Pre-Op Care

Question 1

anaesthetic fitness assessment scale?

Answer 1

ASA

Question 2

when to stop warfarin before surgery?

Answer 2

5 days prior

Question 3

what to do if stopping warfarin in high-risk patients?

Answer 3

LMWH or unfractionated heparin used as a bridge

Question 4

who is a high risk warfarin patient?

Answer 4

mechanical heart valve

recent VTE

Question 5

when to stop DOACs before surgery

Answer 5

48 hours prior

Question 6

when to stop clopidogrel before surgery?

Answer 6

7 days prior

Question 7

when to stop OCP

Answer 7

4 weeks prior to surgery

Question 8

NSAIDs in surgery

Answer 8

withheld

Question 9

steroids in surgery

Answer 9

add IV hydrocortisone

double dose once eating and drinking post

Question 10

ACEI/ARBs on day of surgery

Answer 10

stop on day due to risk of profound hypotension

Question 11

PPIs/H2RAs

Answer 11

given on day

offer to BMI >30

Question 12

what has to be present to have capacity?

Answer 12

understand
retain
weigh-up
communicate

Question 13

consent form types

Answer 13

• Consent form 1= patient consenting to procedure
• Consent form 2= parental consent on behalf of a child
• Consent form 3= where the patient won’t have consciousness impaired
• Consent form 4= where the patient lacks capacity

Question 14

HbA1c before surgery

Answer 14

<69 before elective surgery

Question 15

triad of balanced anaesthesia

Answer 15

depress consciousness
block painful stimuli
relax skeletal muscle

Question 16

two ways to give anaesthetic

Answer 16

IV

inhalation

Question 17

fasting requirements prior to surgery

Answer 17

no food 6 hours prior

sips of water for 2 hours prior

Question 18

IV hypnotic agents

Answer 18

propofol (GABA mediated)

ketamine (NMDA)

Question 19

inhaled hypnotic agents

Answer 19

sevoflurane
desflurane
NO

Question 20

risks of hypnotic agents

Answer 20

sore throat
PONV
accidental awareness
aspiration
dental injury
anaphylaxis
cardio
malignant hyperthermia (dantrolene)
death

Question 21

depolarising muscle relaxants

Answer 21

suxamethonium

Question 22

action of suxamethonium

Answer 22

hyper-stimulates NMJ

used in RSI

Question 23

non-depolarising muscle relaxants

Answer 23

rocuronium

atracurium

Question 24

action of non-depolarising

Answer 24

competitive antagonists of ACh at NMJ

Question 25

how to reverse muscle relaxants

Answer 25

neostigmine

Question 26

what does an epidural contian?

Answer 26

levobupivacaine +/- fentanyl

Question 27

local anaesthetic options

Answer 27

lidocaine
cocaine
levoprovacaine

Question 28

how to reverse local anaesthetics

Answer 28

intralipid

Question 29

action of ketamine

Answer 29

non-competitive antagonism of NMDA receptor

Question 30

action of clonidine

Answer 30

alpha 2 receptor agonist

Question 31

when to avoid metoclopramide

Answer 31

females <60 as can cause oculogyric crisis

Question 32

difficult airway progression

Answer 32

1. Laryngoscopy and tracheal intubation
2. Supraglottic airway device
3. Face mask ventilation
4. Cricothyroidotomy