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Acute Care > Preparing a patient for theatre and perioperative care > Flashcards

Preparing a patient for theatre and perioperative care Flashcards

1
Q

Treatment for LA toxicity?

A

Intralipid

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2
Q

Symptoms of LA toxicity?

A
  • 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.
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3
Q

Name the two main categories of anaesthesia

A
  • 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).
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4
Q

When is the risk of aspiration the highest during GA?

A
  • Before and during intubation.
  • Extubation.
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5
Q

What is the ASA classification?

A

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.
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6
Q

How to reduce the chance of post operative N+V?

A
  • Using regional anaesthesia.
  • Use of > 1 anti-emetic.
  • Use of total intravenous anaesthesia (TIVA).
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7
Q

What is awareness under general anaesthesia?

A
  • 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.
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8
Q

What can be used to test if the regional anaesthesia has worked?

A

Cold spray

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9
Q

Management for a difficult airway

A
  • Tracheal intubation.
  • Supraglottic airway device.
  • Facemask ventilation.
  • Cricothyroidotomy.
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10
Q

What are the maximum doses for LA?

A
  • 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)
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11
Q

Is Bupivacaine used with adrenaline?

A

No - only Lignocaine or Prilocaine.

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12
Q

Why is adrenaline added to LA?

A

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).

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13
Q

What is the dose of Bupivacaine?

A

2mg/kg

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14
Q

MOA of Lidocaine?

A

Blockage of sodium channels

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15
Q

Hypertrophic vs. Keloid scar

A
  • 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.

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16
Q

What is the management for an anastomotic leak?

A

Emergency surgery

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17
Q

Which drug should be used with caution in patients with a pneumothorax?

A

Nitrous oxide

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18
Q

Which anaesthetic doesn’t cause a drop in BP, so is useful in trauma?

A

Ketamine

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19
Q

What is the MOA of ketamine?

A

Blocks NMDA receptors

20
Q

What is the MOA of propofol?

A

Potentiates GABA-A

21
Q

Which anaesthetic has some anti-emetic effects, so useful for patients at risk of post-op N+V?

A

Propofol

22
Q

Which anaesthetic may cause malignant hyperthermia?

A

Volatile liquid anaesthetics e.g. isoflurane, desflurane, sevoflurane.

23
Q

What is the muscle relaxant of choice for rapid sequence induction for intubation?

A

Suxamethonium

24
Q

Name 2 adverse effects of depolarising neuromuscular blocking drugs

A
  • Malignant hyperthermia
  • Hyperkalaemia (normally transient)
25
Q

A 67-year-old female undergoes an oesophagogastrectomy for carcinoma of the distal oesophagus. She complains of chest pain. The following day there is brisk bubbling into the chest drain when suction is applied.

A

Air leak

26
Q

A 20-year-old man has a protracted stay on ITU following a difficult appendicectomy for perforated appendicitis with pelvic and sub phrenic abscesses. He has now deteriorated further and developed deranged liver function tests.

A

Portal vein thrombosis

27
Q

A 63-year-old man undergoes an Ivor - Lewis oesophagogastrectomy for carcinoma of the distal oesophagus. The following day a pale opalescent liquid is noted to be draining from the right chest drain.

A

Chyle leak

28
Q

Abdominal pain, bloating and vomiting following bowel surgery?

A

Postoperative ileus

29
Q

A 22-year-old lady undergoes a total thyroidectomy for Graves disease. 6 hours post operatively she develops respiratory stridor and develops a small haematoma in the neck

A

Immediate removal of skin clips on ward

30
Q

A 44-year-old lady undergoes a total thyroidectomy for recurrent multinodular goitre. 3 days post operatively she is still troubled by a hoarse voice.

A

Laryngoscopy

31
Q

A 48-year-old lady undergoes a redo thyroidectomy for a multinodular goitre. 24 hours post operatively she develops oculogyric crises and diffuse muscle spasm.

A

Intravenous calcium

32
Q

Which anaesthetic agent is associated with hepatotoxicity?

A

Halothane

33
Q

A patient is on 30mg of modified-release morphine every 12 hours, what is the correct breakthrough dose?

A

10mg

34
Q

What can be used to measure accidental oesophageal intubation?

A

Capnography

35
Q

Outline the causes of post-op pyrexia

A

Early causes of post-op pyrexia (0-5 days) include:

  • Blood transfusion
  • Cellulitis
  • Urinary tract infection
  • Physiological systemic inflammatory reaction (usually within a day following the operation)
  • Pulmonary atelectasis - this if often listed but the evidence base to support this link is limited

Late causes (>5 days) include:

  • Venous thromboembolism
  • Pneumonia
  • Wound infection
  • Anastomotic leak

When considering causes of post-op pyrexia, it is helpful to consider the memory aid of ‘the 4 W’s’ (wind, water, wound, what did we do? (iatrogenic).

36
Q

Which airway provides poor control against reflux of gastric contents therefore is unsuitable in non fasted patients?

A

Laryngeal mask airway (LMA)

37
Q

Treatment for post-op hypovolaemia?

A

500ml 0.9% normal saline fluid challenge

38
Q

Name one complication of poor post-operative pain management

A

Pneumonia

39
Q

Suxamethonium can cause…

A

Malignant hyperthermia

40
Q

What is the muscle relaxant used for rapid sequence induction for intubation?

A

Suxamethonium

41
Q

Capnography can be used to detect…

A

Accidental oesophageal intubation

42
Q

What are the 3 phases of the WHO surgical safety checklist?

A

1) Before the induction of anaesthesia (sign in)
2) Before the incision of the skin (time out)
3) Before the patient leaves the operating room (sign out)

43
Q

Which diabetes drugs can be continued on the day of surgery?

A
  • DDP 4 inhibitors (gliptins)
  • GLP-1 analogues (tides)
44
Q

Which anaesthetic has inherent anti-emetic properties?

A

Propofol

45
Q

What are the post-operative causes of pyrexia?

A

Post operative pyrexia (5 W’s):

  • Day 1 - wind: atelectasis.
  • Day 3 - water: UTI.
  • Day 5 - wound: site infection.
  • Day 7 - walking: DVT/PE.
  • Anytime - wonder drugs: adverse drug reaction.
46
Q

Name one side effect of etomidate

A

Adrenal supression

47
Q

What is required prior to surgery for patients taking prednisolone?

A

Hydrocortisone supplementation

Acute Care (7 decks)

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