Module 1: overview of anaesthesia

Question 1

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

Answer 1

False, anesthesia includes acute and chronic pain management

Question 1

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

Answer 1

pre-operative, intra-operative and post-operative

Question 2

Who forms part of the team in surgery

Answer 2

surgeons, anesthetists, nurses and porters

Question 3

what are the 2 types of anesthesia?

Answer 3

General and local/regional

Question 4

what is general anaesthesia

Answer 4

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

Question 5

What is local/regional anaesthesia?

Answer 5

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

Question 6

what is in the triad of anaesthesia

Answer 6

hypnosis, analgesia and immobility

Question 7

what does hypnosis entail

Answer 7

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.

Question 8

What does analgesia ential

Answer 8

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.

Question 9

Why is it necessary to add analgesia when inducing

Answer 9

Pain activates the sympathetic nervous system which can be deleterious.

Question 10

What does immobility entail?

Answer 10

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.

Question 11

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

Answer 11

deep general anesthesia

Question 12

what forms part of the perioperative journey?

Answer 12

induction, maintanace and emergence

Question 13

What happens during pre-induction

Answer 13

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

Question 14

What happens during induction

Answer 14

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

Question 15

What happens during maintenance?

Answer 15

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

Question 16

What happens during emergence

Answer 16

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

Question 17

what are the 4 stages of general anaesthesia

Answer 17

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

Question 18

In what order are reflexes lost in anaesthesia

Answer 18

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

Question 19

What entails recovery from anaesthesia

Answer 19

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

Question 20

what forms part of the post-operative management

Answer 20

majority will wait in recovery area and moved to ward

day cases go home

special care required goes to ICU

Question 21

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

Answer 21

medicolegal requirement(Consent)

Identifying chronic diseases or risk factors

Identifying areas which may require optimization before surgery

Question 22

What is the end goal of pre-operative assessment?

Answer 22

appropriate anesthetic plan

Question 23

What are the aims of preoperative visit?

Answer 23

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

Question 24

What patient considerations should you take into account?

Answer 24

Medicolegal documents History: coexisting disease, allergies, medications, prior surgeries examination esp airway

Question 25

When is a patient for elective surgery seen?

Answer 25

day before in ward or morning of surgery

Question 26

when is a patient seen for urgent/emergency surgery?

Answer 26

in front room/induction room

Question 27

when is a critical ill patient seen?

Answer 27

rushed to theatre with very little time to be seen

Question 28

what surgical considerations do you need to take into account?

Answer 28

Urgent/elective surgery: urgent has less time to assess=> RISK Type of procedure: superficial or deep Location of surgery Positioning

Question 29

what is the required fasting period for solid foods/formula milk?

Answer 29

6hrs

Question 30

what is the fasting period for breast milk?

Answer 30

4hrs

Question 31

What is the fasting period for clear fluid?

Answer 31

2hrs

Question 32

What are the risk factors for aspiration?

Answer 32

full stomach Pregnancy Increased abdo pressure: masses, ascites, obesity Autonomic neuropathy in diabetes renal failure Gastric pathology like GERD, hernia, PUD

Question 33

what special investigations might be needed?

Answer 33

FBC Blood cross match U&E: hpt, renal disease, elderly ECG: elderly, cardiac pathology, IHD CXR: resp/cvs disease ECHO: valve disease

Question 34

What is ASA classification I

Answer 34

normal healthy patient. Mortality rate: 0.06%-0.08%

Question 35

What is ASA classification II

Answer 35

mild systemic disease and no functional limitations. Mort rate: 0.27%-0.4%

Question 36

What is ASA class III?

Answer 36

moderate to severe systemic disease that results in some functional limitation, but not incapacitating MORT RATE: 1.8-4.3%

Question 37

What is ASA IV?

Answer 37

severe systemic disease that is a constant threat to life and incapacitating MORT RATE: 7.8-23%

Question 38

What is ASA V

Answer 38

moribund patient that is not expected to live for more than 24 hours with or without the surgery MORT RATE: 9.4-51%

Question 39

What is ASA VI?

Answer 39

brain-dead patient whose organs are being harvested

Question 40

What is ASA E?

Answer 40

EMERGENCY

Question 41

What are the four parts of an anesthetic plan

Answer 41

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

Question 42

In a patient who received neuromuscular blocker as analgesia, what is used to check depth of analgesia?

Answer 42

Activation of sympathetic nervous system

Question 43

What is the most important reflex for anesthetists to look for?

Answer 43

Loss of glottic reflex. In deep anesthesia it is the loss of medullary respiration