Module 1 Flashcards
What is consider an anesthesiologists job
Perioperative physicians, this means that they are involved in the care of patients pre, intra and postoperatively and are involved in pain management
What are the components of the anaesteria triad
- Analgesia
- Immobility
- Hypnosis
What are the minimum requirements for anesthesia
Surgical field immobility and good analgesia
How are adults induced
Using IV induction agents
What is a good description of anaestesia
A drug induced reversable coma
What is the first step in preoperative care of a patient
To identify the patient and take a history of the patient
How do patients emerge from anesthesia
They emerge by the discontinuation of anaesthesia drugs and the dissociation of the drugs from the brain
What are the main areas of focus in the preoperative assessment
Resp
Cardio
Airways
What are the 6 classes in the ASA class grading
1: Healthy patient
2: Patient has a comorbidity but it is well controlled
3: A comorbidity that is not well controlled
4: A disease that is a constant threat to life e.g. unstable angina
5: Patient in iminate death e.g. ruptured aneurysm
6: Brain dead organ donor patients
What is the ASA class a predictor of
The postoperative mortality
What is the time needed to pass food and fluids
Clear fluid: 2hours
Breast milk: 4
Solids: 6
What is meant by regional or local anaestetics
This is where a part of the body is rendered insensitive to pain, sensation and in some cases movement by blocking nerves with a local anaesetic agent
What is meant by hypnosis
This is loss of consiosness
What is the problem with pain in surgery
The sensation of pain activates the sympathetic NS
What is the problem with too deep or too light of anaesthesia
To light and the patient can become aware and too deep and you worsen the side effects of anaesthetic drugs
What are the 4 stages of general anesthesia (Guedel)
Stage 1: Analgesia
Stage 2: Excitement phase: This is where there is paradoxical excitation as a result of a loss of inhibition
Stage 3: Surgical anaesthesia: Normal area where we operate
Stage 4: Overdose: Diaphragm paralysis and a loss of all the reflexes
In which agents are all 4 the stages not seen
In rapidly acting IV agents
What are the 3 places patients go post op
- Majority will go the recovery and then be moved to ward
- Some may be discharged home
- Severe patients are moved to the ICU or post anaesthesia high care for special management
What are the 3 main preoperative assessments that need to be done
- Medico legal consent
- History
- Examinations
What are the 2 main aims of the preoperative assessments
- Formulate an anaesthetic plan
- Identify areas for optimisation
What are the 7 important questions in an anaesthetic history
- Current problem
- Co morbidities
- Medication History
- Previous anaestetic
- Relevant family history
- Systemic review
- Last oral intake
What are the 6 factors that increase the risk of aspiration
- Full stomach
- Preganancy
- Increased intra-abdominal pressure
- Gastric pathologies e.g. peptic ulcers
- Renal failure
- Autonomic neuropathies e.g. diabetics
What are the 3 systems that should be investigated when preoperative exams are done
- Resp
- Cardio
- Airway
What are the 6 questions that should be asked on a patient history
- History of the current problem
- Co morbidieties
- Allergies
- Previous anastesia
- Smoking
- NPO
What is the risk of postoperative death in each ASA class
1: 0.06-0.08
2: 0.27-0.4
3: 1.8-4.3
4: 7.8-23
5: 9.4-51
What is meant by optimisation
This aims to identify and correct any medical problems before surgeries to improve the outcomes
What are the colours of the triage system
Red: Immediate
Orange: 1-3 hours
Yellow: In the next 6 hours
Green: 24hours
Blue: Elective
When should smoking be stopped
Ideally 8 weeks before surgery but if not feasible then there should be no smoking on the day of the surgery to help remove the nicotine
What are the 3 main anti emetics given premedications [Prevent Da barf]
- Phenothiazine
- Dexamethozone
- Butyrophenones
What are the main drugs that are given as acid aspiration prophylaxis
Sodum citrate
PPI
Metroclopramide
What are the 2 ways of testing the depth of the anaesthesia
- Somatic response: wrinkling the forhead, irregular breathing
- Sympathetic responses
What are the 2 most important reflexes to block
- Glottic reflex: This allows for the intubation of the patient
- Medullary control of respiration: This allows us to control ventilation
What are the components of the immediate control of an unconscious patient
ABCD
A: Airway
B: Breathing
C: Circulation
D: Drugs
Glucoses in unconscious patients is also very important
What are the 3 criteria that must be met for a patient to be moved from theatre to the recovery area
- Airway can be maintained
- Ventilation is adequate
- Cardiovascularly stable
What are the 5 factors that indicate that a patient can leave recovery
- Activity
- Respiration
- Circulation
- Consciousness
- Colour/O2
Above what must the score be for them to be discharges from the recovery area
9
What is the scoring system for each of the 5 criteria for discharge from the recovery area
Activity
2: Moves all 4 limbs
1: Moves only 2 limbs
0: Moves no limbs
Resp.
2: Deep breaths and coughs
1: Limited
0: Apneoic
Circulation
2: Less than 20mm of the normal
1: Less than 50mm of normal
0: more than 50
Conseousness
2: Awake
1: Arousable
0: Not responding
O2
2: Above 90
1: Above 90 on supplimentation
0: Less than 90
What are the 5 criteria for home discharge
- Mental state
- Pain and PONV
- Bleeding
4: Vitals
5: Input and output
