Peri-op Management And Post-op Complications Flashcards
3 principles of anaesthetics
-Hypnosis
-Analgesia
-Muscle relaxation
What type of agents can be used as muscle relaxants? (Examples)
Depolarising agents - suxamethonium
Non-depolarising agents - rocuronium, atracurium
3 stages of anaesthesia
Induction
Maintenance
Emergence
3 methods of induction and example drugs
IV - Propofol
Inhalation of volatile agent - sevoflurane (paeds + hard IV access)
Rapid sequence intubation (unfasted patients, emergencies)
2 ways of maintenance
Total IV anaesthesia - propofol + opiate via pump
Volatiles - MAC and expired end tidal conc.
Sequence of emergence
Switch of maintenance
Anti-emetic + analgesia
Reverse neuromuscular blockade
Extubate
Transfer to recovery
Types of regional anaesthesia
Local anaesthetic
Peripheral nerve block
Nerve plexus block
Central neuraxial block - spinal and epidural
What layers does an epidural pass through?
Skin
Subcutaneous tissue
Fascia
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
What layers does a spinal pass through?
Same as epidural + arachnoid mater
What system is used to determine someone’s suitability for surgery?
ASA grading (1-6)
What should pain management be based off of?
WHO pain ladder
What should you prescribe alongside strong opioids?
Laxatives + anti-emetics
What should you prescribe alongside steroids?
Bone protection (bisphosphonates/Vit D/calcium)
Stomach protection (PPI)
What should you prescribe alongside NSAIDs?
Stomach protection (PPI)
3 types of fluids
Resuscitation
Maintenance
Replacement
Clinical signs of fluid depletion
Dry mucous membranes
Reduced urine output
Hypotension
Tachycardia
Increased capillary refill
Clinical signs of fluid overload
Raised JVP
Peripheral oedema
Pulmonary oedema
Daily fluid requirements
Water 25ml/kg/day
Na + K = 1mmol/kg/day each
Glucose = 50g/day
What is a fluid challenge?
Is a stat dose (one-off) given over 15 minutes
Usually 250-500ml depending on weight and co-morbidities
When should metoclopramide and haloperidol not be given?
Parkinson’s or Lewy-Body dementia patients
Bowel obstruction for metoclopramide
When to not give cyclizine?
To patients who have a history/background of drug addiction
4 different types of laxatives
Bulk-forming
Osmotic
Stimulants
Surfactants