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AH2 > Pre/Intra/Post Op Management > Flashcards

Pre/Intra/Post Op Management Flashcards

1
Q

Anaesthetic airway examination (LEMON)

A 
Look - obesity, open mouth
Evaluate - 3-3-1 rule, mouth opening, anterior jaw subluxation, thyromental distance 
Mallampati score (view of uvula)
Obstruction - FB, stridor
Neck mobility
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2
Q

ASA Grading

A

1 - normal and healthy
2 - mild systemic disease
3 - moderate to severe systemic disease causing some functional limitation
4 - severe systemic disease, constant threat to life, functionally incapacitating
5 - moribund patient, not expected to survive 24hrs
6 - brain dead

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3
Q

Pre op Ix

A 
bHCG
ECG
BGL
FBC
UEC CMP
LFT
group and hold + cross match
coagulation screen
CXR & spirometry if resp disease present
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4
Q

Drugs to stop before operations

A

CHOW
clopidogrel and other antiplatelets - 7 days prior
hypoglycemics (oral) - insulin sliding scale instead
OCP - 4 weeks before
warfarin - stop 5 days before
NOACs - stop 24-48hrs before

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5
Q

Drugs to start before/just after surgery

A

TED stockings
LMWH or UFH
Antibiotics - usually cefazolin and metronidazole

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6
Q

CI for mechanical VTE prophylaxis

A

severe PVD or ulcers
peripheral arterial bypass graft
severe leg oedema or pulmonary oedema
severe local disease ie infection

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7
Q

CI for pharmacological VTE prophylaxis

A

active major bleeding or recent bleed (<48hrs)
already anticoagulated
low platelets
bleeding disorder
recent stroke/TBI/tumour/bleed
conditions with bleeding risk eg peptic ulcer

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8
Q

VTE prophylaxis post op

A

non pharm - TEDs, intermittent pneumatic compression, early mobilisation, hydration

pharm - enoxaparin 40mg subcut OR NOAC eg rivaroxiban OR heparin 5000 units BD

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9
Q

Anaesthetic types for surgery

A 
General 
Regional block
Local block
Topical
Sedation
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10
Q

Insertion of ETT

- location, confirming placement, complications

A

Location - 2cm above carina
Placement - visualise it passing through cords, CO2 exhaled gas, auscultate chest, bilateral chest wall expansion, no abdominal distension
Complications - dental damage, laceration, laryngeal trauma, oesophageal intubation, aspiration, bronchospasm

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11
Q

Anaesthetic induction agents

A

propofol
ketamine
benzodiazepine
sodium thiopental

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12
Q

General post operative care (acute and long term)

A

Analgesia
Chest physio
VTE prophylaxis
Encourage moving and feeds

long term:
4-6 weeks to recover 
avoid heavy lifting 
keep site clean and covered 
F/U about 6 weeks
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13
Q

Consequences of poorly controlled pain

A

slower recovery - less likely to mobilise

increased complications - cannot breathe deeply –> atelectasis –> HAP

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14
Q

WHO analgesic ladder

A
  1. paracetamol +/- NSAIDs
  2. oral opioid - paracetamol and codeine
  3. opioids IV or subcut (add motility agent) - morphine or fentanyl
  4. contact anaesthetist
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15
Q

Positives and negatives of patient controlled analgesia (PCA)

A

Positive - tailored to individual requirement, controlled release (safe), accurate recording of how much is being administered

Negatives - prevents patient mobilising, can’t be used in those with poor manual dexterity or learning difficulties

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16
Q

Septic sources on surgical wards (5Cs)

A 
chest infection 
cut - wound infection 
catheter 
collections - abscess
cannula and central line
17
Q

Types of post op bleeding in regards to time periods

A

primary - intra operative
reactive - within 24 hours of op
secondary - erosion of vessel due to spreading infection

18
Q

Mx of tension haematoma post neck surgery

A

DRS - call surgeon, MET call
A - decompress by removing sutures and suction haematoma
B - 15L non rebreather O2
C - theatre for haemostats, IVF, IV blood products

19
Q

Complications of post operative nausea and vomiting (PONV)

A 
aspiration pneumonia
low K and Na
metabolic alkalosis
suture dehiscence
bleeding
incisional hernia
20
Q

Causes of PONV

A 
pain
infection 
metabolic - uremia, electrolyte disturbance, DKA
post op ileum or bowel obstruction 
increased ICP
medications
21
Q

Causes of post op fever (5Ws)

A

<1 day - usually physiological and benign

post op day 1-2 (wind) - lung source, atelectasis, aspiration, pneumonia

POD 3-5 (water) - UTI

POD 5-7 (wound) - surgical site infection, IV line, superficial and deep abscess

POD 8+ (walk) - DVT and PE

Anytime (what did we do) - anastomotic leak, antibiotics, prosthesis, CNS infection, drug and transfusion reaction

22
Q

Risk factors for anastomotic leak

A

surgical - emergency, long intra op time, oesophageal gastric and rectal anastomosis, ischaemia at suture line

patient - DM, immunosuppression, obesity, smoking, alcohol

23
Q

Risk factors for paralytic ileus

A

patient - elderly, electrolyte derangement, opioids, anticholinergics, fluid overload

surgical - pelvic and abdo surgery, intestinal resection, handling bowel in operation, peritonitis

24
Q

Causes of post operative oliguria

A

pre renal - hypovolemia (haemorrhage, dehydration)
renal - pre existing renal disease, ATN
post renal - blocked catheter, damage to ureters

25
Q

What is gastric dumping syndrome

A

complication of gastric bypass surgery

early - excessive amount of hypertonic food in SI –> fluid shift into lumen –> distention, osmotic diarrhoea

late - excess sugar in SI –> excessive insulin spike –> low BGL

26
Q

Components of crystalloid fluids - Hartmann’s, NSaline, dextrose

A

Hartmann’s - Na, K, Ca, Cl, lactate, doesn’t cause metabolic acidosis, used in maintenance

NSaline - NaCl, causes NAGMA, used in resuscitations

Dextrose (D5W) - glucose rapidly taken up by cells, causes dilutional hyponatremia

27
Q

Crystalloids vs colloids

A

crystalloids:

  • electrolytes with no macromolecules
  • IV and ISF
  • NS, Hartmann’s, D5W

Colloids:

  • protein and non protein colloids
  • IV only
  • used in TBI
28
Q

Calculating daily fluid requirement

A

replace fluid deficit (250-500ml fluid challenge then reassess) + maintenance rate (weight + 40ml/hr) x 24hrs + replace losses

29
Q

Calculating maintenance fluid rates

A

4:2:1 rule for crystalloids:
4ml/kg/hr for 1st 10kg
2ml/kg/hr for 2nd 10kg
1ml/kg/hr for every extra kg

OR
weight + 40ml/hr (ideal weight if obese)
eg 70kg + 40ml = 110ml/hr = 2.6L/day

30
Q

Amount of K and Na required / day in mmol/kg

A

K = 1mmol/kg/day

Na = 2mmol/kg/day

how to remember: Na has 2 letters, therefore 2 mmol

31
Q

Indications for blood transfusion

A

Hb <70
Hb <80 and symptomatic

acute blood loss of >1,500 mL or 30% of blood volume

32
Q

Causes of post operative delirium

A

Infection - sepsis, chest, cut (surgical site), cannula, collection, catheter, central line

Withdrawal from alcohol

Acute metabolic disturbance - hypoglycaemia, hypercalcemia, hyponatremia

CNS - ↑ICP, stroke

Hypoxemia

Acute vascular events

Toxins & drugs - anaesthetics, ketamine, anticholinergics, opioids

Pain - including urinary and faecal retention

33
Q

General surgical complications to counsel patient on pre operatively

A

surgical

  • infection
  • haemorrhage
  • adverse reaction to anaesthetic
  • atelectasis and pneumonia
  • MI and stroke
  • DVT and PE
  • death

anaesthetic

  • n&v
  • dizziness
  • headache
  • hypersensitivity reaction
  • aspiration
  • DVT/PE

AH2 (5 decks)

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