wk 11- perioperative medicines, procedures and cams Flashcards
what general anaesthetic do pods have access to
methoxyflurane
what is methoyflurane used for now
a short term, low dose analgesic inhaler
a mild sedative effect in some patients
not as an anaesthetic
where is methoxyflurane metabolised/excreted
metabolised - liver
excreted- lungs and kidneys
what is the onset and duration
onset-1-3mins
duration 5-10mins
what is methoxyflurane contraindicated in
allergy
<1 yr old
severe cardiac disease
renal disease
orhepatic disease
respiratory depression
malignant hyperthermia
pregnancy (CAT C)
breastfeeding
methoxyflurane drug interactions
beta blockers- hypertension
rifampicin, tetracycline, gentamicin, and other antibiotics - antibiotics
barbiturates- eplisepsy
drugs that reduce CNS- narcotics
IV adrenaline
what can you use methoxyflurane for in operation
prior to local injection to reduce pain
lorazepam is used for
pre procedural anxiety
any drug interactions for lorazepam
no
when do they take it for the procedure
night before and or 1/2 hours before the procedure
what does LA with adrenaline do
prolongs LA block and provides haemostasis (vasoconstrictive)
who cant you use adrenaline with
- hyperthyroidism
- severe heart disease
- extremities with lack of blood supply (fingers and toes, PVD, raynaud’s)
EMLA cream is
local anaesthetic topical
whats a conservative way to make the needle stick less painful
icing
local corticosteroid injections used for
soft tissue inflammation
should you use corticosteroid injection for joint inflmmation
no, too many risks v benefit
when would you use US guided injection
smaller tissues such as tendon sheath or neural
risks of corticosteorid injections
infection
tissue necrosis
systemic factors
how many local corticosteroid injections can someone have per year
4
whats the risk with multiple corticosteroid injections into weightbearing tendons
spontaneous rupture
so keep it minimal if any
what are long acting corticosteroids
dexamethasone
betamethasone
short acting corticosteroids are
hydrocortisone
cortisone
predinisone
triamcinolone
different preparations of corticosteroid
cortico and LA- to provide rapid relief of symptoms and confirm diagnosis
short acting and long acting cortico- to offer benefits of both, fast acting and long duration
if a cortico is less soluble what does that mean for duration
longer duration
if a corticosteroid is soluble what does that mean for duration
small duration
where shouldnt you use low soluble agents
what agent should you use thats got a higher solubility
soft tissue due to risk of tissue atrophy
methylprednisiolone agent of choice or hydrocortisone
corticosteroid injection indicated in what soft tissue conditions
bursitis
tendonitis
ganglion cysts
neuromas
entrapment syndromes
fascitiis
trigger points
joint condiitons you can use cortico for
RA
OA
gout
must rule out sepsis/septic arthritiis
what is contraindicated in corticosteroids
infection
fracture
joint prosthesis
achilles/patella tendinopathies
allergy
minimal relief after 2 injections
anticoagulation therapy
surrounding joint osteoporosis
too many surrounding structures
unmanaged diabetes
how long do steroid flares last
1-3 days and ice can help relieve
corticosteroids can cause what in unmanaged diabetes
hyperglycaemia
