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Anesthetics > Theory > Flashcards

Theory Flashcards

1
Q

ASA classification

A

1 - A normal healthy patient 2 - A patient with mild systemic disease and no functional limitations 3 - A patient with moderate to severe systemic that results in functional limitation 4 - A patient with severe systemic disease that is a constant threat to life and functionally incapacitating 5 -A moribund patient who is not expected to survive 24 hours with or without surgery 6 - A brain-dead patient whose organs are being harvested E - If the procedure is an emergency, the physical status is followed by “E”

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2
Q

Mallampati classification

A

1 - Faucial pillars (palatoglossal and platopharyngeal folds), Soft palate, Uvula (Should be easy) 2 - Faucial pillars, Soft palate, Uvula masked by base of tongue (Should be easy) 3 - Only soft palate visible (Associated with difficulty) 4 - Soft palate not visible (Associated with difficulty)

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3
Q

Drugs used for premedication

A

Sedative/Anxiolytic/Amnestic (Benzodiazepines) - have a large interindividual variation Acid reduction (Sodium citrate) - Recommended prior to caesarian section to prevent Mendelsohn’s syndrome Gastric volume reduction (Metoclopramide) - Not routinely done Anti-emetics (Metroclopramide, Droperidol, Ondansetron) - Given prophylactically if previous history of severe nausea and vomiting post-operatively Antisialogogue (Atropine, Glycopyrrolate) - Not routinely given unless awake instrumentation Depression of Autonomic Nervous system (Beta-blocker) - May be indicated for patients with ischaemic heart disease. Very controversial Prophylaxis for endocarditis/ Artificial joint replacements/ pacemakers etc (Penicillins, Aminoglycosides, Quinolones) - ADMINISTER ACCORDING TO PROTOCOL OF INSTITUTION

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4
Q

Colours of gas outlets

A

Oxygen - white Nitrogen - blue Carbon dioxide - green Air - black Suction - yellow

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5
Q

Monitoring during anesthetic

A

Qualified anesthesia personnel Oxygenation (inspired gas oxygen concentration and pulse oximetry) Ventilation (clinically, capnography) Circulation (blood pressure, pulse, ECG, pulse oximetry) Temperature Invasive monitoring as indicated (direct arterial pressure, CVP) Depth of anesthesia (clinically, bispectral analysis, evoked potentials)

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6
Q

Disadvantages of pulse oximetry

A

Artifact (loose contact, ambient light, electrocautery, vasoconstriction, nail polish) Abnormal Hb (methemaglobin, carboxyhemaglobin) Anemia Slow response time Inaccuracy at low saturation Does not measure ventilation

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7
Q

Management of falling oxygen saturation

A

Rapidly falling saturation: - turn on emergency oxygen - replace ventilator circuit with Magill circuit and bag patient - auscultation chest and stomach - check ETT, replace if necessary Slowly falling saturation - check inspired oxygen concentration and gas flow - check for pneumothorax - check for mucus plug or endobronchial intubation - check circulation

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8
Q

Capnography - normal pattern

A

Normal - I: no CO2 from anatomical and apparatus dead space - II: rising CO2 as alveolar air mixes with dead space - III: plateau of alveolar air only - IV: end tidal CO2 measurement of end of plateau - V: CO2 rapidly falls to zero as inspiration starts

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9
Q

Capnography - abnormal patterns

A

No plateau - obstructive Leung disease Curare clefts - muscle relaxant wearing off Failure of CO2 to return to zero - rebreathing Sudden drop to zero - cardiac arrest - pulmonary embolus - disconnection Increasing end tidal CO2 - increased production (malignant hyperthermia) - hypoventilation Decreasing end tidal CO2 - hyperventilation - decreasing cardiac output

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10
Q

Hypothermia - causes

A

Children Elderly Large exposure Abdominal surgery Long surgery Large IV fluid infusion

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11
Q

Hypothermia - complications

A

Deceased metabolic rate Decreased cardiac output Left shift in oxyhemoglobin curve Metabolic acidosis Oliguria Altered platelet and clotting function Reduced hepatic flow and reduced drug metabolism Decreased MAC Prolonged duration of action of muscle relaxants Postoperative shivering

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12
Q

Hyperthermia - causes

A

Sepsis Drug interactions Catecholamine release Malignant hyperpyrexia

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13
Q

Hyperthermia - complications

A

Acidosis Seizures CNS damage

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14
Q

Complications of direct arterial pressure measurement

A

Bleeding Arterial damage and thrombosis Embolization Distal ischemia Sepsis

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15
Q

Colic actions of CVP measurement

A

Arrhythmia Bleeding Pneumothorax Damage to surrounding structures Cardiac puncture Catheter embolisation Air embolism Sepsis Thrombosis

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16
Q

Indications for intubation

A

Airway maintenance Airway protection Muscle relaxant Ventilation Extremes of age Tracheal toilet Long operation

17
Q

Difficult intubation

A

Look for signs of obstruction - congenital anatomical abnormality (receding or protruding mandible) - acquired congenital anatomical abnormality (tumour, sepsis, trauma) - bull neck - dentition Evaluate 3-3-2 score (inability to open mouth may be due to features or TMJ disease) Mallampati score 2 and 3 Obesity, pregnancy Neck mobility

18
Q

Intubation procedure

A
  • Check anesthetic equipment; ensure everything fits together
  • Prepare ETT and check cuff and connector
  • Position the patient’s head
  • Pre oxygenate for 3-5 minutes
  • IV induction
  • For elective sequence, check that you can bag
  • Muscle relaxant
  • Wait for effect; manually ventilate with oxygen and volatile
  • Insert laryngoscopy blade, visualize cords
  • Insert ETT, cuff just beyond cords
  • Inflate cuff Check position of ETT
19
Q

How to check position of ETT

A

Visualize intubation Push on chest for blow back Tension on bag Chest rise No abdominal distension Misting of the tube Auscultation chest and epigastrium Measure expired CO2 Fibre optic laryngoscopy Patient condition (sats, colour, pulse, BP, cyanosis)

20
Q

Failed intubation

A

Don’t panic, call for help Prepare tracheostomy set if necessary Bag-mask ventilation Reposition patient Further attempts with visualization aids e.g. bougie LMA Discontinue surgery Surgical airway

21
Q

Age-specific ETT sizes

A

Adult male - 8.0-8.5 Adult female - 7.5-8.0 6 to mid teen - 6.5-7.0 1-6 years - 3.5 + age/3 Birth - 3.5 Premature - 2.0-3.0 Length - 2x distance from tragus to angle of the mouth

22
Q

Complications of intubation

A

Trauma (teeth, soft tissue, laryngeal ulceration, vocal cord paralysis, arytenoid dislocation) Infection (pharyngitis, laryngitis, tracheitis, pneumonia) Autonomic disturbance (hypertension. tachycardia, dysrhythmia, laryngospasm) Misplacement (esophageal, endobronchial, extubation) Obstruction (kinking, herniation, over inflation, blood, vomit, foreign body) Aspiration of gastric content

23
Q
A
  1. Inspiratory reserve volume
  2. Tidal volume
  3. Expiratory reserve volume
  4. Residual volume
  5. Vital capacity
  6. Inspiratory capacity
  7. functional residual capacity
  8. Total lung capacity
24
Q

Cardiac Stable Drugs

A
  • Induction: etomidate
  • Muscle relaxant: vecuronium or rocuronium
  • Opiate: fentanyl
  • Volatile: haltohane, isoflurane
  • B-blocker: esmolol
25
Q

Drugs to avoid in asthma

A

Histamine-releasing drugs:

  • Atracurium
  • Mivacurium
  • Thiopentone
  • Morphine
26
Q

Anesthetic drugs contraindicated in porphyria

A

Avoid

  • Thiopentone
  • Etomidate

No data

  • Ropivacaine
  • Remifentanyl
  • Desflurane
  • Cisatracurium
27
Q

Patients at risk of aspiration

A
  • Emergency
  • Pregnant
  • Bowel obstruction
  • Acute abdomen
  • Hiatus hernia
  • Peptic ulceration
  • Upper airwat bleeding
  • Diabetes
  • Uremia
  • Obesity
28
Q

PONV Risk Factors (Every. Single. One)

A
  • Patient Factors
    • 6-16 age group
    • Women 2-4x more likely than men
    • Obesity
    • Non-smoker
    • Gastroparesis
    • History of motion sickness, PONV
    • Chemotherapy patients
  • Preoperative
    • Prolonged pre-op fasting
    • Not starved
    • Anxiety
    • Premedication
  • Intraoperative
    • Intubation
    • Deeper plane of anaesthesia
    • Gastric inflation during mask ventilation
    • Intraoperative dehydration
    • Drugs
    • Opioids
    • Ketamine > propofol and thiopentone
    • N20 > sevoflurane, isoflurane, desflurane
    • General anaesthesia > regional anaesthesia
    • Neostigmine in high doses
  • Postoperative
    • Head movement of patient after waking
    • Postoperative pain
    • Early ambulation, dizziness
    • Early intake of food

Anesthetics (10 decks)

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