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Year 6 > Surgery and anaesthesia > Flashcards

Surgery and anaesthesia Flashcards

1
Q

How long do you have to be fasted before surgery

A

6hrs solids
2 hrs liquids including black coffee and tea without milk

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2
Q

How long do you have to stop COCP before surgery

A

4 weeks

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3
Q

Which Diabetic drugs need to be modified for surgery

A

Metformin- normal- but omit lunch dose if TDS
Sulphonylureas- if morning omit morning, afternoon, both
SGLT2- omit on day

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4
Q

DVT prophylaxis

A

 Low risk: early mobilisation

 Med: early mobilisation + TEDS + 20mg enoxaparin 2 hrs pre

 High: early mobilisation + TEDS + 40mg enoxaparin 12 hours pre surgery

Avoid in eGFR <15

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5
Q

ASA grades

A

1- normal
2- mild systemic disease
3- severe- limits
4- systemic this a constant threat
5- not expected to survive in 24 hrs

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6
Q

Insulin changes for surgery

A

Reduce long acting by 20% night before and day of
Omit other insulin
Start sliding scale
Continue until tolerating food

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7
Q

Risks of steroids during surgery

A

Poor wound healing
Infection
Adrenal crisis

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8
Q

Stopping warfarin and DOACs before surgery

A

Warfarin 5days bridge with LMWH
DOACs- 2 days

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9
Q

Drugs used in anaesthesia

A

Induction- propofol
Muscle relaxant- suxamethonium- depolarising
Vecuronium- non
Maintain- halothane

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10
Q

Sx of malignant hyperpyrexia

A

Complication of suxamethonium or sevoflurane

Rise in temp and masseter spasm

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11
Q

Tx of malignant hyperpyrexia

A

Dantrolene and cooling

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12
Q

VTE prophylaxis after surgery

A

LMWH 6-12/ Fondaparinux 6 hours after surgery

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13
Q

Cause of post op fever and their time line

A

Day 1-2 - wind- pneumonia, PE
3-5 water- UTI
5-7 wound - surgical site
5+ walking- DVT

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14
Q

Types of IV access

A

Peripheral- large 14G if emergency, small 20G if not

Hickman- long term - 3 lumens- better for chemo

PICC-2 cannulas

Swanz gauz- in heart measure pressure

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15
Q

ASA levels

A

1- normal
2- smoker, mild disease
3- substantial disease
4- severe
5- moribund

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16
Q

Alcoholics requirement for anaesthesia and post surgery seizure

A

Often require larger doses of induction agent

IV lorazepam for seizure IV 4mg

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17
Q

If raised ICP in ICU what factors can you do

A

Mannitol
Raise head to 30
Increase RR to hyperventilate

18
Q

If low BP after propofol induction what should you start

A

Metaraminol

19
Q

Why do you apply cricoid pressure

A

Occludes upper oesophagus
Prevents passive reflux

20
Q

Induction given with no chest movements what are the next steps

A

Insert OPA
Then once neuromuscular blockade given
Intubate

21
Q

Suxamethonium affects on electrolytes

A

Hyperkalaemia

22
Q

Rapid sequence induction steps

A

Preoxygenate- 5 min
Paralysis- induction and paralysing agent
Protection- cricoid pressure
Placement- intubation

23
Q

If patient with stent from MI what do you do regarding stopping medications

A

Speak to cardiology
AS stopping may cause stenosis

24
Q

Analgesia for rib fratures

A

Transversus abdominal plane block

25
Q

How to change steroids before surgery

A

Long term
Increase HC
Stop FC
Start again 48-72 hours post op if eating and drinking

26
Q

Mx of spasmodic pain

A

Diazepamm

27
Q

Mx of lactate acidosis after surgery

A

Fluid bolus
Can be caused by metformin

28
Q

Local anaesthesia toxicity sx

A

Numbing
Tinnitus
Dizziness

29
Q

Diabetic drugs and surgery

A

Metformin- if 3 omit lucch
sulph-omit morning

Gliptins, GLP- take normal

SGLT2- omit on surgery

30
Q

Prescribing fluid

A

30ml/kg/day
Calculate fluid deficit and add it on

31
Q

BMI ASA grading

A

30-40 ASA 2
>40- ASA 3

32
Q

If on prednisolone and about to have surgery what do you prescribe

A

Hydrocortisone

33
Q

End stage renal disease with dialysis ASA

A

3

34
Q

What goes in ASA 4

A

Recent MI, stroke, severe valve disease, end renal disease with no dialysis

35
Q

SE of etomidate

A

Adrenal suppression

36
Q

Inducing agent in haemodynamically unstable patients

A

Ketamine

37
Q

T2DM on gliclazide with HbA1c of 70 for morning surgery, what do you do

A

Omit morning gliclazide
VRII- since above 69

38
Q

Inheritance of malignant hyperthermia

A

AD

39
Q

When is suxamethonium CI

A

Eye injuries
Glaucoma
Since increases IOP

If hyperkalaemic

40
Q

When to do tracheostomy instead of ETT

A

Severe upper airway obstruction

Year 6 (28 decks)

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