Peri-operative care Flashcards
Risk factors for difficult ventilation
OBESE
Obese Beard Edentate (no teeth) Spine (poor neck movement) Elderly
Anaesthetic history
PC SR DH PMH PAH (Past Anaesthetic Hx) FH SH
Effect of acute alcohol on anaesthetic
Decreases effects of anaesthetic
Effect of chronic alcohol on anaesthetic
Increases effects of anaesthetic
ASA 1
Healthy pt
ASA 2
Pt with mild systemic disease
ASA 3
Pt with severe systemic disease
ASA 4
Severe systemic disease that is constant threat to life
ASA 5
Moribund pt not expected to survive with or without the operation
ASA 6
Declared brain dead pt whose organs are being removed for donation
ASA E
Added for emergency operations
Sensitivity
Proportion of diseased pts who test positive
Specificity
Proportion of healthy pts who have normal result
Prevalence
Proportion of population with disease
Positive predictive value
Likelihood of pt with positive result having disease
Negative predictive value
Likelihood of pt with normal result not having disease
Most common blood borne virus
Hep B
Hep C
HIV
Rx of Malignant Hyperthermia
Dantrolene
Drugs causing malignant hyperthermia
Halothane
Suxamethonium
Anti-psychotics
Cyanosed o2 sats
80-85 percent
Different types of ventilation
NIPPV
IPPV
NIPPV
Non-invasive intermittent positive pressure ventilation
NIPPV types
BiPAP
CPAP
IPPV involves?
Intubation and ventilation
CPAP
continuous positive airway pressure
BiPAP
Bi-level PAP
CPAP use
hypoxia
BiPAP use
Resp failure secondary to COPD exacerbation
nasal cannulae normal flow rate
2-4l/min
nasal cannulae FiO2
28-36%
normal o2 mask flow rate
4 L/min
normal o2 mask FiO2
35-40%
Non-rebreather FiO2
up to 85%
What group of pts need controlled O2 delivery
COPD
CF
Morbidly Obese
When to stop warfarin before surgery
5 days before
Mendelson’s syndrome
chemical pneumonitis
Smoking effect on anaesthetics
risk of bronchospasm
Fluid restriction before surgery
no fluids within 2 hrs of op
Food restriction before surgery
no food within 6 hrs of op
Oral med restriction before surgery
no med within 30 mins
before could have with 30 mls of water
Chewing gum restriction before surgery
no gum within 2 hrs
Effect of trauma on gastric emptying
slows it down
Prokinetics mech of action
speeds gastric emptying (used when risk of aspiration)
Prokinetics example
Metoclopromide
Erythromycin
When should antiacids be given before a surgery
immediately before op
When should PPIs be given before a surgery
90 mins before anaesthesia
When should prokinetics be given before a surgery
90 mins before anaesthesia
When should anti-H2 be given before a surgery
90 mins before anaesthesia
PE sx
Dyspnoea
Pleuritic chest pain
Haemoptosis
CVS consequence of PE
Pulmonary HTN
Right ventricular failure
Low cardiac output
Cardiac arrest
RFs for VTE
Patient factors
Associated disease
Operation factors
Patient factors for VTE
Age >60 Immobility/travel Pregnancy/puerperium BMI>30 Unopposed E2
Associated disease RFs of VTE
IBD Nephrotic Thrombophilia Malignancies MI/CVA
Examples of thrombophilia
Protein C, S deficiency,
Factor V Leiden
Operation RFs for VTE
Op >30mins
Joint replacement/abdo op
Rapid induction
Thiopentone
Suxamethonium