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Anaesthesiology > Pre-operative > Flashcards

Pre-operative Flashcards

1
Q

In regards to airway assessment, what 5 things would make it difficult to mask ventilate a patient?

A 
-We use the acronym BONES
B- beard
O-obesity
N-no teeth
E-elderly
S-snoring
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2
Q

What conditions would make it difficult to intubate a patient?

A

The 4 D’s

  • disproportion-macroglossia(big tongue), macrognathia(small chin)
  • dysmobility-fixed cervical spine
  • distortion-airway trauma
  • dentition-passion gap, buck teeth
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3
Q

How do we do the mallampati score?

A
  • patient sitting upright with head in neutral position

- patient to open mouth

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4
Q

What is the thyromental distance?

A
  • The thyromental distance is the distance between the patients chin (with the neck extended) to the thyroid notch
  • anything less than 6 cm means that the patient will have a difficult intubation
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5
Q

How do we check that spontaneous breathing has been achieved pre-operatively using effective mask ventilation?

A
  1. check for adequate chest rise
  2. absence of tracheal tug and accessory muscle use
  3. inspection of the reservoir bag attached to the breathing circuit
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6
Q

What are some of the advantages of tracheal intubation?

A
  1. guaranteed airway
  2. effective positive pressure ventilation
  3. prevention of aspiration
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7
Q

What size endotracheal tubes do we use for men and women?

A
  1. male-7,5mm to 8mm

2. female-7,0mm to 7,5mm

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8
Q

How do you calculate endotracheal tube sizes in children?

A

(age/4) plus 4

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9
Q

How can we ensure that the endotracheal tube is at the correct place/length?

A
  • We can ensure by checking with an X-ray

- We can use auscultation to check

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10
Q

What do you need to do before you fully extubate a patient?

A

-ensure that the patient is not “light” because this can cause laryngospasm

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11
Q

What do we need to do to washout nitrous oxide?

A

-High flow oxygen with air for at least 1-2 minutes

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12
Q

What should you do if a patient experiences laryngospasm upon extubation?

A

-You should provide CPAP( continuous positive airway pressure, give 25mg of suxamethenonium and reintubate

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13
Q

What are the complications of extubation?

A
  1. hoarseness and sore throat
  2. oedema of the trachea and larynx
  3. tracheal stenosis
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14
Q

Does LMA protect you from aspiration?

A

No it does not

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15
Q

What are the drugs we can consider pre-operatively?

A
  • midazolam
  • lorazepam
  • diazepam
  • ketamine
  • flumazenil
  • benzodiazepine antagonist
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16
Q

When do we give midazolam pre-operatively?

What is the dosage?

A
  • 30 minutes prior
  • 7,5mg to 15mg(orally)
  • 0,01-0,05 IV
17
Q

If someone is allergic to penicillin what would be the alternatives?

A

-clindamycin and erythromycin

18
Q

How many centimeters should we expect the patient’s mouth to be open by?

A

should not be less than 2-2.5cm

19
Q

How long should the patient remain nil per os?

A

8 hrs- big meal with fat and protein
6 hrs- food, formula milk
4 hrs- breast milk
2 hrs- clear fluids, apple juice, dextrose containing fluid

20
Q

What are the characteristics of ASA 1 and 2?

A

ASA 1- healthy patient that does not smoke or drink
ASA 2- healthy patient that occasionally drinks and smokes, has well controlled DM or DM and has a BMI of between 30 and 40(mild systemic conditions)

21
Q

What are the characteristics of ASA 3 and 4?

A

ASA 3- severe systemic conditions- MI in the more than 3 months, CVA, TIA, uncontrolled DM and HPT, active hepatitis, alcohol abuse
ASA 4- patient with life threatening systemic disease: patient not undergoing scheduled dialysis, <3 months MI, TIA, CVA, cardiac disease or stents

22
Q

What are the characteristics of ASA 5 and 6?

A

ASA 5- moribund patient that would die without the operation(example being abdominal aortic aneurysm rupture, massive trauma, intracranial bleed with mass effect
ASA 6- patient brain dead and harvested for organ donation

23
Q

What are some indications for doing a spinal over general anaesthesia?

A
  1. the op is less than 2 hours
  2. the patient has easy airway access
  3. the op is below the umbilicus
  4. no major blood loss
24
Q

What are some aspiration risks?

A
  • decreased lower oesophageal sphincter tone
  • increased gastric pressure
  • delayed gastric emptying
  • defective laryngeal protective reflexes
25
Q

What are the causes of delayed gastric emptying?

A
  • pain
  • diabetes
  • active labour
  • opiates
  • anticholinergics
26
Q

What are the causes of increased gastric pressure?

A
  • pregnancy
  • diabetes
  • not nil per os
  • ascites
  • obesity
27
Q

What are the causes of decreased oesophageal sphincter tone?

A
  • achalasia
  • gastro-oesophageal reflux history
  • caffeine and alcohol
  • pregnancy
  • obesity
28
Q

What are the characteristics of the laryngeal protective reflexes?

A
  • GCS <8/15

- CEREBRAL PALSY, parkinsons, multiple sclerosis, myopathies

Anaesthesiology (25 decks)

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