Wk 2

Question 1

What is anaesthesia

Answer 1

Implies a pt is unconscious and all sensation is lost

Question 2

Types of anaesthesia

Answer 2

General: reversible, unconscious state, affects CNS, characterised by amnesia (sleep), analgesia (freedom form pain),depression of reflexes, muscle relaxation
Regional: loss of sensation to specific area or region of the body I.e. Spinal, epidural
Local: administered to one part of the body by local infiltration, purposely blocks nerve fibre in and around operative site

Question 3

Premedication to surgery

Answer 3

Sedative
Narcotics
Anticholinergics
Anti emetics 
To decrease anxiety,bronchial secretions 
Analgesia
Amnesia

Question 4

Describe action of sedative and give example

Answer 4

Sedate
Amnesia
Calm/hypnotic state
E.g. Benzodiazepines which include Valium and midazolam (amnesia, decrease anxiety and fear), barbiturates (sleeping pills, prolonged sedative state, assists with sleep)

Question 5

Describe action of narcotics and give example

Answer 5

Raise pain threshold
Lower metabolic rate
Decrease amount of anaesthetic required
E.g. Morphine (useful for pt already in pain, prolonged action), fentanyl (short acting, IV admin immediately before induction)

Question 6

Action of Anticholinergics and example

Answer 6

Interfere with stimulation of vagus nerve
Increase HR
Decrease oral and respiratory secretions
Prevent vagal mediated hypotension, cardiac arrhythmia and bradycardia
E.g. Atropine sulfate, gycopyrrolate

Question 7

What is the action of Antiemetic and examples

Answer 7

Minimise nausea and vomiting

E.g. Phenergan, droperidol, ondansetron

Question 8

Process of general anaesthesia

Answer 8

Arrive in OR
Pt identified/consent/lab test reviewed
Monitoring connected
Iv access
Pt preoxygenated with 100% O2 for 3-5mins
Opioids and benzodiazepines administered
1. Induction: administer anaesthesia agents until pt is ready for positioning or surgical prepping
2. Maintenance: from this point until near completion
3. Emergence: pt begins to emerge and pt is ready to leave OR
4. Recovery

Question 9

Inhalation agents of anaesthesia

Answer 9

Nitrous oxide: poor relaxation, minimal nausea and vomiting, increased vol in air pockets
Halothane: non-irritant, little muscle relaxation, potentially toxic to liver, raises ICP
Enflurane: some muscle relaxation, cardiac stability, don’t take if renal disease
Isoflurane: low organ toxicity, expensive, potent muscle relaxation
Thiopentone: short acting, depresses myocardium
Propofol: short half life, hypotension, irritation at injection site

Question 10

Types of muscle relaxants

Answer 10

Depolarising: (suxamethanonium) last 5mins, acts in seconds

No depolarising: (vecuronium) acts over 2-3mins, lasts 30-60mins

Question 11

What is used in intubation

Answer 11

LMA: laryngeal mask airway, inserted without muscle relaxant, posited over larynx and inflated

ETT: endoctracheal tube, women size 8, males 8.5, 7.5mm, ventilation and aspiration, position head (neck flexed, sniffing air, head in straight line)

Question 12

Laryngoscopes

Answer 12

Used to intubate
Consists of a blade (size 1-4), with fibre optic light and handle
Blade is curved
Children blade is straight

Question 13

Pre-op checklist

Answer 13

1. Pre-op nurse verifies info: consent, correct pt, correct procedure, correct side, side marked by pt, correct time
2. Pt states name DOB, procedure
3. Mandatory examination results
4. Allergies
5. Patient property/personal effects
6. Periop fasting
7. Meds to be administered
8. Bowel prep completed

Question 14

Rapid sequence induction

Answer 14

Fats intubation in emergency 
Obese pt
Cricoid pressure to prevent aspiration 
Digital pressure applied to cartilage 
Prevents regurgitation and aspiration (close oesophagus behind it)
Released when ETT cuff is inflated

Question 15

Aspiration

Answer 15

Decreased throat reflex
Acidic gastric contents enter lungs
Impede lung function and gas exchange

Question 16

Aim to maintain pt’s state during analgesia

Answer 16

Oxygenate 
Unconsciousness
Analgesia
Muscle relaxation
Control autonomic reflexes

Question 17

The anaesthetic machine

Answer 17

Delivers o2 and anaesthetic gas mix
Mechanical ventilator
Source of gas
Reservoir bag
Monitors: ECG, BP, inspired o2, end tidal o2
Alarms: apnoea, breathing circuit disconnected
Daily checking procedure

Question 18

What occurs during emergence

Answer 18

Recovery of pharyngeal and laryngeal reflexes
Extubation delayed until spontaneous respiration confirmed
Auctioning and oxygenation
Warm blankets

Question 19

Asepsis

Answer 19

Without infection

Absence of micro-organisms that cause infection

Question 20

Aseptic technique

Answer 20

Microbial contamination is prevented in the environment
Reduce exposure to potentially infectious blood and tissue
Every effort is to minimise and control the microorganism
Handwashing/surgical scrub
Maintain sterile field
Safe operative technique
Barriers
Client prep

Question 21

Principles of asepsis

Answer 21

People must wear sterile gown and gloves and only touch sterile items
Unsterile personnel must touch unsterile items
Sterile drapes must be used
Items in sterile field must be sterile
Anything below waists or table level is unsterile
Items to be opened, dispensed and transferred in a sterile way
Must be monitored and never left unattended
Move around the sterile field carefully
Don’t lean across or walk between sterile fields

Question 22

Creating a sterile field

Answer 22

Placing sterile towels/drapes around procedure site and stand that will hold sterile instruments
Pt is centre of field
Skin prep clean to dirty
Reusable/disposable drapes

Question 23

Principles of applying drapes

Answer 23

Time and space 
Handle as little as possible
Carry folded drape to operation site
Hold above waist level
No flip, fan or shake
Don't reach across the unsterile area
Non perforating towel clips

Question 24

What is strike through

Answer 24

Liquids soak through a barrier from sterile to unsterile area and vice versa

Passage of organisms through the barrier

Sometimes dry and not noticeable so look for stains

Question 25

Steps to maintain a safe environment

Answer 25

Limit number of people in and out
Limit talking
Close door and curtains
Enclose areas to minimise dust and insects
Air condition room
Clean and disinfect surfaces between pt’s

Question 26

Surgical conscience

Answer 26

Inner morality system and professional honesty which allows no compromise in practice