Preparing a patient for theatre and perioperative care Flashcards
Treatment for LA toxicity?
Intralipid
Symptoms of LA toxicity?
- Initial: agitation, confusion, dizziness, drowsiness, dysphoria, auditory changes, tinnitus, perioral numbness/tingling, metallic taste, and dysarthria.
- Progression if not recognised early: seizures, respiratory arrest, and/or coma.
Name the two main categories of anaesthesia
- General anaesthesia: making the patient unconscious. Patient will be intubated or have a supraglottic airway device, and their breathing will be controlled by a ventilator.
- Regional anaesthesia: blocking feeling to an isolated area of the body (e.g. a limb).
When is the risk of aspiration the highest during GA?
- Before and during intubation.
- Extubation.
What is the ASA classification?
The American Society of Anesthesiologists (ASA) physical status classification system is a grading system to determine the health of a person before a surgical procedure that requires anaesthesia.
- ASA I: person in good health (e.g. healthy, non-smoking, no or minimal alcohol use).
- ASA II: mild but well-managed or treated condition (e.g. current smoker, social alcohol drinker, pregnancy, obesity (BMI 30 - 40), well-controlled Diabetes Mellitus/Hypertension, mild lung disease).
- ASA III: serious condition that has an impact on a person’s overall health (e.g. poorly controlled Diabetes Mellitus/Hypertension, COPD, morbid obesity (BMI > 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, End-Stage Renal Disease (ESRD) undergoing regularly scheduled dialysis, history (>3 months) of Myocardial infarction, Cerebrovascular accidents).
- ASA IV: severe condition that’s life-threatening (e.g. (< 3 months) of Myocardial infarction, Cerebrovascular accidents, ongoing cardiac ischaemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis).
- ASA V: life-threatening condition that needs immediate surgery to increase survival odds (e.g. ruptured abdominal/thoracic aneurysm, massive trauma, intra-cranial bleed with mass effect, ischaemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction).
- ASA VI: deceased person who is an organ donor.
How to reduce the chance of post operative N+V?
- Using regional anaesthesia.
- Use of > 1 anti-emetic.
- Use of total intravenous anaesthesia (TIVA).
What is awareness under general anaesthesia?
- When the patient becomes conscious during a general anaesthetic and can remember things that happened. Can lead to significant psychological sequelae, including anxiety, depression, and post-traumatic stress disorder.
- It occurs when the depth of anaesthesia is inadequate to achieve a state of unconsciousness.
What can be used to test if the regional anaesthesia has worked?
Cold spray
Management for a difficult airway
- Tracheal intubation.
- Supraglottic airway device.
- Facemask ventilation.
- Cricothyroidotomy.
What are the maximum doses for LA?
- Lignocaine 1% plain - 3mg/ Kg - 200mg (20ml)
- Lignocaine 1% with 1 in 200,000 adrenaline - 7mg/Kg - 500mg (50ml)
- Bupivicaine 0.5% - 2mg/kg- 150mg (30ml)
Is Bupivacaine used with adrenaline?
No - only Lignocaine or Prilocaine.
Why is adrenaline added to LA?
It causes vasoconstriction, prolonging the duration of action at the site of injection and permits usage at higher doses (e.g. Lignocaine with adrenaline is 7mg/kg, but Lignocaine on its own is 3mg/kg).
What is the dose of Bupivacaine?
2mg/kg
MOA of Lidocaine?
Blockage of sodium channels
Hypertrophic vs. Keloid scar
- Hypertrophic: confined to the extent of the wound itself. They may go on to develop contractures.
- Keloid: extend beyond the limits of the incision/boundary of original injury.
Both have excessive amounts of collagen.
