Mod 10c: complications in anaesthesia

Question 1

How do you avoid complications

Answer 1

thorough assessment
adequate planning
appropriate referral if complications suspected

Question 2

What are 5 minor complications of anaesthesia

Answer 2

Sore throat
damage to teeth
corneal damage
muscular pain(sux)
PONV

Question 3

What are some risk factors for PONV?

Answer 3

Patient: young, female, hx of PONV/motion sickness

Anaesthetic: opiods, etomidate, N2O

Surgical: strabismus, laparoscopy, ear, orchidopexy, gynae

Postop:pain, opiates, hypotension

Question 4

What is the prophylaxis of PONV?

Answer 4

Avoid risk factors

Pharmacological: odansetron, droperidol, dexamethosone

Non-pharma: good hydration

Question 5

What are 3 more serious complications?

Answer 5

Nerve damage
Central venous line complications
Hypothermia

Question 6

What can cause nerve damage?

Answer 6

positioning( arms in non-supine positions)

Neuraxial and regional blockade(neuropraxias vs long term damage)

Hypoperfusion of spinal cord

Question 7

What are the early complications of central venous lines?

Answer 7

• Pneumothorax
• Haemothorax
• Nerve damage
• Arrhythmia
• Air embolism

Question 8

What are the late complications of central venous lines

Answer 8

• Sepsis
• Endocarditis
• Thrombosis
• Tamponade

Question 9

What is hypothermia and what precipitates it?

Answer 9

core temp<35 C

Precipitating factors:
- cold environment, IV fluids, gases
- Vasodilatation due to anaesthesic agents

Question 10

How long should you monitor the temp of any anaesthetic

Answer 10

> 15 min

Question 11

How do you prevent hypothermia

Answer 11

Warm theatre environment
Passive warming of patient
* Forced air warmer
Warm IV Fluids, Blood, Gases (HMEF)
Active warming

Question 12

What is the pathophysiology of hypothermia

Answer 12

Platelet dysfunction and bleeding risk
Delayed metabolism of drugs
Delayed emergence from anaesthesia
Arrhythmias
Post-op shivering
*Increased oxygen consumption

Question 13

What are 6 major categories of complications?

Answer 13

Death
Airway complications
Equipment failure
Awareness
Cardiac complications
Drug related

Question 14

What are the patient risk factors for complications?

Answer 14

*Comorbidities
*ASA status
*Surgical condition
*Age

Question 15

What are the anaesthestic risk factors for complications

Answer 15

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

Question 16

What are the surgical risk factors for complications

Answer 16

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

Question 17

How do you manage a difficult airway

Answer 17

recognise->management plan

Unrecognised-> failed intubation drill

Question 18

How do you manage a failed intubation?

Answer 18

*Call for help!
*100% oxygen
*Reposition
*Difficult airway trolley
*Ventilate between
attempts
*BACKUP AIRWAY →
LMA

Question 19

What are causes of rising airway pressures

Answer 19

Obstructed ETT
Kinked ETT
Circuit blockage
Bronchospasm
Mucus plug in airway
PNEUMOTHORAX

Question 20

What are some causes of sudden leak in circuit

Answer 20

dislodged ETT
Disconnection at any point
Vaporisers, sodalime not connected

Question 21

What are 2 warning signs of sudden leak in circuit

Answer 21

ventilator alarms
ventilator bellows keeps collapsing

Question 22

What are the 3 things that can fail under equipment failure

Answer 22

machine failure
hypoxic gas mixture
ventilator disconnection

Question 23

How can you prevent drug errors?

Answer 23

 Important to label drugs
 Draw drugs up yourself
 Use colour coding system of
labels
 DILUTE DRUGS
APPROPRIATELY!

Question 24

What are patient risk factors for MI/arrest?

Answer 24

*IHD
*CCF
*valvular disease
*arrhythmia,
*Peripheral Vascular
Disease
*hypovolaemia

Question 25

What are the anaesthetic risk factors for MI/arrest

Answer 25

• hypo/hypertension
• tachycardia
  *hypoxia

Question 26

What surgical procedures are a risk for MI/arrest

Answer 26

*Major intrathoracic
*Major abdominal
*Major vascular
*Emergency surgery

Question 27

What are the common causes of anaphylaxis?

Answer 27

antibiotics(commonest)
muscle relaxants
latex

Question 28

What is the triad of symptoms in anaphylaxis?

Answer 28

cvs collapse
bronchospasm
skin changes

Question 29

How do you manage anaphylaxis

Answer 29

ABC’s
Adrenaline(0.5mgIMI/boluses of 10-15ug IVI)
Addtional measures: hydrocortisone, antihistamines

Question 30

Which underlying diseases put you at risk for postoperative respiratory failure?

Answer 30

• Pulmonary
  disease
• Myasthenia
  gravis
• Neurological
• Muscular
• Morbid obesity

Question 31

Which metabolic disease put you at risk for post op resp failure?

Answer 31

• Hypokalaemia
• Hypoglycaemia

Question 32

Which complication in surgery put you at risk for post operative resp failure

Answer 32

• Aspiration
• Pulmonary
  embolism

Question 33

Which drugs put you at risk of postoperative resp failure

Answer 33

• Opioids
• Muscle relaxants
• Magnesium

Question 34

Which groups are at high risk for awareness under anaesthesia

Answer 34

obstetric GA
trauma
previous awareness

Question 35

How do you prevent awareness under anaesthesia

Answer 35

vigilance and angent analyzer

Question 36

What monitoring should be included to prevent awareness under anaesthesia

Answer 36

clinical judgement of depth
processed EEG