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FRCA Final > Specific diseases and anaesthesia > Flashcards

Specific diseases and anaesthesia Flashcards

1
Q

What are the criteria of the STOP BANG assessment?

A
  • S - Snoring
  • T - Tiredness during daytime, often with headache
  • O - Observed apnoeas
  • P - Pressure (HTN)
  • B - BMI > 35
  • A - Age > 50
  • N - Neck circumference > 41 cm women, > 43 cm men
  • G - Gender (male)
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2
Q

What score on STOP BANG constitutes high risk of OSA?

A

≥ 5

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3
Q

What is the AHI?

A

Apnoea / Hypnea Index. The number of apnoeas or hypnoeas lasting > 10s recorded in 1 hour.

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4
Q

What are the risk stratifications for the AHI?

A
  • ≥5 mild
  • ≥15 moderate
  • ≥30 severe
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5
Q

What constitutes a significant desaturation in OSA?

A

desaturations >4% if ≥5 in 1 hour.

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6
Q

Which features of OSA does nocturnal CPAP most improve?

A
  • CCF
  • platelet aggregation
  • dysrhythmias
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7
Q

Which features of OSA should prompt to postpone surgery and optimise?

A
  • Untreated CCF
  • Hypercapnoea with PaCO2 > 6.5
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8
Q

What is the most common and most severe muscular dystrophy?

A

Duchennes Muscular Dystrophy

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9
Q

What is the incidence of DMD?

A

1 in 3500 male LB

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10
Q

Define muscular dystrophy

A

A group of inherited disorders characterised by progressive muscle weakness without evidence of denervation

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11
Q

What are the cardiac effects of DMD?

A
  • Cardiomyopathy
  • Conduction defects
  • Heart Failure
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12
Q

What are the respiratory effects of DMD?

A

scoliosis resulting in restrictive lung defects improper secretion management recurrent chest infections Failure to wean from ventilation Respiratory muscle weakness

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13
Q

What are the neurological effects of DMD?

A

Learning disability

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14
Q

What is the typical life expectancy in DMD?

A

15-25 years

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15
Q

What is pseudohypertrophy?

A

Muscle enlargement in muscular dystrophy caused by replacement of muscle with fat and fibrous tissue

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16
Q

What are the biochemical abnormalities found in DMD?

A

Raised CK

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17
Q

What are the common operations in DMD?

A

Orthopaedic - scoliosis corrections Cardiac - angiography, valve replacement Ophthalmic - Cataracts Incidental - Dental work 2nd to low IQ

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18
Q

Why should you perform lung function tests in DMD?

A

VC less than 20ml/kg associated with increased mortality

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19
Q

List 3 acquired, non drug related causes of Long-QT

A

Subarachnoid haemorrhage Anorexia Nervosa Hypothermia

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20
Q

How do you diagnose long QT?

A

QTc greater than 440 ms

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21
Q

What is your perioperative anaesthetic management of Long QT?

A
  • Seek cardiologist opinion
  • Check electrolytes
  • Perform ECG with valsalva
  • Stop any drugs that increase QTc
  • Continue beta blockers
  • Avoid suxamethonium
  • Obtund pressor response to laryngoscopy
  • Avoid use of reversal (use sugammadex)
  • Consider transvenous pacing
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22
Q

What causes long QT?

A

Depolarisation abnormality Malfunction in cardiac ion channels

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23
Q

What is porphyria?

A

Group of disorders characterised by an inherited or acquired abnormality in the enzymes relating to haem synthesis.

24
Q

What is the pathophysiology of porphyria?

A

Failure in haem synthesis. Accumulation of porphyrins and precursors (ALA, aminolaevulinic acid, and PBG, porphobilinogen)

25
Q

Which enzyme is an important rate limiting step in porphyria?

A

ALA synthetase

26
Q

What is the incidence of porphyria?

A

1 in 20,000

27
Q

How is a diagnosis of porphyria confirmed?

A

Urinary ALA and porphobilinogen

28
Q

What are the different types of porphyria?

A

Acute Intermittent Variagate Hereditary

29
Q

Which premedication drugs are considered SAFE in porphyria?

A

NONE

30
Q

Which induction agents are considered SAFE in porphyria?

A

Propofol only

31
Q

Which maintenance agents are considered SAFE in porphyria?

A

Most volatiles Nitrous Oxide

32
Q

Which analgesics are considered SAFE in porphyria?

A

Paracetamol Aspirin Fentanyl, Alfentanyl, Morphine, Pethidine, Codeine

33
Q

Which local anaesthetics are considered SAFE in porphyria?

A

Bupivacaine Prilocaine

34
Q

Which uterotonics are considered SAFE in porphyria?

A

Oxytocin

35
Q

Define BMI

A

Body mass divided by the square of the height expressed in units of kg/m2

BMI = Mass / Height2

36
Q

What is the WHO BMI classification?

A
  • < 18.5 Underweight
  • 18.5 - 24.9 Normal
  • 25 - 29.9 Overweight
  • 30 - 34.9 Obese 1
  • 35 - 39.9 Obese 2
  • > 40 Obese 3 (previously ‘morbid obesity’)
37
Q

What is morbid obesity?

A
  • BMI > 40 or;
  • BMI > 35 with a recognised co-morbidity:
    • T2DM
    • Sleep disordered breathing
    • HTN
    • Cardiovascular disease
    • Cerebrovascular disease
38
Q

Define central obesity

A
  • Waist circumference > 88 cm in a woman
  • Waist circumference > 102 cm in a man; or
  • A waist-to-height ratio > 0.55
39
Q

What risks is OSA specifically associated with in the perioperative period.

A

OSA patients have double the incidence of:

  • postoperative desaturation
  • respiratory failure
  • postoperative cardiac events
  • ICU admission
40
Q

What is obesity hypoventillation syndrome?

A

A triad of:

  1. Obesity (BMI > 35)
  2. Sleep disordered breathing (usually OSA)
  3. Daytime hypercapnoea (PaCO2 > 6 kPa)
41
Q

What is the typical compliance with nocturnal CPAP for OSA?

A

Around 50%

42
Q

Obesity Hypoventillation Syndrome - Pathophysiology

A
  • Leptin intollerence / Resistance
  • Reduction in CO2 chemoreceptor sensitivity
  • Particularly susceptable to opiod respiratory depression
43
Q

What are the cardiovascular sequelae of obesity?

A
  • HTN
  • Increased cardiac output and cardiac work
  • Pulmonary HTN
  • CCF
  • Arrhythmias
    • 2° to sino-atrial node dysfunction and fatty infiltration of the conducting system
    • 1.5x RR for atrial fibrillation
    • increased risk of sudden cardiac death
    • increased incidence of prolonged QT interval
44
Q

Which anaesthetic drugs should be dosed on Lean Body Weight?

A
  • Induction agents
    • Propofol (induction)
    • Thiopental
    • Fentanyl
  • Non-depolarising Muscle Relaxants:
    • Rocuronium
    • Atracurium
    • Vecuronium
  • Morphine
  • Paracetamol
  • Bupivacaine
  • Lidocaine
45
Q

Which anaesthetic drugs should be dosed on Adjusted Body Weight

A
  • Propofol (infusion)
  • Antibiotics
  • Low molecular weight heparin
  • Alfentanil
  • Neostigmine (maximum 5 mg)
  • Sugammadex
46
Q

Ideal Body Weight

A

IBW = height (cm) - x

(where x = 105 in females, x = 100 in males)

47
Q

Lean Body Weight

A

The patient’s weight excluding fat. Many of the formulae for calculating lean body weight are complex but one of the most widely used is that of Janmahasatian et al.

48
Q

Adjusted Body Weight

A

ABW = IBW + 0.4 x (TBW - IBW)

Adding 40% of the excess weight to the IBW

49
Q

What is OS-MRS?

A

Obesity Surgery Mortality Risk Stratification

  1. BMI > 50 kg.m-2
  2. Male
  3. Age > 45 years
  4. Hypertension
  5. Risk factors for pulmonary embolism
    • Previous VTE
    • Venocaval filter
    • Sleep disordered breathing
    • Pulmonary HTN
50
Q

What is the mortality for OS-MRS?

A
  • Class A: 0-1 points: 0.2-0.3%
  • Class B: 2–3 points: 1.1-1.5%
  • Class C: 4–5 points: 2.4-3%
51
Q

What are the main benefits of a pre-operative discussion in bariatric surgery?

A
  • Promote smoking cessation
  • Stress importance of VTE-prophylaxis and early mobilisation
  • Plan management of medication before admission
  • Remind patients to bring their own CPAP machine
  • Commense “Liver Shrinking” diet
  • Ensure CPAP adherance
52
Q

What collar size is associated with a difficult airway?

A

> 60 cm

53
Q

How much epidural catheter should be left in the space in bariatric cases

A

At least 5 cm to prevent catheter migration

54
Q

Why might suxamethonium be a bad idea in bariatric cases?

A

Suxamethonium associated fasciculations increase oxygen consumption and have been shown to shorten the safe apnoea time. It is unlikely to wear off before profound hypoxia occurs.

55
Q

List some general techniques to deliver a “Safe Sleep-Disordered-Breathing Anaesthetic”

A
  • Avoid GA/Sedatives where possible
  • Use short acting agents
  • Use DoA monitoring to limit anaesthetic load
  • Use neuromuscular monitoring to ensure complete reversal of block before waking
  • Maximal use of local anaesthetic and multimodal opioid sparing analgesia
  • Maintain head–up position throughout recovery
  • Monitor of oxygen saturations until mobile
  • Reinstate CPAP early
56
Q

Which surgical fluids are considered safe in porphyria?

A

Glycine

57
Q

Describe the basic pathophysiology of Acromegaly

A
  • eosinophilic adenoma
  • growth hormone production

FRCA Final (21 decks)

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