Module 7 Triage Flashcards
What is meant by optimisation
This is trying to resolve the reversible medical conditions before surgery
Why are hypertension patients more susceptible to hypotension in surgery
They are more sensitive to vasodialators as a result of the constant hypertension meaning that they have a decreased ability to compensate for drops in bp
What are 2 possible surgical stimuli for hypertension
- Intabation
- Surgical stimulation
Which hypertensive patients are at highest risk for anaesthesia
- Diastolic of above 120
- Untreated, uncontrolled
- Treated but not controlled
- Treated and controlled
What are the factors that need to be assessed in a patient that is hypertensive 4
- BP charting and record keeping
- Effort tolerance
- End organ function
- ECG and CXR
What needs to be done in a preoperative patient 6
- Optimise BP control
- Continue the AHT
- Premedicate to minimise anxiety
- Blunt the intubation response
- Avoid decreases in the systolics of more than 25%
- Give adequate post op analgesia to decrease the pain response
Why should we beware of IHD in diabetics
They can have silent infarcts
What is the best induction agent to give a patient with IHD
Etomidate or propofol given slowly and continuously
Which are the best inhalational agents to give
Sevo and then switch to iso
What are stenotic valves not able to compensate for an why
They have a fixed cardiac output and so are unable to accommodate changes in the systemic vascular resistance
What is the optimal heart rate and rhythm in a stenotic lesion
Slow sinus rhythms
What is the optimal HR in a regurge valve lesion
Fast sinus rhythm
What are the 3 requirements for intraoperative management of a cardiac failure patient
- A line to monitor beat to beat variation in the BP
- Central line to administer the ionotropes
- Maintain preload and reduce afterload
How do you manage acute dysrhythmia
- Exclude hypoxia, hypercapnia and acidosis
- If it is haemodynamically significant we can try to give pressors and fluids
- If not then leave it and identify the cause
What are the 6 factors that decrease the FRC
- Lying supine
- Intubation: It means that the diaphragm is not flat
- All anaesthetic agent
- Muscle relaxants and muscle immobility
- Surgical retractors
- Abdominal masses
What does the FRC signify
This is the pool of gas what we can live from and is the gas left after a normal expiration
What can be done preoperatively to optimise an asthmatic patient
- B2 agonist
- Steroids
What is the optimal anaesthesia for a patient with asthma
Induction: Propofol : This is the best because of its bronchodilatory effects. Ketamine is also a good option as it is a dialator.
Thiopentone can cause spasms
Inhalation: Sevo is best. Iso and des are irritants but all cause dilation
Muscle relaxant: Rocuronium that is reversed with sugammadex because the other MR cause histamine release and neostigmine causes constriction
Analgesia: Fentanyl, morphine and pethidine should be avoided as it causes spasms
What is a sign of an acute bronchospasm
There will be a sudden increase in the airway pressures
What are the 4 steps in treatment of a bronchospasm
- Give high conc. O2
- Deepen the anaestetic plane
- Broncodialators
- Ketamine and MgSO4
In TB which type of anaesthetics should be avoided
Hepatotoxic drugs
What should be avoided in patients with obstructive sleep apnea
Opioids
What is the main reason that risky in patients with upper respiratory tract infections?
Spasms
