Anaesthesia

Question 1

Aims of anaesthesia (4)

Answer 1

1. No conscious awareness of
pain
2. Still surgical field
3. Anxiolysis, sedation or
complete hypnosis
4. Cardiorespiratory stability

Question 2

The 7 A’s of anaesthesia

Answer 2

1. Allergy
2. Aspirations
3. Apnea
4. Access
5. Activity levels/function
6. Aortic stenosis
7. Airway assessment

Question 3

What level activity generally sufficient for aneasthesia

Answer 3

Carrying two arms of groceries up two flights of stairs

Question 4

Items to discuss with the anethetist

Answer 4

1. Previous anaesthesia
2. Family history->malignant hyperthermia, bleeding, reactions to anaesthesia
3. Medications->considerations to cease/withhold
4. CVD risk: comorbidities, risk factors
5. CNS: stroke, TIA, seizures
6. Respiratory: smoke, asthma, triggers, bronchitis
7. LFTs, OSA, ABG
8. Airway examination
9. Endocrine, thyroid, obesity
10. Fluid status
11. Strategy for blood replacement
12. GIT aspiration risk
13. Arthritis

Question 5

Indication of end point LOC

Answer 5

Loss of eyelash response

Question 6

Examination pre-aneasthetic

Answer 6

1. Open mouth
2. Presence of teeth
3. Size of tongue
4. Subluxation of TMJ
5. Relative position of larynx
6. CV and respiratory
7. Assess recent blood
8. Signs and symptoms of reason for operation

Question 7

Patient monitoring during anaesthesia

Answer 7

1. Blood pressure
2. ?ECG
3. Respiratory
4. Depth of anaesthesia monitoring

Question 8

Management of acute post-operative pain

Answer 8

1. NSAIDS
2. Paracetamol
3. Opioids
   a. PCA 1mg morphine bolus with 5-8 minute lockout
   b. Consider tramadol if no PCA
4. Epidural

Question 9

Preoperative check list

Answer 9

1. Bloods and investigations
FBC, UEC, LFTs, crossmatch GH, INR, glucose (some will depend on patient)
2. IV cannula
3. ECR + CXR
4. Drug chart
Regular medications
Analgesia
Antiemetic
Antibiotics
Heparin, compression stockings
5. Consent
6. Mark side/site
7. Inform anaesthetics
8. Inform theatre
9 Infections risk
10. NBM >2 hr preop clear fluids, >6-8 h for solids
11. Catheter if required
12. Post-op physioT

Question 10

Specific complications of surgery: laparoscopic, biliary, thyroid, breast

Answer 10

1. Laparoscopic: conversion to open procedure
2. Biliary: damage to common bile duct, anastomic leak, retained stone with another surgery, post hepatic jaundice, stricture, pancreatitis
3. Thyroid: bleeding->airway compromised, hypocalcemia, hypothyroid, recurrent and superficial laryngeal nerve palsy, voice different for few days (intubation and swelling)
4. Breast: lymphedema, seroma, hematoma, brachial plexus injury

Question 11

Specific complications of surgery: arterial, colonic, SB surgery, splenectomy

Answer 11

1. Arterial: graft infection, AV fistula, graft failure
2. Colonic: damage to other structures, leakage, ileus, adhesions
3. SB: damage to surrounds, leak, ileus, short gut, adhesions
4. Splenectomy: damage to surrounds, acute gastric dilitation, sepsis/future infections->will need vaccinations

Question 12

Specific complications of surgery: GU, hemorrhoidectomy, prostate, gastrectomy

Answer 12

1. GU: Damage, ureters, subfertility
2. Hemorrhoidectomy: stenosis
3. Prostate: blood in urine/ejaculate initially, urethral stricture, retrograde ejaculation, incontinence and impotence
4. Gastrectomy: dumping syndrome, weight loss, malabsorption, ulceration of stomach, tumor, blind loop syndrome, abdominal fullness/early satiety

Question 13

General surgical risks

Answer 13

1. Anaesthetic
Toxic->brady, asystole, dizzy, NV, CNS depression
Failure
MI, stroke
Allergy
Death
2. Surgical
Hemorrhage
Infection of wound, other
Impaired healing
Surgical injury
Atelectasis, pneumonia, ARDS
VTE
Sepsis
Urinary retention
UTI
Electrolyte disturbances
Antibiotic colitis
Pressure sores

Question 14

ASA system

Answer 14

1. Healthy person.
2. Mild systemic disease-
   X interfere normal activity
3. Severe systemic disease-
   limits normal
4. Severe systemic disease-
   that is a constant threat to life.
5. A moribund person who is not
   expected to survive without the operation-
   wont live >24 hours
6. A declared brain-dead person whose
   organs are being removed for donor purposes.
   E- signifies emergency