The Role of the Anaesthetist

Question 1

What is the role of the anaesthetist in the preoperative period?

Answer 1

1) Reducing surgical stress response
2) Effective post-op analgesia
3) Prevention of post-op N&V
4) Fluid homeostasis and bleeding management
5) Temperature maintenance
6) Care of patient positioning and protection of pressure areas

Question 2

What physiological responses can be caused by tissue injury and pain during surgery? (3)

Answer 2

1) Sympathetic NS mediated physiological changes
2) Neuro-hormonal changes
3) Hormonal / metabolic changes

Question 3

What issues can arise from the surgical stress response? (6)

Answer 3

1) Unwanted cardiovascular changes
2) Fluid retention
3) Electrolyte disturbance
4) Metabolic changes (Catabolism and hyperglycaemia)
5) Systemic inflammatory response
6) Hypercoagulability

Question 4

The physiological responses in a patient to surgical insult cause raised or increased: (8)

Answer 4

• Adrenocorticotrophic hormone
• Growth hormone
• Vasopressin
• Prolactin
• Insulin resistance
• Carbon dioxide (CO2) production
• Oxygen consumption
• Circulating catecholamine levels

Question 5

How does regional anaesthesia modify the surgical stress response?

Answer 5

Prevents transmission of nociceptive signals to the CNS.

Therefore: reducing neuroendocrine stress response.

Question 6

What are the the three main parts of the body where analgesic drugs work?

Answer 6

1) Brain / Thalamus
2) Spinal cord & Nerves
3) Source of pain and peripheral nerves