Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Surgery > Surgical Basics + Anaesthetics > Flashcards

Surgical Basics + Anaesthetics Flashcards

1
Q

List 6 methods of preventing Post-op DVT

A

Pre op mobilisation

Post op mobilisation

Graduated compression/ Anti-embolism stockings

Intra-operative intermittent calf compression

Maintain hydration

Stop pro-thrombotic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Compare effectiveness of;

  • LMWH started within 12hrs of finishing surgery
  • LMWH started before surgery

Suggest 2 reasons why this may be? (Need to check if these are true)

A

Just as effective

  • Reduced renal blood flow in 3day post-op phase, so in both cases les heparin is being excreted
  • Half life of 2hrs, so steady state reached at 10-12hrs after starting LMWH. Heparin is stopped before surgery anyway. (24hrs, 12 if prophylactic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why must 4hrs have passed since epidural insertion, before administering LMWH?

(Some sources say 2hrs after removal)

A

Risk of Epidural or Spinal Haematoma
Bleeding into spinal canal can cause Spinal Cord Ischaemia, Parapelgia

(Risk also present with removal of epidural catheter)

(Insertion of epidural catheter should be delayed until anticoagulant effect of medication is minimal: Usually 8–12 hrs after a SC dose of heparin or a BDS prophylactic dose of LMWH, or at least 18 hrs after an ODS prophylactic dose of LMWH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Who is eligible to give blood

A

Fit and healthy

Between 50 and 158kg

Between 17 and 66 (70 if given blood before)

Over 70, if given full blood donation in last 2 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How often can blood be given

A

Men- every 6wks

Women- every 12wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Who can’t give blood

A

Possible HIV, HTLV or Hepatitis

Previously had Syphilis, even if treated

Ever injected/ been injected with drugs (may be able to if prescribed)

Taking Pre-Exposure or Post-Exposure Prophylaxis (PrEP or PEP)

People who have had a transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is blood regularly checked for before being sent to blood bank?

Other than blood type

A

Syphilis, HIV, Hep B, Hep C, Hep E

HTLV (Human T-lymphotropic Virus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List some additional tests that may be done on blood being given for donation

A

Malaria, T-Cruzi (Can cause Chagas disease)
WNV, West Nile Virus, CMV
Non-specific reactivity (doesn’t affect donor’s health)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How long does a full cross match of blood take?

A

45mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How long can you wait after eating and drinking for anaesthetic administration

A

6-8hrs food, 2 hrs clear fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Outline Rapid Sequence Induction, RSI

Used if an emergency surgery needed on someone who isn’t starved

A

Anaesthetic agent as uscle relaxant

ODP presses on Cricoid cartilage to prevent reflux

Anaesthetist puts in ET tube and blows up balloon so that refluxed food doesn’t go beyond pharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which vasopressor is commonly used to manage sepsis

A

Noradrenaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define septic shock

A

Lactate >4mM
Systolic = 90mmHg, not responsive to IV fluids

OR

MAP <70mmHg, not responsive to IV fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How long can RBCs be stored in refrigerator and freezer

A

42 days fridge, 10yrs freezer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Fresh Frozen Plasma (FFP) used for?

(Can be used to prepare Cryoprecipitate, contains Clotting Factors)

How long can it be stored in freezer

A

To provide coagulation factors or treat shock due to plasma loss (Burns or bleeding)

1yr in the freezer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Concentrate of platelets

How long can it be stored at room temp (Only stored this way)

A

To treat/ prevent bleeding due to low platelet levels

5 days at room temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Cryoprecipitate used for?

How long can it be stored in freezer

(Contains Fibrinogen and Factor VIII)

A

To treat fibrinogen deficiency (Given with Frozen Plasma, to absorb Coag factors)

1yr in freezer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When does the ABO blood group develop in a new-born

A

After 3mths of life, due to lack of immune system and antigenic exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How long should a blood transfusion take?

A

A couple hours, maximum 4 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define a massive blood transfusion

A

Replacement by transfusion of 10 units of RBCs in 24hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List 5 Acute Transfusion Reactions

A

Acute Haemolytic Transfusion reaction (Fever, Chills, HypoT, TachyC, Flank pain, Haemoglobinuria)

  • Anaphylaxis
  • Urticarial reaction (Only urticaria)
  • Febrile non-haemolytic transfusion reactions (Idiopathic >1 degree temp. rise)

TRALI (Dyspnea, Hypoxia, non-Cardiogenic pulmonary oedema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can TRALI be confused for?

A

TACO- Transfusion associated circulatory overload

Biggest cause of death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How can pts’ Hb be optimised before surgery

A
  • Oral iron
  • EPO
  • Consider stopping antiplatelets/ coagulants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

List some blood alternatives

A

Iron (Supplements, Diet, IV iron)

EPO/ ESAs (Erythropoiesis Stimulating Agents)

PAD (Preoperative Autologous Blood Donation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

If normal renal function, Hhow long should pt not take DOACs prior to;

  • Surgery with low bleeding risk
  • Surgery with high bleeding risk
A

Low risk: 24hrs

High risk: 48hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Compare Colloids to Crystalloids

A

Crystalloids: Smaller molecules, Immediate fluid resuscitation, may cause Oedema

Colloids: Increase Oncotic Pressure, More costly, Can cause Anaphylaxis, AKI, Clotting disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Outline the 4 stages of blood loss

A

1: Upto 750ml
2: Upto 1.5L
3: Upto 2L
4: >2L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

List 3 general transfusion complications

A

Clotting abnormalities (Dilution effect as packed RBCs don’t have clotting factors)

Electrolyte abnormalities (Low Ca or High K)

Hypothermia (Monitor core body temp)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How can clotting abnormalities be prevented after transfusion?

A

Fresh Frozen Plasma and Platelets should be given, usually if >4 units of RBCs

30
Q

List 3 Delayed Complications of Transfusion

Delayed transfusion is becoming more common

A

Infection (Hep B/C, HIV, Syphilis, Maria, vCJD)

Graft vs Host Disease, GvHD (HLA Mismatch)

Fe Overload (Repeated transfusions)

31
Q

Outline Transfusion Associated Circulatory Overload

(Presentation, Diagnosis, Management)

Prophylaxis: 20mg Furosemide during transfusion

A

Dyspnea + Fluid Overload features
Agitation, Confusion

CXR

O2 + Diuretic

32
Q

Outline an Acute Haemolytic Reaction (ABO incompatibility)

(Presentation, Diagnosis, Management)

(Tell blood bank if happened, as may have happened to other pts)

A

Urticaria, HypoT, Fever.
May have Haemoglobinuria

Reduced Hb, High LDH + Bilirubin
+ve Direct Antiglobulin test (DAT) to confirm

Stop transfusion, Give O2 and Fluids

33
Q

How is Wound Dehiscence managed

A

Cover wound with Wet sterile gauze
(Dry gauze may stick to wound contents)

Suture in theatre

34
Q

List 4 ways emergence can be carried out
(other stages: Induction, Maintenance)

(Some people use Respiratory Stimulants)

A

Allow drug to wear off (Suxamethonium, Mivacurium)

Withdraw (TIVA, Volatiles)

Reverse

Antagonise (Opiates, Benzodiazepines)

35
Q

List 3 types of Regional Anaesthesia

A

Local infiltration

Nerve/ plexus blocks

Central neuraxial blocks

36
Q

What is Monitored Anaesthesia Care

A

Conscious sedation

37
Q

List the 2 components of pre-anaesthetic care

A

Pre-op Assessment and Optimisation

38
Q

Compare Spinal and Epidural anaesthetics

A

Epidural: Injected/ catheterised into Epidural space
- Between Dura Mater and Vertebral Wall

Spinal: Injected into Subarachnoid space, so immediate relief
- Between Pia and Arachnoid Mater

39
Q

Why is Pre-oxygenation done?

A

To increase O2 reserves to prevent Hypoxaemia during Apnoea

40
Q

When is the Pre-op Assessment done for pts schedueld for elective procedures

List components of the Assessment

A

2-4wks before surgery

History
Examination
Routine investigations

41
Q

List components of the Pre-op History

Similar to usualy history taking, but with some added Anaesthetic+Surgical topics

A

PC Hx: Presentation, Operation scheduled
PMHx:
- CVD, Resp disease (Can lie flat, Chronic cough)
- Renal Function, Endocrine (DM, Thyroid)
- Pregnancy, Sickle Cell

Past Surgical Hx, Past Anaesthetic Hx: Had before? Any problems?
Drug + Family Hx: Allergies, Problems with Anaesthesia run in the family
Social Hx: Smoking, Alcohol, Recreational drugs

42
Q

List the 2 components of the Pre-op Examination

A

General Exam: Underlying pathology. Look for CV, Resp, Abdo signs

Airway Exam:

  • Predict difficuilty of airway management
  • Mallampati score involved
43
Q

A pt’s ASA Grade correlates with their risk of Post-op Complications and Absolute Mortality

Outline the grading system

A

Grade I: Normal + healthy (No Alcohol or smoking)
Grade II: Mild Systemic disease

Grade III: Severe Systemic disease
Grade IV: Severe Systemic disease, that is a constant threat to life

Grade V: Moribund, not expecetd to survive w/o operation

Grade VI: Brain-dead pt, whose organs are being used for donation

44
Q

List examples of Grade II ASA

Without substantiative functional limitations

A

Smoking, Social drinking, Obesity
Pregnancy
Well controlled DM/HTN, Mild lung disease

45
Q

List examples of Grade III ASA

Substantiative functional limitations

A

1/+ moderate-severe diseases

  • Morbid obesity (40 or more)
  • Poorly controlled DM/ HTN
  • COPD, Alcohol dependence
  • > 3mth Hx of MI, TIA, CVA, CAD/ stents
  • ESRD undergoing regular dialysis
46
Q

List examples of Grade IV ASA

A
  • <3mth Hx of MI, CVA, TIA or CAD/ Stents
  • Severe EF Reduction
  • Sepsis, DIC, ARD
  • ESRD not undergoing regular Dialysis
47
Q

List some potential Pre-op Investigations

Exact ones depend on Age, Comorbidities, Procedure

A

Bloods:

  • FBC: Assess for Anaemia or Thrombocytopenia
  • G+S, Crossmatch, Clotting screen, U&Es, LFTs
  • ECG, Spirometry, CXR
  • Urinalysis, MRSA Swab, CPET
48
Q

Ehanced Recovery After Surgery, ERAS is used to help people recover faster post-op

Outline it, in its 3 stages

A

Pre-op: Pt education about surgery. Fasting. Optimisation (Weight, Exercise)
Intra-op: Analgesia, PONV prophylaxis, Minimally invasive surgery
Post-op: Analgesia, Early oral intake

49
Q

Outline which drugs are to be Stopped as part of Pre-op Management

(D-CHOW)

A

DOACs stopped 2 days before

C:

  • Clopidogrel stopped 7days (5 days) before
  • Aspirin + Anti-platelets can be continued

H: Hypoglycaemics

O: Contraceptive Pill/ HRT stopped 4wks before

W: Warfarin

  • Stopped 5days before, can reverse with Vit K
  • Surgery often only goes ahead if INR<1.5
50
Q

What drugs must be Altered before surgery

A

SC Insulin -> IV Variable rate infusion

Long term Oral steroids-> Must be continued IV, higher dose as steroid demand increases after acute stress (Hydrocortisone 50-100mg)

51
Q

Outline which drugs are to be Started as part of Pre-op Management

A
  • LMWH (if GI surgery for cancer, discharge with TEDs and 28 days of LMWH)
  • Below knee TED Stockings (Contra-Is: Severe PVD, Peripheral Neuropathy/ Eczema, Recent skin graft)
  • Abx Prophylaxis (Ortho/Vascular/General op)
52
Q

Outline Specific Pre-op Management for Type I DM pts

All should be 1st on morning list

A

Insulin:

  • Night before op, reduce SC Basal insulin dose by 1/3
  • Omit Morning Insulin
  • Start IV Variable Insulin Infusion

Glucose:

  • While NBM, 5% Dextrose 125ml/hr
  • Nurse should check BM/ Capillary Glucose every 2hrs

Once able to eat + drink;

  • Overlap SC and Variable rate Insulin
  • Give Rapid-acting SC Insulin 20mins before meal
  • Stop IV Insulin 30-60mins after meal
53
Q

Outline Specific Pre-op Management for Type II DM patients

If diet controlled, no action needed

A

Metformin: Stop on Morning of Surgery if taking TDS, otherwise continue

Other Hypoglycaemic agents:

  • Stop 24hrs before operation
  • Put on VR Insulin and 5% Dextrose
54
Q

Pts having Colorectal surgery may need Bowel Preparation

Outline this

(Can prolong pt Recovery+ Stay length)

A

Phosphate Enema on Morning of Surgery:

  • Left hemi-colectomy
  • Sigmoid colectomy
  • AP Resection

2 sachets of Picolax day before OR Phosphate Enema on Morning of Surgery:
- Anterior resection

None required for:

  • Upper GI, HPB or SI Surgery
  • Right (extended) Hemi-colectomy
55
Q

Compare Lidocaine and Bupivacaine

A

Lidocaine works faster

Bupivacaine lasts longer

56
Q

Why is adrenaline used peri-operatively

A

Increases the effect of Anaesthetic agents used

Vasoconstricts vessels, reducing bleeding around incision site

57
Q

Who are Transfusion assoicated complications reported to

A

SHOT

58
Q

List reasons a Spinal Anaesthetic may be better than a General Anaesthetic

A
  • Lower cost
  • Better Post-op Pain
  • Allergy to GA
  • Contra-I to GA (e.g COPD)
59
Q

When starting a DM pt on VRII for their surgery, which fluid should be prescribed to run alongside

A

5% Dextrose in 0.45% NaCl w/ 0.15-0.3% KCl

60
Q

List reasons why DM is considered to carry a high peri-op risk

A
  • Risks of GA
  • Obesity associated w/ higher mortality
  • Predisposition to Peripheral Vascular Disease
  • Renal problems
  • Cardiac arrest due to Autonomic neuropathy
  • IHD carries a greater risk of Peri-op MI
61
Q

List RFs for PONV

A
  • Female, Age, Non Smoker, PONV FHx, Hx of motion sickness
  • Poor pain control, Long Op, Intracranial op, Intra-abdominal Laparoscopic surgery
  • Opioid/ Spinal analgesia, Inhalation agents, Dehydration
62
Q

Suggest 3 anti-emetics for PONV

A

Ondansetron
Cyclizine- Good in Functional bowel obstruction
Metoclopromide- Avoid in Bowel obstruction

63
Q

How would you manage Post op Ileus

(Physiological= ≤3 days post-op
Paralytic= ≥3 days
Mechanical obstruction= Fibrous adhesions, take ≥1wk to form
Functional obstruction= Absent bowel sounds)

A
  • NBM, IV Fluids, Daily bloods
  • Encourage mobilisation, Reduce Opioid analgesia
  • Fluid balance chart
64
Q

Explain the benefit of RSI

A

Minimises insufflation of air into pt’s stomach, reducing risk of regurgitation

This reduces aspiration risk and risk of unexpected contents entering lungs (No ventilation)

65
Q

Name drugs used in RSI

A

Modern: Propofol, Ketamine, Etomidate

Traditionally: Suxamethonium, Na Thiopentone

66
Q

What is the mutation in Malignant Hyperthermia

A

Autosomal dominant mutation in Ryanodine Receptor 1

Increased Ca levels In sarcoplasmic reticulum and increased metabolic rate

67
Q

How does Malignant Hyperthermia present

A
  • Hyperthermia, TachyC
  • Muscle rigidity and/or Spasms
  • Metabolic acidosis
  • Increased exhaled CO2
68
Q

How is Malignant Hyperthermia managed

A
  • Stop causative agent
  • IV Dantrolene, O2
  • Restore Normothermia (Cooling Blankets/ Cooled Fluids/ Ice Packs)
69
Q

List advantages of using Regional Blocks over GA

A
  • Better pain control post-op
  • Reduced risk of cardiac complications post-op
  • Allergy to GA
  • Contra-I to GA
70
Q

List post-op complications that can cause TachyC

A

Sepsis, AFib, PE, Haemorrhage, Uncontrolled Pain

Year 3 Surgery (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions