Perioperative Management

Question 1

What are the 3 steps of the WHO pain ladder?

Answer 1

Non-opioid: aspirin, paracetamol, NSAID
Weak opioid: codeine
Strong opioid: morphine

Question 2

Name 3 commonly used anti-emetics

Answer 2

Ondansetron
Cyclizine
Dexamethasone

Question 3

What is temperature control when under GA?

Answer 3

Keep > 36
Bear hugger blanket
Fluid warming (long procedures)

Question 4

Why is it important to control temperature under GA? Give an example of what would happen if this failed

Answer 4

Enzymes denature when out of their temperature boundaries
GA disrupts homeostasis
E.g. drop in temperature would prolong clotting + increase blood loss

Question 5

Describe the management of asthma as an anaesthetic emergency

Answer 5

Severe bronchospasm: Use acronym O SHIT M
O2 high flow + gain IV access
Salbutamol nebulised 2.5-5mg
Hydrocortisone IV 100mg
Ipratropium nebulised .5mg
Theophylline
Magnesium 2g IV

Question 6

Describe the management of pneumothorax as an anaesthetic emergency

Answer 6

FNA 2nd ICS MCL using a large bore cannula

Question 7

Describe the management of anaphylaxis as an anaesthetic emergency

Answer 7

ABCDE
Adrenaline IM
Chlorphenamine
Hydrocortisone
Fluids

Question 8

Describe signs of pneumothorax as an anaesthetic emergency

Answer 8

Airway swelling: difficulty breathing/ swallowing
Stridor + wheeze
SOB
Signs of shock- pale, clammy
Tachycardia
Hypotension
LOC
Cardiac arrest.

Question 9

List 4 triggers of pneumothorax

Answer 9

Nuts
Stings
Antibiotics
Anaesthetic drugs

Question 10

At what Hb should blood be transfused?

Answer 10

< 70 in most patients

< 90 in ACS, severe sepsis, neurological injury

Question 11

What parameters are measured in NEWS scores?

Answer 11

RR
O2 Sats.
Temp.
Pulse rate
SBP
Level of consciousness

Question 12

What is sepsis?

Answer 12

Infection + SIRS:
Temp >38 or <36
HR >90 bpm
RR >20/min
WCC > 12,000mm

Question 13

What must be completed within 3 hours of presentation with sepsis?

Answer 13

Measure lactate
Blood cultures
Broad spectrum abx
Crystalloid for hypotensives

Question 14

What must be completed within 6 hours of presentation with sepsis?

Answer 14

Vasopressors (for hypotension that doesn’t respond to fluid resus)
Reassess volume status
Reassess lactate

Question 15

What can be assessed from an ABG sample?

Answer 15

Oxygenation levels 
Potential respiratory/ metabolic derangements 
Acid-base status 
Carboxyhaemoglobin in CO poisoning 
Lactate

Question 16

List 5 contraindications to ABG sampling

Answer 16

Local infection
Distorted anatomy
Presence of arterio-venous fistulas
Peripheral vascular disease of limb to be sampled
Severe coagulopathy or recent thrombolysis

Question 17

List 4 sampling errors that may occur in ABG sampling

Answer 17

Air in sample
Collection of venous rather than arterial blood
Improper quantity of heparin in the syringe or mixing after blood is drawn
Delay in transportation

Question 18

List 5 complications related to ABG sampling

Answer 18

Haematoma
Nerve damage
Arteriospasm/ involuntary contraction of the artery
Aneurysm of artery
Fainting/ vasovagal response