OT Dr Nabilah

Question 1

What are the important points to present in Paediatric history?

Answer 1

1) Name
2) Age
3) Weight
4) Diagnosis
5) Operation plan
6) Co-morbidities (including syndromes: may have facial changes)
7) PMH (Previous operations)
8) Anaesthesia complications

Question 2

What are paediatric cases at risk of developing during intubation?

Answer 2

Laryngospasm

Question 3

How long should a patient fast from:

1) Food
2) Fluids

before surgery?

Answer 3

1) Food: 6 Hours
2) Clear fluids: 2 hours

Question 4

What is TIVA?

Answer 4

Total Intravenous Anaesthesia

Question 5

When is TIVA chosen over Inhalational maintenence of General Anaesthesia? (4)

Answer 5

• Recent upper respiratory tract infection
• Patient with throat pathology
• patient with history of Malignant hyperthermia
• High risk for PONV

Question 6

What is used to monitor patient awareness during TIVA? AND
What is the range of that device parameter to ensure patient is not aware?

Answer 6

Bispectral index (BIS): form of Electroencephalogram (EEG)
Range: 40-60

Question 7

1) What does MAC Stand for?
2) Define MAC.
3) What MAC value is appropriate to ensure patient is not aware?

Answer 7

1) Mean Alveolar concentration
2) The MAC value is the concentration of an inhalational agent in the alveoli required to prevent movement in response to a noxious stimulus in 50 percent of subjects after allowing sufficient time for uptake and redistribution of the inhalation agent to reach a steady state
3) MAC 1

Question 8

Which volatile agent can be used during induction and maintenance phase?

Answer 8

Sevoflurane

Question 9

What is the formula to calculate ETT size:
1) Without cuff?
2) With cuff?

Answer 9

1) Without cuff: Age/4 +4
2) With cuff: Age/4+ 3.5

Question 10

What are the formulas to calculate ETT anchor? (2)

Answer 10

1) Age x3
2) Age/2 +12

Question 11

Analgesia can be divided into two categories! What are they? And give examples for each.

Answer 11

Opioid: Fentanyl, remifentanil, sufentanil, alfentanil, hydromorphine, morphine, methadone
Non- opioid: Ketamine, Lidocaine, Nsaids, Paracetamol

Question 12

What are the three main types of regional anaesthesia?

Answer 12

1) Peripheral nerve blocks
2) Epidural and spinal anaesthesia (also have combined Spinal epidural aka CSE)
3) Intravenous regional anaesthesia (Bier block)

Question 13

What is Holliday-Segar rule? And provide the formula.

Answer 13

It is the 4-2-1 rule used to calculate the daily and hourly need of fluid in children.
*4mL/kg for the first 10kg
*2ml/kg for the next 10kg
*1ml/kg for the next 1kg beyond 20kg

Question 14

When fasted for 6 hours prior to surgery, the fluids missed should be replaced during surgery if patient was not on IV fluids prior, true or false?

Answer 14

True, use 4-2-1 rule to calculate maintenance and multiply it by 6 hours.

Question 15

How to maintain temperature of patient? (3)

Answer 15

Wrap patient
Bair hugger
Blanket

Question 16

Muscle relaxants can be divided into two categories (2)

Answer 16

Depolarising muscle relaxants
Non-depolarising muscle relaxants

Question 17

How do depolarising muscle relaxants work?

Answer 17

• Acts at the neuromuscular junction, at the motor endplate
• They act as Acetylcholine (ACh) receptor agonist
• By binding to ACh receptor, they cause persistent depolarisation of the muscle fibers by keeping the receptor open
• In Phase I: there is transient muscle fasciculation
  -In phase II (desensitizing phase): muscles are no more receptive to Ach released by motor neurons
  -At this point, the depolarising agent has fully achieved paralysis
• They are resistant to and not metabolized by acetylcholinesterase
• Targets nicotinic and muscarinic receptors

Question 18

What are the adverse effects of depolarising muscle relaxants? (9)

Answer 18

• dysrhythmias (muscarinic effect)
• autonomic symptoms (blocked nicotinic receptors of autonomic ganglia or adrenal medulla)
• hypotension, flushing and tachycardia (histamine release)
• Transient release of potassium (causing hyperkalemia and cardiac arrhythmias)
• Jaw rigidity
• Respiratory depression
• Increased IOP
• Hypersalivation
• Malignant hyperthermia

Question 19

What are the contraindications of depolarising muscle relaxants? (7)

Answer 19

• Bradycardia patients
• Neurological injury: Cerebral vascular accident, spinal cord injury
• Drug hypersensitivity
• Malignant Hyperthermia
• Ocular surgery
• Myopathy
• Burns; Severe tissue injury (extensive denervation of skeletal muscle or UMN injury)

Question 20

What is Sugammadex?

Answer 20

• Reversal agent for rocuronium

Question 21

What are examples of depolarising muscle relaxants

Answer 21

• Succinylcholine
• Atropine

Question 22

What are examples of non- depolarising muscle relaxants?

Answer 22

• Rocuroniun
• Atracurium
• Vecuronium
• Mivacurium

Question 23

Reversal agent for succinylcholine and suxamethonium?

Answer 23

• Neostigmine

Question 24

Why is Rapid Sequence Intubation (RSI) used?

Answer 24

RSI is used to protect the airway from aspiration of gastric contents by minimizing regurgitation during induction of anaesthesia

Question 25

What are the indications(cases) of RSI?

Answer 25

• Abdominal masa
• Intestinal obstruction
• Obese patient
• Paediatric patient
• Pregnant patients >=2nd trimester
• Emergency case
• Critically ill (Shock, TBI)

Question 26

What drugs are used in RSI?
For:
•Hypnotics
•Relaxant
•Analgesia

Answer 26

• Hypnotics:
° Thiopental
° Propofol 2-3mg/kg
° Ketamine
° Midazolam 0.1-.02mg/kg

• Relaxant:
° Suxamethonium 1-2mg/kg

• Analgesia:
° Fentanyl 1-2mcg/kg
° Morphine 25-50mcg/kg
° Lidocaine

Question 27

What are the steps of RSI?

Answer 27

1) Pre Oxygenate patient (3-5mins)
2) Induce (Ketamine, Fentanyl, Thiopentone, Suxamethonium)
3) No bagging
4) Cricioid pressure: {Patient awake: 10N, asleep: 30N}
Modified:
• Use Propofol
• Modify dose 1.2mg/kg
• Minimal bagging

Question 28

Why Minimal bagging is done during RSI?

Answer 28

• To prevent aspiration of gastric content due to relfux
• Upper oesophageal pressure is 25mmHg
• Bagging heavy >25mmHg, causes sphincter to open and reflux of gastric content

Question 29

What is the standard ETT size for adult
1) Male
2) Female ?

Answer 29

1) Male: 8.5mm
2) Female: 7.5mm

Question 30

During intubation , what is the best method to ensure that patient is the unconscious and has adequate paralysis? (2)

Answer 30

Train of four (TOF)
Also MAC 1

Question 31

What is TOF?

Answer 31

• Peripheral nerve stimulator via Train-of-four monitor
• assess neuromuscular transmission
• By assessing depth of neuromuscular blockade
• peripheral nerve stimulation can ensure proper medication dosing

Question 32

Ketamine is contraindicated in?

Answer 32

Patients with IHD, Ketamine causes tachycardia

Question 33

What sedative drug is long acting (60-120min)but cardiostable?

Answer 33

Midazaloma

Question 34

What type of drug is sodium thiopentone?

Answer 34

A Sedative drug

Question 35

Local anaesthesia can be divided into two groups. Give examples for each.

Answer 35

Ester: procaine, tetracaine, cocaine, chlorprocaine
Amide: Lidocaine, bupivacaine, ropivacaine, levobivacaine

Question 36

In Spinal anaesthesia Bupivacaine (heavy) is mixed with a solution?
Why is it mixed with that solution?

Answer 36

Bupivacaine + dextrose (80mg/mL)
This is called HEAVY BUPIVACAINE
- The gravity of heavy bupivacaine allows it to diffuse better into the intrathecal space than normal bupivacaine

Question 37

What is heavy marcain?

Answer 37

Also basically the same thing as heavy bupivacaine

Question 38

What are the contraindications to regional/spinal anaesthesia?

Answer 38

• Instrumentation and spinal surgery
• Raised ICP
• Sepsis
• ## Urea>25 (there is platelet dysfunction when there is high urea; n: 1.8-7.1 mmol/L)