Anaesthesia (14 decks)

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