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Perioperative Care Flashcards

1
Q

Name some induction agents

A

Propofol, sodium thiopentone, ketamine, etomidate

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2
Q

Describe the indications for the various induction agents

A

Propofol: ITU sedation and day case surgery
sodium thiopentone: RSI
ketamine: haemodynamic instability
Suxamethonium - RSI (muscle relaxant)

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3
Q

What are the pros and cons of propofol

A
  • myocardial depression
  • vasodilator

+ antiemetic properties
+ quickly metabolised

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4
Q

What are the pros and cons of sodium thiopentone

A
  • marked myocardial depression
  • no analgesic effects
  • poorly metabolised

+ rapid onset

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5
Q

What are the pros and cons of ketamine

A
  • causes dissociative nightmares

+ not much myocardial depression
+ strong analgesic

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6
Q

What are the pros and cons of Etomidate

A
  • no analgesic properties
  • vomiting
  • adrenal suppression

+ not much myocardial depression

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7
Q

What are the 2 types of neuromuscular blocking agents.
Give examples
State their MOA

A

Depolarizing: Suxamethonium
- acts by binding to the nicotinic ACh receptor and repeatedly depolarizing it

Non-depolarizing: rocuronium, atracurium, vecuronium
- competitive antagonist at the nicotinic ACh receptor

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8
Q

What are the contraindications to using a depolarizing paralytic agent?

A

penetrating eye injury
acute closed angle glaucoma
burns
cord injury/paraplegia

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9
Q

What are the ADRs of depolarizing paralytic agents?

A

Malignant hyperthermia

Hyperkalaemia

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10
Q

In which group of patients should you be cautious with when using non-depolarizing paralytic agents

A

Myasthenia gravis - they will be over sensitive and so have a prolonged recovery

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11
Q

What are the ADRs of non-depolarizing agents?

A

Hypotension

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12
Q

What are the risk factors/ causes of lidocaine toxicity? Why?

A

hepatic dysfunction (hepatic metabolism)
metabolic acidosis (causes detachment from protein)
Low protein state (protein bound)
Given IV

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13
Q

How does lidocaine toxicity present?

A

CNS overactivity and then depression

Arrhythmia’s

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14
Q

What common drugs does lidocaine interact with?

A

b-blockers
Ciprofloxacin
Phenytoin

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15
Q

What is the reversal agent used in lidocaine toxicity?

A

20% lipid emulsion IV

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16
Q

Compare the maximum lidocaine you can use with or without adrenaline

A

without: 3mg/kg up to 200mg
with: 7mg/kg up to 500mg

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17
Q

What are the contraindications to using adrenaline with lidocaine?

A

in hand surgery (as end arteries)

MAOs or TCAs

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18
Q

What is an indication and a contraindication to using Bupivacaine as a LA agent?

A

Often used in wounds at the end of surgery as it is long acting

Not to be used in regional blocks as is cardiotoxic so too risky if the tourniquet fails

19
Q

When is cocaine used as a LA agent?

A

ENT surgery as it is rapid acting and causes marked vasoconstriction

20
Q

When and why is Prilocaine used as a LA agent?

A

Regional blocks as it is the least cardiotoxic of all agents in case the tourniquet fails

21
Q

How is hypothermia prevented?

A

Don’t take to theatre unless >36
Bair Hugger used
Warmed fluids

22
Q

Why is hypothermia bad?

A
  • causes coagulopathy
  • causes vasoconstriction which leads to poor healing and wound infection as reduced white cell delivery
  • prolongs drug actions meaning a longer recovery
23
Q

What is a Kochers incision?

A

Under right subcostal margin used for cholecystectomy

24
Q

What is a Lanz and a Gridiron incision?

A

RLQ
Lanz is horizonal
Gridiron is oblique

25
What is a Pfannensteil incision?
Suprapubic transverse
26
What is a McEvedy's incision?
In the groins - used for emergency hernia repair
27
What is malignant hyperthermia?
Autosomal dominant condition in which there is excessive release of Ca from the SR of skeletal muscle in reaction to volatile agents such as Suxamethonium and halothane
28
How does malignant hyperthermia present?
``` Hyperpyrexia Muscle rigidity +++ CK Tachycardia and arrhythmias Raised ETCO2 ```
29
How is malignant hyperthermia managed?
Dantrolene
30
What can cause a paralytic ileus?
``` Bowel handling Leak or intra-abdominal collection MI Stroke AKI Pneumonia ```
31
What examination finding is key in paralytic ileus?
Absent bowel sounds
32
What drugs slow wound healing?
NSAIDs Steroids Immunosuppressants and cancer drugs
33
Describe the VTE prophylaxis used for a) NOF fracture b) hip replacement c) knee replacement
a) 1 month LMWH b) 10 days LMWH then 1 month aspirin c) 14 days aspirin
34
Aside from drugs, what other measures can minimise VTE risk?
Pneumatic compression devices | Anti-embolism stockings
35
Describe the grades of ASA physical status classification
1: no limitations 2: mild systemic disease with no limitations (smoking, alcohol, BMI 30-40) 3: systemic disease resulting in limitations (alcohol dependant, BMI >40) 4: severe disease with constant threat to life (MI <3 months ago) 5: won't live without surgery 6: brain dead - surgery is for organ removal
36
What are your differentials for post-op pyrexia?
Infection - catheter - wound - lines - collection or leak
37
What are your differentials for post-op confusion?
hypoglycaemia electrolyte imbalance infection drugs
38
What can cause post-op hyponatraemia? | How does it present?
``` Paralytic ileus (due to third spacing) Fluid overload ``` Confusion and hypotension
39
What can cause post-op oligouria?
pre: Hypovolaemia and sepsis renal: NSAIDs and IV contrast post: Catheter blocked
40
What cause cause post-op hypotension? What would you be looking for to point towards these causes?
hypovolaemia: abdo distension, drains cardiogenic: raised JVP, ECG abnormalities septic: fever, flushed
41
What can cause post-op reduced saturations?
respiratory depression fluid overload acidotic due to AKI atelectasis
42
What is atelectasis? What does it lead to?
basal small airway collapse leads to secretions accumulating causing hypoxaemia and infection
43
How does atelectasis present?
Within 24 hours post-op Increased RR, reduced saturations Fine crackles Low grade fever
44
What are the advantages and disadvantages of a central line at the femoral vein?
+ easier insertion + iatrogenic vessel damage easier to manage as compressible - infection

Finals (16 decks)

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