14151243
Description
Flashcards by Elizabeth Then, updated more than 1 year ago
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Created by Elizabeth Then
almost 6 years ago
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| Question | Answer |
| What is anaesthesia | 'without perception' aim: perform procedure without discomfort |
| GA | lack of consciousnes |
| RA | blocking groups of nerves or spinal cord, pt remains conscious |
| LA | blocking local nerves |
| role of anaesthetic assistant | guided by ANZCA set education standards, outlines, responsiblities, nurses vs technicians |
| preoperative assessment | patient assessment must include: baseline physiology current and past medical history medication sensitivities past anaesthetic experience psychology |
| airway assessment | length of incisors, mobility of cervical spine, length and thickness of neck, mallampati score, ability to sublux mandible forward ( under bite) thyromental distance (three fingers) |
| mallampati score | used to predict ease of intubation, class 1 - complete visualisation of soft palate class 2 - complete visualisation of uvula class 3 - view of base of uvula class 4 - soft palate not visible |
| GA | reversible and characterised by: amnesia, analgesia, suppression of reflexes |
| GA IV agents barbiturates | thiopentone: rapid induction, short duration, hypotension, tachycardia, minimal post op effect, repeated does = hangover effect |
| GA IV agents Non-barbiturates | propofol: rapid onset, distribution, metabolism, can be used for maintenance (TIVA), bradycardia, dysrhythmias, severs hypotension, nausea and vomiting, hiccups |
| GA IV agents dissociative anaesthetics | ketamine: administered IV of IM, potent analgesic and amnesic, hallucinations/nightmares, increased intracranial pressure, increased intraoccular pressure, tachycardia, hypertension |
| GA Inhalation agents Volatile liquids | sevoflurane: predicatable on CVS/resp, rapid acting, non-irriitating, emergency delirium Desflurane: rapid onset/offset, bradycardia, hypotension, airway irritnt isoflurane: less cardiac depressing, unpleasant odour, airway irritant nitrous oxide: reduce volatile dosage, increased induction rate, nausea and vomiting, must be administered with oxygen, adjunct, not a true anaesthetic |
| GA - adjuncts | opioids: pain relief, induction/maintenance, resp depression, nausea, vomiting, bradycardia, pruritius, e.g. fentanyl, morphine, remifentanil, alfentanyl benzodiazapine: sedative, induction/maintenance, increase effect of opioid, resp depression, hypotension, tachycardia e.g midazolam |
| GA - adjuncts continued | antiemetics: prevent nausea and vomiting, headache, dizziness, shivers, diarrhoea, fatigue e.g. ondansatron,dexamethasone, droperidol neuromuscular blocking agents: depolarising - suxamethonium non-depolarising - rocuronium, vecuronium, atracurium * non-depolarising can be reversed with anaticholinesterase (neostigmine) |
| vortex airway management | prepare interventions prevent hypoxia promote teamwork |
| gas induction - GA (PAEDS) | parent present, hold face mask on with oxygen and nitrous oxide slowly increase sevo child begins to wrestle place on operating table and apply monitoring insert iv and airway - or hold face mask start procedure |
| GA - IV induction (adults) | patient on table apply monitoring insert cannula preoxygenate administer medications insert airway start operation |
| GA - supraglottic airways | laryngeal mask airway - lma supreme laryngeal mask airway |
| GA- difficult intubation | 10% of population have difficulties 1% severely difficult management: avoid GA different blades videolaryngoscopes fibreoptic scopes |
| regional anaesthesia central nerve block | spinal (subarchnoid) single dose motor and sensory L3-4 OR L4-5 spinal needle inserted until CSF flashback, then solution injected bupvicicaine (hyperbaric vs isobaric) can include fentanyl complications: hypotension (metaraminol and fluids), spinal headache (bloodpatch) |
| Regional anaesthesis - central nerve block epidural | intermittent or continuous sensory only block use saline to make the space, loss of resistance complications: hypotension, dural puncture (combined spinal/epi), nerve damage, haematome, abscess |
| regional anaesthesia | peripheral nerve block -US guided, nerve stimulator, or landmark -medication depends on type of block, and length required, medications commonly mixed common blocks: retrobulbar, peribulbar, subtenon (eye) -transverse abdominus plan (TAP) (abdomen) -femoral plexus block - fascia llliaca, femoral nerve (leg) -brachial plexus - interscalene, supraclavicular, axillary (arm) |
| patient positioning to prevent | pressure injury nerve injury patient vs floor |
| anaesthestic delivery systm system checks | level1 - performed yearly level 2 - performed at start of list by anaesthetist assistant level 3 - performed inbetween cases by anaesthetic assistant |
| level 2 check | confirm level 1 check is up to date test reserve oxygen for leaks and volumes ensure pipeline gas at appropriate pressure test flow controls and anti-hypoxic system check vapourisers are full and leak free check breathing circuit in manual and automatic modes, leak less than 150ml/min check suction check scavange check monitoring check local and intravenous devices |
| level 2 check | check vapouriser if changed check breathing system if changed check local and intravenous devices |
| patient monitoring ANZCA standards | circulation- monitored clinically appropriate intervals, detection of arterial pulse and blood pressure ventilation - monitored constantly, both direct and indirect oxygenation - oximetric values interpreted in conjunction with clinical observations of pt oxygen analyser - continuous, audible signal for low oxygen breathing circuit disconnect/ventilator failure alarm- automatic pulse oximetry - variable tone ECG Intermittent non-invasive BP continuous BP invasive CO2 volatile gas monitor temperature neuromuscular function monitor anaesthetic effect on brain |
| anaphylaxis - anaesthetic emergency | antibody mediated reaction 90% occur in first 3 min of induction treatment: cease causative agent if known cease all anaesthetic drugs 100% oxygen commence fluid resuscitation treat bronhospasm with salbutamol administer adrenaline 1mcg/kg bolus administer adrenaline infusion |
| laryngospasms | irritation of vocal cords, complete or total obstruction caused by pain, instrumentation of airway or secretions treatment: deepen anaesthetic, suction airway, administer 100 oxygen, provided CPAP/PEEP, if unsuccessful administer suxamethonium (1-2mg/kg) |
| Bronchospasm- anaesthetic emergencies | expiratory wheeze, hard to ventilate, caused by local airway irritation, aspiration, drug hypersensitivity treatment: deepen anaesthetic, reposition tube, administer salbutamol, adrenaline, steroid |
| aspiration - anaesthetic emergencies | responsible for 10-30% of all anaesthetic deaths cause by gaastric contents in lungs, severity of injury related to ph of stomach treatment: 100 oxygen, suction airway/lungs, bronchoscopy to check for soiling/suction, ABG, antibiotics, ventilate in ICU |
| anaesthetic emergencies malignant hyperthermia | rare autosomal muscle disorder, life theatening caused by inhalational agents and suxamethonium presentation: sudden increase in ETCO2 unexplained tachycardia, tachypnoea, liable BP and arrhytmias, acidosis, muscle rigidity jaw, fever late sign, myoglobinuria, mottled cyanotic skin |
| treatment for malignant hyperthermia | call for help cease anaesthetic, hyperventilate 100% oxygen administer dantrolene 2.5mg/kg IV up to 10mg/kg administer sodium bicarbonate correct hyperkalaemia with insulin/glucose maintain urine output of up to 2mg/kg remove all warming use cold fluids |
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