Perioperative And Critical Care Flashcards
What is suxamethonium apnoea (and what is it also sometimes called)?
Sometimes called pseudocholinesterase deficiency - a rare abnormality in the production of plasma cholinesterases = increased duration of action of muscle relaxants such as suxamethonium. Respiratory arrest is inevitable unless the patient can be mechanically ventilated safely while waiting for the circulating muscle relaxants to degrade. Establish any family history of this
Rapid sequence induction (RSI) can be used e.g. when a patient has not fasted/ there is a risk of aspiration, what muscle relaxant is appropriate to use for RSI?
Suxamethonium - a depolarising muscle relaxant. It has the fastest onset and shortest duration of action of all muscle relaxants.
What adverse things/ cautions are there to consider when using suxamethonium?
Can cause hyperkalaemia (avoid in burns/trauma patients), malignant hyperthermia, suxamethonium apnoea, and is CI for patients with penetrating eye injuries or acute narrow angle glaucoma as suxa increases intra-ocular pressure.
What does a 2% strength liquid medication e.g. 2% lidocaine mean?
It means that 2g of the drug are dissolved in 100ml
What is used to treat local anaesthetic toxicity?
IV 20% lipid emulsion
What local anaesthetic is the agent of choice for intravenous regional anaesthesia e.g. Biers block?
Prilocaine (it is far less cardiotoxic than other agents)
What drug can be given with local anaesthetics so that higher doses of LA can be used?
Adrenaline (because it limits the systemic absorption via its vasoconstrictive action)
What is the treatment for malignant hyperthermia?
IV dantrolene
What is the advice regarding eating and drinking before an operation?
No food for 6 hours and no clear fluids for 2 hours before an operation
Briefly, what are the ASA grades?
ASA I - a normal healthy patient (non-smoking, minimal alcohol)
ASA II - mild diseases only without substantive functional limitations: current smoker, pregnancy, obesity, well-controlled diabetes or hypertension, mild lung disease
ASA III - a patient with severe systemic disease (substantive functional limitations)
ASA IV - a patient with severe systemic disease that is a constant threat to life e.g. recent (<3 months) MI, CVA, ongoing cardiac ischaemia or severe valve dysfunction, sepsis, DIC
ASA V- a moribund patient who is not expected to survive without the operation
ASA VI- a declared brain-dead patient whose organs are being removed for donor purposes
When should patients be advised to stop taking the oral contraceptive pill prior to major surgery?
4 weeks prior to surgery the OCP should be stopped
What VTE prophylaxis regimen (i.e. LMWH) should be initiated after the following procedures: elective hip replacement, elective knee replacement, hip fracture surgery.
For elective hip replacement- 28 days of LMWH, for elective knee replacement - 14 days of LMWH and for hip fracture surgery LMWH until the patient no longer has significantly reduced mobility.
When is intraosseous access used and what site is most common for this?
Can be used in both adults and children and is indicated when vascular access is difficult to obtain in an emergency setting. In general, in a paediatric case it is suggested to try intraosseous access after 2 failed attempts at a peripheral IV line. The most common site is the proximal tibia, however the distal femur and humeral head can also be used
What drug reverses the action of benzodiazepines?
Flumazenil
What may excessive administration of sodium chloride (saline fluid) cause?
Hyperchloraemic acidosis
What is the anaesthetic triad?
Muscle relaxation, hypnosis and analgesia
When should clopidogrel be stopped before surgery?
5-7 days before the surgery
When does sign in, time out and sign out occur in theatre?
Sign in i.e. before the start of anaesthesia
Time out i.e. before the start of surgery
Sign out i.e. at the end of surgery
Which anaesthetic agent has inherent anti-emetic properties?
Propofol
