Peri-op Management And Post-op Complications

Question 1

3 principles of anaesthetics

Answer 1

-Hypnosis
-Analgesia
-Muscle relaxation

Question 2

What type of agents can be used as muscle relaxants? (Examples)

Answer 2

Depolarising agents - suxamethonium
Non-depolarising agents - rocuronium, atracurium

Question 3

3 stages of anaesthesia

Answer 3

Induction
Maintenance
Emergence

Question 4

3 methods of induction and example drugs

Answer 4

IV - Propofol
Inhalation of volatile agent - sevoflurane (paeds + hard IV access)
Rapid sequence intubation (unfasted patients, emergencies)

Question 5

2 ways of maintenance

Answer 5

Total IV anaesthesia - propofol + opiate via pump
Volatiles - MAC and expired end tidal conc.

Question 6

Sequence of emergence

Answer 6

Switch of maintenance
Anti-emetic + analgesia
Reverse neuromuscular blockade
Extubate
Transfer to recovery

Question 7

Types of regional anaesthesia

Answer 7

Local anaesthetic
Peripheral nerve block
Nerve plexus block
Central neuraxial block - spinal and epidural

Question 8

What layers does an epidural pass through?

Answer 8

Skin
Subcutaneous tissue
Fascia
Supraspinous ligament
Interspinous ligament
Ligamentum flavum

Question 9

What layers does a spinal pass through?

Answer 9

Same as epidural + arachnoid mater

Question 10

What system is used to determine someone’s suitability for surgery?

Answer 10

ASA grading (1-6)

Question 11

What should pain management be based off of?

Answer 11

WHO pain ladder

Question 12

What should you prescribe alongside strong opioids?

Answer 12

Laxatives + anti-emetics

Question 13

What should you prescribe alongside steroids?

Answer 13

Bone protection (bisphosphonates/Vit D/calcium)
Stomach protection (PPI)

Question 14

What should you prescribe alongside NSAIDs?

Answer 14

Stomach protection (PPI)

Question 15

3 types of fluids

Answer 15

Resuscitation
Maintenance
Replacement

Question 16

Clinical signs of fluid depletion

Answer 16

Dry mucous membranes
Reduced urine output
Hypotension
Tachycardia
Increased capillary refill

Question 17

Clinical signs of fluid overload

Answer 17

Raised JVP
Peripheral oedema
Pulmonary oedema

Question 18

Daily fluid requirements

Answer 18

Water 25ml/kg/day
Na + K = 1mmol/kg/day each
Glucose = 50g/day

Question 19

What is a fluid challenge?

Answer 19

Is a stat dose (one-off) given over 15 minutes
Usually 250-500ml depending on weight and co-morbidities

Question 20

When should metoclopramide and haloperidol not be given?

Answer 20

Parkinson’s or Lewy-Body dementia patients
Bowel obstruction for metoclopramide

Question 21

When to not give cyclizine?

Answer 21

To patients who have a history/background of drug addiction

Question 22

4 different types of laxatives

Answer 22

Bulk-forming
Osmotic
Stimulants
Surfactants