Peri-Operative management Flashcards

1
Q

What are the definitions of the ASA scoring system?

A

ASA 1: no organic, physiological, biochemical or psychiatric disturbance. Surgical pathology is localised

ASA 2: Mild/Mod systemic disruption caused by the surgical disease or pre-existing disease

ASA 3: Severe systemic disruption caused by surgical pathology or pre-existing disease

ASA 4: Severe systemic disease that is a constant threat to life

ASA 5: moribund and will not survive without surgery

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2
Q

What medication should be administered to a patient who is due to have surgery for a pheochromocytoma?

A

Alpha and beta blockers

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3
Q

What is the risk of over using normal saline as a resuscitation fluid?

A

Hypercholeraemic metabolic acidosis

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4
Q

What is a complication of central lines?

A

Pneumothorax

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5
Q

What is atropine?

A

Muscarinic antagonist

Inhibits parasympathetic activity

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6
Q

What are the effects of Lidocaine/Lignocaine?

A
  • Local anaesthetic
  • Less commonly used a anti arrhythmic drug

Affects Na channels in the axons of nerves

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7
Q

What are the features of toxicity of Lidocaine/Lignocaine?

A

CNS overactivity first
CNS depression later

Lidocaine initially blocks inhibitory pathways but then begins to also block activating pathways causing cardiac arrhythmias

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8
Q

How can higher doses of lidocaine/ligocaine be used?

A

Administer with adrenaline to limit systemic absorption

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9
Q

What is an alternative agent to lidocaine if a patient has an allergy to lidocaine?

A

Bupivacaine

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10
Q

What anaesthetic agent is used in intravenous regional anaesthesia (e.g. Biers block)?

A

Prilocaine

It is a lot less cardiotoxic

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11
Q

What is the max dose of lidocaine with and without adrenaline?

A

Plain: 3mg/kg

With adrenaline: 7mg/kg

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12
Q

In which scenarios should you never use adrenaline with the LA?

A

Finger related surgeries
Circumcision

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13
Q

In which clinical situations is Bupivicaine used?

A
  • Allergy to lidocaine
  • Flail chest
  • Spinal access surgery
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14
Q

Which anaesthetic agent is normally used to rapidly sedate an UNSTABLE patient?

A

Ketamine

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15
Q

What is the most commonly used anaesthetic agent in everyday theatre, ITU and electives?

A

Propofol

  • has anti-emetic effedcts
  • Rapid onset
  • Pain on injection
  • causes myocardial depression
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16
Q

What is a side effect of using ketamine for sedation?

A

Dissociative anaesthesia (nightmares while under)

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17
Q

What is the most commonly used muscle relaxant used in theatre and how does it work?

A

Suxamethonium

  • Inhibits ACH and depolarises
  • Rapid onset leading to paralysis
  • SE of Hyperkalaemia and Malignant Hyperthermia
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18
Q

What is malignant hyperthermia characterised by and how is it managed?

A
  • Hyperpyrexia
  • Muscle rigidity

Managed by Dantrolene (prevents Ca2+ release from the sarcoplasmic reticulum from skeletal muscle)

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19
Q

When is the use of tourniquet in surgery contraindicated?

A
  • AV fistula
  • Severe PVD
  • Prev vascular surgery
20
Q

What tourniquet pressures are used on the upper and lower limbs?

A

Upper limb: SBP 250

Lower limb: SBP 350

21
Q

If a patient receives a blood transfusion, they can still be a blood donor?

22
Q

If young child who is fit and healthy is being prepared for an elective tonsillectomy, will they need any pre-operative tests and if so, which ones?

A

No tests required

The patient is ASA 1 and is being admitted for minor/moderate surgery as per NICE guidelines

23
Q

What is the criteria for brain death testing?

A
  • Deep coma of known aetiology
  • Reversible causes excluded
  • No sedation
  • Normal electrolytes
24
Q

What would be the recommended analgesia to use for a patient post thoracotomy/lobectomy?

A

Epidural analgesia

25
What type of block is given for a episiotomy?
Pudendal block
26
What type of block is done for a haemorhoidectomy?
Caudal block
27
What is the first line analgesia used in advanced pancreatic cancer?
NSAIDs
28
How is pain controlled in patients with flail chest?
Bupivicaine infiltration + O2
29
What is the first line medication for neuropathic pain?
- Amitriptylline (SE of hypotension) - Pregabalin if pt hypotensive/orthostatic hypotension
30
What is the first line medication for diabetic neuropathy?
Duloxetine
31
What is the definition of massive haemorrhage?
- 50% blood loss in 3hrs - Blood loss of 150ml/min
32
What are biochemical side effects of massive blood transfusions?
- Hypocalcaemia - Hyperkalaemia
33
What is the name of the screen tool for malnutrition?
MUST
34
What are the criteria for diagnosis of malnutrition?
- BMI <18.5 - Unintentional wt loss >10% over 3-6 months - BMI <20 AND unintentional weight loss >5% over 3-6 months
35
What are the metabolic consequences of refeeding syndrome?
- Hypophosphataemia - Hypokalaemia - Hypomagnesaemia - Abnormal fluid balance
36
What nerve is at risk of injury during an axillary node clearance?
Long thoracic nerve
37
What nerve is at risk of injury during a carotid endarterectomy?
Hypoglossal nerve
38
What structure can most commonly be damaged during colonic resections?
Ureter
39
Why are beta blockers not stopped acutely prior to surgery?
May cause rebound effect causing more intra-operative complications
40
What dye can be used to identify the parathyroid gland intra-operatively?
Methylene blue dye IV Stains parathyroid glands
41
When should clopidogrel be stopped pre-operatively?
5-7 days prior
42
What autonomic concern for surgery does diabetic neuropathy cause?
Decreased heart rate variability leading to haemodynamic instability intra-operatively
43
What can cause pyrexia post-operatively?
Day 1: systemic response to surgery / pre-operative infection Day 2: Atelactasis / chest infection Day 3 - 7: Infection / Anastomotic leak Day 7 - 10: DVT/PE
44
What is the mechanism of action of succinylcholine?
Direct binding and activation of nicotinic acetylcholine receptors
45
When initiating rapid sequence intubation with concern of ICP (cases of head injury), what is the preferred anaesthetic agent?
Etomidate