Module 1: overview of anaesthesia Flashcards

(44 cards)

1
Q

True or false. Anaesthesia includes acute pain management but not chronic

A

False, anesthesia includes acute and chronic pain management

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1
Q

what part of the operation/surgery do anesthesiologists form part of

A

pre-operative, intra-operative and post-operative

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2
Q

Who forms part of the team in surgery

A

surgeons, anesthetists, nurses and porters

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3
Q

what are the 2 types of anesthesia?

A

General and local/regional

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4
Q

what is general anaesthesia

A

it is an unconscious patient (induced coma) with inhalational or IV drugs. Depending on surgery the patient may need to have assisted ventilation. ANALGESIA NEEDS TO BE ADMITTED SEPERATELY

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5
Q

What is local/regional anaesthesia?

A

part of the body is rendered insensitive to pain/sensation by blocking nerves. PATIENT IS FULLY CONCIOUS. specific nerves may be blocked or whole sections, includes neuraxial blocks

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6
Q

what is in the triad of anaesthesia

A

hypnosis, analgesia and immobility

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7
Q

what does hypnosis entail

A

Loss of consciousness achieved by inhalation or IV drugs. Usually induced by IV and maintained by inhalational. Does not cause anaelgesia, only hypnotic. If there is pure regional anesthesia the patient will still be awake.

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8
Q

What does analgesia ential

A

Body still experiences pain under general anaesthesia. Additional analgesics are given (usually IV). Typically fentanyl or morphine is used (strong opiates), REGIONAL ANAESTHESIA (NERVE BLOCKS) ADDED.

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9
Q

Why is it necessary to add analgesia when inducing

A

Pain activates the sympathetic nervous system which can be deleterious.

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10
Q

What does immobility entail?

A

Immobile surgical field is essential esp in large body cavity surgeries like abdomen or thorax or delicate microsurgeries. Large body cavity surgeries require neuromuscular blockers which results in patient being intubated and assisted ventilation.

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11
Q

what type of anaesthesia causes a degree of muscle relaxation without need to be assisted with ventilation

A

deep general anesthesia

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12
Q

what forms part of the perioperative journey?

A

induction, maintanace and emergence

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13
Q

What happens during pre-induction

A

patient is assessed, consent given, theatre prepped, equipment checked.
IV access achieved in adults
Pre-induction drugs given (sedatives) for anxiolysis
Patient connected to monitor
Pre-oxygenated
given opiods pre-emptively

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14
Q

What happens during induction

A

Usually with IV drugs/ some inhalational drugs.
LOC confirmed
Anaethetist responsible for maintaining airway with definitive airway strategy like supraglottic device, mask ventilation or endotracheal tube.
If intubation is required give neuromuscular blocker 1-5min before

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15
Q

What happens during maintenance?

A

Done by inhalational drugs(propofol can given via infusion instead).
ventilator settings adjusted if used
Additional monitoring may be sited or be used
surgical area is prepared + cleaned
WHO surgical safety checklist
monitor throughout surgery

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16
Q

What happens during emergence

A

surgery is concluded
returning control of respiration is crucial prior to emergence
muscle relaxant =reversed
respiration and oxygenation must be adequate
anesthetic is discontinued
airway devices removed

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17
Q

what are the 4 stages of general anaesthesia

A

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

18
Q

In what order are reflexes lost in anaesthesia

A

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

19
Q

What entails recovery from anaesthesia

A

patient regains consciousness
anaesthetic drugs dissociates from binding site-no specific antidote for IV or inhalational drugs
Neuromuscular blockers require antidote

20
Q

what forms part of the post-operative management

A

majority will wait in recovery area and moved to ward

day cases go home

special care required goes to ICU

21
Q

What are the 3 main areas to focus on in pre-operative assessment

A

medicolegal requirement(Consent)

Identifying chronic diseases or risk factors

Identifying areas which may require optimization before surgery

22
Q

What is the end goal of pre-operative assessment?

A

appropriate anesthetic plan

23
Q

What are the aims of preoperative visit?

A

anaesthetic plan
baseline physiological state
risk factors
optimizing conditions
prepare patient psychologically

24
What patient considerations should you take into account?
Medicolegal documents History: coexisting disease, allergies, medications, prior surgeries examination esp airway
25
When is a patient for elective surgery seen?
day before in ward or morning of surgery
26
when is a patient seen for urgent/emergency surgery?
in front room/induction room
27
when is a critical ill patient seen?
rushed to theatre with very little time to be seen
28
what surgical considerations do you need to take into account?
Urgent/elective surgery: urgent has less time to assess=> RISK Type of procedure: superficial or deep Location of surgery Positioning
29
what is the required fasting period for solid foods/formula milk?
6hrs
30
what is the fasting period for breast milk?
4hrs
31
What is the fasting period for clear fluid?
2hrs
32
What are the risk factors for aspiration?
full stomach Pregnancy Increased abdo pressure: masses, ascites, obesity Autonomic neuropathy in diabetes renal failure Gastric pathology like GERD, hernia, PUD
33
what special investigations might be needed?
FBC Blood cross match U&E: hpt, renal disease, elderly ECG: elderly, cardiac pathology, IHD CXR: resp/cvs disease ECHO: valve disease
34
What is ASA classification I
normal healthy patient. Mortality rate: 0.06%-0.08%
35
What is ASA classification II
mild systemic disease and no functional limitations. Mort rate: 0.27%-0.4%
36
What is ASA class III?
moderate to severe systemic disease that results in some functional limitation, but not incapacitating MORT RATE: 1.8-4.3%
37
What is ASA IV?
severe systemic disease that is a constant threat to life and incapacitating MORT RATE: 7.8-23%
38
What is ASA V
moribund patient that is not expected to live for more than 24 hours with or without the surgery MORT RATE: 9.4-51%
39
What is ASA VI?
brain-dead patient whose organs are being harvested
40
What is ASA E?
EMERGENCY
41
What are the four parts of an anesthetic plan
Premedication: sedation, anxiolysis, regular medication, preemprive analgesia, antiemetics Type of analegesia: general, local, regional, conscious sedation Intraoperative management: monitoring, positioning, fluid management, airway management Post-operative care: pain control, placement
42
In a patient who received neuromuscular blocker as analgesia, what is used to check depth of analgesia?
Activation of sympathetic nervous system
43
What is the most important reflex for anesthetists to look for?
Loss of glottic reflex. In deep anesthesia it is the loss of medullary respiration